Fatal Outcome of COVID-19 Reactivation in a Patient With Multiple Myeloma After Reintroduction of Myeloma Therapy

Abstract

We report a case of coronavirus disease 2019 (COVID-19) reactivation in a 52-year-old man with diagnosis of multiple myeloma (MM) of immunoglobulin G (IgG) kappa subtype, with a previously resolved COVID-19 who received a salvage regimen of carfilzomib, daratumumab and dexamethasone. He was admitted to the hospital with COVID-19. He presented with fever, diarrhea, dry cough and dyspnea, and a chest X-ray showed bilateral pneumonia suggestive of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which was confirmed by real-time polymerase chain reaction (RT-PCR) on a nasopharyngeal sample. Analytical findings revealed an elevation of inflammatory parameters and severe lymphopenia. The patient was treated with oral hydroxychloroquine, oral ritonavir/lopinavir, low-molecular-weight heparin and ceftriaxone, high dose of oral corticosteroids, a single dose of tocilizumab and remdesivir within the clinical trial. Subsequently, the patient showed a satisfactory clinical evolution with resolution of the symptoms and normalization of analytical parameters, and the SARS-CoV-2 RT-PCR test became negative. He received the second dose of carfilzomib and the first dose of daratumumab. Five days after, he was re-admitted to the hospital with a reactivation of COVID-19. A second dose of tocilizumab was administered, as well as hyperimmune plasma as compassionate use. Two days later, he presented with clinical worsening requiring admission to the intensive care unit leading to a fatal outcome. Based on the clinical evolution of the disease, we suggest that daratumumab and carfilzomib treatment could be related to the reactivation of COVID-19. To our knowledge, this is the first case regarding COVID-19 reactivation after any treatment. In this scenario, hematologists need to carefully weigh the risks and benefits before planning chemotherapy treatments.

Clin Infect Immun. 2020;5(3):77-81
doi: https://doi.org/10.14740/cii115