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Abstract
Background The novel coronavirus, known as SARS-CoV-2, or COVID-19 became a pandemic in early 2020, causing significant human suffering and economic woes globally. The pathophysiology of acute respiratory failure may be related to a robust immune reaction against the virally infected cells (figure 1). This mechanism is molecularly similar to that of cytokine release syndrome, which is mediated by cytokine IL-1 and can be seen as a complication of immunotherapy.
Methods Clinical data from cancer patients treated for cytokine release syndrome were collected from an interventional oncology practice and retrospective analysis was performed.
Results Five patients were treated for cytokine release syndrome related to administration of immunotherapy agents. Symptoms included hypotension, loss of consciousness, fever, headache, and respiratory failure. Three of these patients were treated with anakinra, with abrogation of symptoms of cytokine release syndrome (table 1). The remaining two patients received glucocorticoids, vasopressors, and respiratory support, suffering progressive symptoms of cytokine release syndrome, and death (table 2).
Imaging findings of COVID-19 viral pneumoniaAxial, and coronal computed tomography images in a patient with laboratory proven COVID-19 infection demonstrating diffuse ground glass opacities in a peripheral and peribronchovascular distribution interspersed with areas of frank consolidation.
Anakinra cohortThree patients who experienced clinical signs and symptoms of cytokine release syndrome after administration of immunotherapy. These patients were treated with anakinra, and survived.
Glucocorticoids cohortTwo patients who experienced clinical signs and symptoms of cytokine release syndrome after administration of immunotherapy. These patients were treated with glucocorticoids, tacrolimus, and supportive measures, and subsequently died.
Conclusions The IL-1 inhibitor, anakinra, has shown efficacy in ameliorating signs and symptoms of cytokine release syndrome caused by immunotherapy administration. Mechanistic similarities between cytokine release syndrome and COVID-19 related pulmonary damage suggest that this pharmacotherapeutic intervention could decrease mortality and need for mechanical ventilation in patients infected with COVID-19.
Consent Written informed consent was obtained from the patient for publication of this abstract and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
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