Abstract
Cytokine release syndrome (CRS) is a potentially fatal systemic inflammatory response that can occur in patients undergoing peripheral blood haploidentical hematopoietic cell transplantation (haplo-HCT). Severe CRS has previously been associated with increased infection risk. IL-6 inhibitors, such as tocilizumab, are useful in moderate to severe CRS, but their effect on infection risk has not been established in this setting. We examined the effect of tocilizumab on blood stream infections (BSIs) in the early post-transplant period in 235 patients who underwent haplo-HCT from 2013 to 2020. Mild CRS was associated with a lower incidence of BSI than severe CRS (OR 0.31, 95% CI 0.13–0.74). In the tocilizumab group, 31% of patients had positive blood cultures versus 14% in the non-tocilizumab group (OR 1.61, 95% CI 0.30–8.60, p = 0.58). However, when controlling for CRS grade, tocilizumab was not independently associated with increased rates of BSIs, suggesting it does not further increase infection risk.
Acknowledgments
The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Author contributions
Contribution: ED, MS, and RA designed and performed research, analyzed data, and authored the manuscript. WF analyzed data and reviewed the manuscript. KP collected and analyzed data.
Disclosure statement
RA has research funding from Incyte Corporation. The authors have no other conflicts relevant to this publication.