The impact of tocilizumab treatment for cytokine release syndrome on the incidence of early blood stream infections after peripheral blood haploidentical hematopoietic cell transplantation

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.

Keywords:

• Tocilizumab
• cytokine release syndrome (CRS)
• haploidentical
• hematopoietic stem cell transplantation
• bloodstream infection

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.

Additional information

Funding

MS was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR002344. RA is supported by the American Society of Hematology Research Training Award for Fellows and the National Cancer Institute of the National Institutes of Health under Award Number K12 CA167540 and R25 CA190190.