内科理论与实践

内科理论与实践 ›› 2025, Vol. 20 ›› Issue (04): 289-295.doi: 10.16138/j.1673-6087.2025.04.05

• 论著 • 上一篇    下一篇

既往新型冠状病毒感染对多发性骨髓瘤患者自体造血干细胞移植的影响

金诗炜, 潘萌萌, 许捷, 高山, 王焰, 刘元昉, 陶怡, 章卫平, 糜坚青()   

  1. 上海交通大学医学院附属瑞金医院血液科 上海血液学研究所 国家医学基因重点实验室 国家转化医学研究中心，上海 200025
  • 收稿日期:2024-06-07 出版日期:2025-07-31 发布日期:2025-10-27
  • 通讯作者: 糜坚青 E-mail: jianqingmi@shsmu.edu.cn
  • 基金资助:
    国家自然科学基金项目(82000154)

Effects of prior COVID-19 infection on autologous hematopoietic stem cell transplantation in multiple myeloma patients

JIN Shiwei, PAN Mengmeng, XU Jie, GAO Shan, WANG Yan, LIU Yuanfang, TAO Yi, ZHANG Weiping, MI Jianqing()   

  1. Department of Hematology, Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine, Ruijin Hospital,Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-06-07 Online:2025-07-31 Published:2025-10-27

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摘要：

目的：探讨既往新型冠状病毒（新冠）感染对多发性骨髓瘤（multiple myeloma ，MM）患者接受自体造血干细胞移植（autologous hematopoietic stem cell transplantation， auto-HSCT）后造血功能和免疫功能重建，以及移植相关并发症的影响。方法：回顾性分析2022年7月1日至2023年7月31日在上海交通大学医学院附属瑞金医院血液科接受auto-HSCT的 MM患者临床资料，根据移植前新冠感染史将患者分为感染组和非感染组，比较2组患者在造血细胞植入时间、移植相关感染、植入综合征、免疫球蛋白恢复、淋巴细胞亚群以及移植后疗效评估等方面的差异。结果：共纳入63例患者，感染组32例，非感染组31例。2组患者移植后粒系和巨核系植入时间、移植相关感染及植入综合征发生率均无统计学差异。感染组移植前外周血CD3+T、CD3+CD8+T和CD19+B淋巴细胞计数均高于非感染组（P<0.05），但移植后上述淋巴细胞亚群计数2组间无统计学差异。移植后第8天感染组干扰素（interferon，IFN）-γ较非感染组显著升高（P=0.011）。移植后3个月感染组患者多克隆免疫球蛋白恢复比例较非感染组低（P=0.026），但2组患者疗效评估差异无显著性。结论：MM患者感染新冠痊愈后接受auto-HSCT是安全可靠的，植入时间未见延长，移植相关并发症未见增加，但既往新冠感染者存在免疫功能异常，尤其是移植后多克隆免疫球蛋白重建滞后，建议及时补充人免疫球蛋白，预防感染等并发症。

关键词: 新型冠状病毒, 多发性骨髓瘤, 自体造血干细胞移植, 淋巴细胞亚群, 免疫球蛋白重建

Abstract:

Objective To assess the impact of prior COVID-19 infection on clinical outcomes in terms of engraftment, treatment emergent complications, and immune reconstitution in multiple myeloma (MM) patients after autologous hematopoietic stem cell transplantation (auto-HSCT). Methods Data of MM patients who underwent auto-HSCT from July 1, 2022, to July 31, 2023, in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The clinical indices including engraftment time, transplant-related infection, engraftment syndrome, immunoglobulin reconstitution, circulating lymphocytes composition, and short-term efficacy were compared in the two cohorts who had or had not been infected by COVID-19 prior to auto-HSCT. Results Sixty-three patients were included. Thirty-two recovered from COVID-19 before auto-HSCT and the remaining 31 did not show evidence of COVID-19 infection. No differences were observed across the two groups in the rates of infections, neutrophil engraftment, platelet engraftment, as well as the incidence of engraftment syndrome. Preceding auto-HSCT, the numbers of CD3+T, CD3+CD8+T and CD19+B lymphocytes in patients recovered from COVID-19 were significantly higher than those in COVID-19-free group (P<0.05); however, such a disparity was not present after auto-HSCT. At day 8 post-infusion, interferon(IFN)-γ level of COVID-19 group was higher as compared with that of non-infected group (P=0.011).The rate of polyclonal immunoglobulins recovery in COVID-19-affected cohort was 3.1%, which was lower than that in non-infected patients three months post auto-HSCT (P=0.026), while there was no difference in depth of therapeutic response between the two groups. Conclusions The data indicates that auto-HSCT can be safely administered in MM patients who completely recovered from COVID-19, but their immunoglobulins reconstitution was relatively delayed upon adoptive transfer. Timely and routine intravenous immunoglobin supplements are recommended for minimizing the risk of infection.

Key words: COVID-19, Multiple myeloma, Autologous hematopoietic stem cell transplantation, Lymphocyte, Immunoglobulin reconstitution

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