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

doi:10.16138/j.1673-6087.2025.04.05

Abstract

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

CLC Number:

R557.3

JIN Shiwei, PAN Mengmeng, XU Jie, GAO Shan, WANG Yan, LIU Yuanfang, TAO Yi, ZHANG Weiping, MI Jianqing. Effects of prior COVID-19 infection on autologous hematopoietic stem cell transplantation in multiple myeloma patients[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(04): 289-295.

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项目	总例数（n=63）	非感染组（n=31）	感染组（n=32）	Z/χ²	P
年龄（岁）	59(53， 56)	59(51, 63)	59(63， 65)	0.551	0.582
性别[n(%)]				0.813	0.367
男性	35(55.6)	19(61.3)	16(50.0)
女性	28(44.4)	12(38.7)	16(50.0)
疾病类型[n(%)]					0.542
IgG	26(41.3)	16(51.6)	10(31.3)
IgA	16(25.4)	7(22.6)	9(28.1)
IgD	7(11.1)	3(9.7)	4(12.5)
轻链型	12(19.0)	4(12.9)	8(25.0)
未分泌型	2(3.2)	1(3.2)	1(3.1)
ISS分期[n(%)]				0.235	0.889
Ⅰ	18(28.6)	8(25.8)	10(31.3)
Ⅱ	35(55.6)	18(58.1)	17(53.1)
Ⅲ	10(15.9)	5(16.1)	5(15.6)
R-ISS分期[n (%)]				0.508	0.776
Ⅰ	14(22.2)	6(19.4)	8(25.0)
Ⅱ	42(66.7)	22(71.0)	20(62.5)
Ⅲ	7(11.1)	3(9.7)	4(12.5)
auto-HSCT前疗效[n(%)]				3.934	0.269
PR	4(6.3)	2(6.5)	2(6.3)
VGPR	23(36.5)	15(48.4)	8(25.0)
CR	11(17.5)	4(12.9)	7(21.9)
sCR	25(39.7)	10(32.3)	15(46.9)

项目	非感染组（n=31）	感染组（n=32）	Z/χ²	P
CD34（×10⁶/kg)	4.76(2.88,5.70)	3.68(2.83,5.20)	1.072	0.284
粒系植入时间（d）	11.0(11.0, 12.0)	11.0(10.0, 12.0)	0.349	0.727
巨核系植入时间（d）	12.0(11.0, 14.0)	12.5(11.0, 14.0)	0.585	0.558
植入综合征[n(%)]	10.0(32.3)	12.0(37.5)	0.190	0.663
感染[n(%)]	6.0(19.4)	9.0(28.1)	0.668	0.414
auto-HSCT后3个月疗效[n(%)]			2.914	0.405
PR	1.0(3.2)	1.0(3.1)
VGPR	5.0(16.1)	4.0(12.5)
CR	6.0(19.4)	2.0(6.3)
sCR	19.0(61.3)	25.0(78.1)

项目	1~3个月组（n=18）	>3个月组（n=14）	Z/χ²	P
CD34（×10⁶/kg)	3.41(2.43,5.07)	4.04(3.08,5.45)	0.874	0.382
粒系植入时间（d）	11.0(10.0, 12.0)	11.0(11.0, 12.0)	0.102	0.918
巨核系植入时间（d）	12.0(11.0, 13.0)	13.0(12.0, 14.0)	0.443	0.658
植入综合征[n(%)]	7.0(38.9)	5.0(35.7)	0.034	0.854
感染[n(%)]	5.0(27.8)	4.0(28.6)	0.002	0.960
auto-HSCT后3个月疗效[n(%)]			0.874	0.832
PR	1.0(5.6)	0(0)
VGPR	2.0(11.1)	2.0(14.3)
CR	1.0(5.6)	1.0(7.1)
sCR	14.0(77.8)	11.0(78.6)

细胞因子	感染组（n=32）	非感染组（n=31）	Z	P
IL-6
移植前	2.7(1.8,5.2)	3.3(1.2,7.1)	0.344	0.731
回输后第8天	78.9(31.5,198.5)	112.1(35.1,191.8)	0.316	0.752
IL-5
移植前	2.7(1.8,5.2)	2.9(0.2,5.9)	0.816	0.415
回输后第8天	200.1(53.4,483.8)	302.7(69.6,1 048.3)	0.454	0.650
IL-2R
移植前	556.0(396.0,701.0)	452.0(344.8,571.8)	2.007	0.054
回输后第8天	1 128.0(865.0,1811.0)	1 085.5(850.8,1 810.5)	0.346	0.736
IFN-γ
移植前	2.6(0.7,7.9)	2.6(1.2,4.2)	0.297	0.767
回输后第8天	5.0(1.7,8.7)	2.0(0.4,4.1)	2.532	0.011