自体造血干细胞移植过程中感染新型冠状病毒2例并文献复习

doi:10.3969/j.issn.1004-583X.2025.12.011

摘要/Abstract

摘要：

目的探讨多发性骨髓瘤（MM）患者自体造血干细胞移植（ASCT）期间感染新型冠状病毒（SARS-CoV-2）的干预策略，并分析ASCT后免疫重建对抑制过度炎症反应的潜在调控作用。方法报告2例MM患者（IgA-λ型、IgG-κ型）在ASCT期间感染SARS-CoV-2的临床病例，并结合相关文献进行分析。结果 2例患者经早期启动抗病毒、抗菌药物及积极的造血支持治疗后，中性粒细胞恢复与病毒清除呈现同步趋势（病例1：感染后10 d；病例2：感染后3 d）。值得注意的是，炎症标志物（C反应蛋白、降钙素原）在整个病程中持续维持于正常范围，未见重症进展及细胞因子风暴的发生。结论尽管ASCT期间感染SARS-CoV-2风险较低，但严格的防护措施和早期、多维度的干预策略至关重要。同时，ASCT后免疫重建初期特有的淋巴细胞耗竭状态可能通过抑制IL-6、TNF-α等关键促炎因子的释放，联合固有免疫系统的时序性优先重建，协同降低了细胞因子风暴的风险，为临床干预提供了关键的时间窗。

关键词: 多发性骨髓瘤, 自体造血干细胞移植, 新型冠状病毒, 细胞因子风暴

Abstract:

Objective To investigate the intervention strategies for multiple myeloma （MM） patients infected with severe acute respiratory syndrome coronavirus 2 （SARS-CoV-2） during autologous hematopoietic stem cell transplantation （ASCT） and to analyze the potential regulatory role of post-ASCT immune reconstitution in suppressing excessive inflammatory responses. Methods We report two clinical cases of MM patients （with IgA-λ and IgG-κ types） who contracted SARS-CoV-2 during ASCT，supplemented by a review of relevant literature. Results Following the early initiation of antiviral and antibacterial agents alongside aggressive supportive care，neutrophil recovery coincided with viral clearance in both cases （Case 1： at 10 days post-infection； Case 2： at 3 days post-infection）. Notably，inflammatory markers （C-reactive protein and procalcitonin） remained within reference ranges throughout the clinical course，with no progression to severe disease and no evidence of cytokine storm. Conclusion Although the risk of SARS-CoV-2 infection during ASCT is relatively low，strict protective measures and early，multidimensional intervention strategies are crucial. Furthermore，the unique lymphocyte-depleted state during early immune reconstitution post-ASCT may suppress the release of key proinflammatory cytokines such as IL-6 and TNF-α. This mechanism，coupled with the temporally prioritized reconstitution of the innate immune system，may synergistically reduce the risk of a cytokine storm，providing a critical window for clinical intervention.

Key words: multiple myeloma, autologous hematopoietic stem cell transplantation, SARS-CoV-2, cytokine storm

中图分类号:

R733.3

张媛媛, 尤佳文, 宋晓宁, 藏美蓉, 王家琪, 孟建波. 自体造血干细胞移植过程中感染新型冠状病毒2例并文献复习[J]. 临床荟萃, 2025, 40(12): 1113-1118.

Zhang Yuanyuan, You Jiawen, Song Xiaoning, Zang Meirong, Wang Jiaqi, Meng Jianbo. SARS-CoV-2 infection during autologous hematopoietic stem cell transplantation： A report of two cases and literature review[J]. Clinical Focus, 2025, 40(12): 1113-1118.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.12.011

https://www.lchc.cn/CN/Y2025/V40/I12/1113

图/表 2

图1 病例1：中性粒细胞、淋巴细胞与血小板计数的动态；PCT，CRP 水平及SARS-CoV-2检测时间点

Fig.1 Case 1： Neutrophil，lymphocyte and platelet counts trajectories； PCT and CRP levels； SARS-CoV-2 testing timeline

图2 病例2：中性粒细胞、淋巴细胞与血小板计数的动态；PCT、CRP 水平及 SARS-CoV-2 检测时间点

Fig.2 Case 2： Neutrophil，lymphocyte and platelet counts trajectories； PCT and CRP levels； SARS-CoV-2 testing timeline

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