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