De Filippi Rosaria, Marcacci Gianpaolo, Amelio Sabrina, Becchimanzi Cristina, Pinto Antonio
Department of Clinical Medicine and Surgery, Università degli Studi Federico II, Naples, Italy.
Hematology-Oncology and Stem-Cell Transplantation Unit, Istituto Nazionale Tumori-IRCCS-Fondazione 'G. Pascale', Via Mariano Semmola 49, Naples, I-80131, Italy.
Infect Agent Cancer. 2024 Aug 12;19(1):38. doi: 10.1186/s13027-024-00603-5.
Despite the global vaccination campaigns, certain patient groups remain highly vulnerable to SARS-CoV-2 and are at high risk for unfavorable COVID-19 outcomes. As previously shown by our group and a more recent report by Chang Su and coworkers, patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT) represent one of such high-risk populations. This is due to the underlying disease-related immunodeficiency, suboptimal response to vaccines, heavy exposure to dexamethasone, and the use of high-dose melphalan prior to the ASCT procedure. Contracting SARS-CoV-2 and developing COVID-19 during the ASCT procedure remain high-risk events for these patients. It is then crucial to maintain and implement all appropriate strategies to prevent COVID-19 breakthroughs in this clinical setting. This might include targeted pre- and post-exposure prophylaxis with monoclonal antibodies, based on the circulation and prevalence of different SARS-CoV-2 variants/subvariants, and the prompt use of antivirals if, despite prophylaxis, MM patients develop COVID-19 during the transplantation procedure. We emphasize the importance of regularly monitoring MM patients for SARS-CoV-2 infection at all stages of the ASCT procedure. This is crucial to promptly implement measures to reduce the risk of unfavorable COVID-19 outcomes during the current post-pandemic phase.
尽管开展了全球疫苗接种运动，但某些患者群体仍然极易感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2），并且出现不良新冠病毒病（COVID-19）结局的风险很高。正如我们团队之前所表明的以及Chang Su及其同事最近的一份报告所示，接受自体干细胞移植（ASCT）的多发性骨髓瘤（MM）患者就是这类高风险人群之一。这是由于潜在的疾病相关免疫缺陷、对疫苗的反应欠佳、大量接触地塞米松以及在ASCT手术前使用大剂量美法仑。在ASCT手术期间感染SARS-CoV-2并患上COVID-19对这些患者来说仍然是高风险事件。因此，在这种临床环境中维持并实施所有适当策略以预防COVID-19突破至关重要。这可能包括根据不同SARS-CoV-2变体/亚变体的传播情况和流行程度，使用单克隆抗体进行有针对性的暴露前和暴露后预防，以及如果尽管进行了预防，MM患者在移植过程中仍患上COVID-19，则及时使用抗病毒药物。我们强调在ASCT手术的各个阶段定期监测MM患者是否感染SARS-CoV-2的重要性。这对于在当前大流行后阶段及时采取措施降低不良COVID-19结局的风险至关重要。
