The patient was a 65-year-old male. In September 2022, he was diagnosed with IGg-κ multiple myeloma, DS III stage, and R-ISS III stage. The patient received the first and second cycles of PAD chemotherapy on September 30, 2022, and October 26, 2022, respectively. On November 25, 2022, and January 6, 2023, DVRD chemotherapy was performed, and the efficacy evaluation reached PR. The patient started chemotherapy with 280 mg melphalan on May 16th, 2023, and an autologous stem cell transfusion was performed the next day. On May 23rd, 2023, the patient began to have a fever, and the highest body temperature reached 38℃. The nucleic acid test of throat swab showed that SARS-CoV-2 was positive. Moxifloxacin was combined with sulbactam/cefoperazone to prevent infection, posaconazole was used to prevent fungal infection, and nirmatrelvir /ritonavir tablets were used to prevent viral pneumonia. On May 29th, white blood cells began to rise. On June 1st, the patient’s highest temperature was 38.4℃, the absolute value of neutrophils was 7.12*109/L, and the platelet was 15 * 109/L (Fig. 1). Moxifloxacin was stopped, and linezolid combined with imipenem was used to fight the infection. On the same day, the patient was transferred out of the transplant warehouse and then continued to raise platelets by means of herombopag and platelet transfusion. By June 7, the patient had no fever and chills, and his platelets continued to rise. On June 12, the patient was discharged from the hospital, and the white blood cell (WBC) classification count was basically normal, and his general condition was good. Until October 5, 2023, he continued to maintain treatment with Lenalidomide.

Neutrophil and lymphocyte count and SARS-CoV-2 detection time. The abscissa indicates the days from ASCT

The other patient is a 57-year-old female who was diagnosed with IGg-κ multiple myeloma on January 4, 2023, with DS III stage and R-ISS III stage. From January 4, 2023, to March 27, 2023, four cycles of VRD regimen were performed, and the curative effect reached PR. The patient was admitted to the hospital again in June 2023, during which the SARS-CoV-2 nucleic acid test was positive. After knowing the risk of chemotherapy, he was transferred to a general hospital for antiviral pneumonia treatment, and after the situation improved, he underwent another VRD chemotherapy. On July 19, 2023, after receiving 300 mg of melphalan chemotherapy, autologous stem cells transfusion was performed on July 21. However, the patient developed IV degree bone marrow suppression. Cefoperazone sodium and sulbactam sodium were added to the treatment to prevent infection (Fig. 2). On July 26th, the patient developed a fever, and the highest body temperature reached 38.5℃. The next day, the patient developed symptoms of dyspnea and hypoxemia. Laboratory tests showed that the patient was positive for SARS-CoV-2, cytomegalovirus, influenza A virus, and influenza B virus.Therefore, the patient continues to receive targeted anti-infection treatment. On August 1, the patient had intermittent fever, and his dyspnea did not improve. The patient requested to be transferred to the hospital for treatment and died more than ten days after discharge. The details are unknown.

Neutrophil and lymphocyte count and SARS-CoV-2 detection time. The abscissa indicates the days from ASCT