Autologous hematopoietic transplantation following COVID‐19 infection

Abstract

Autologous hematopoietic cell transplantation following induction therapy is standard of care for most patients with newly diagnosed multiple myeloma. 1 Though active coronavirus disease-2019 (COVID-19) infection is typically a contraindication to aggressive therapy, little is known about the safety of autologous hematopoietic cell transplantation (HCT) after apparent resolution of acute symptoms and undetectable pathogen by nasopharyngeal PCR. We report here a case of newly diagnosed multiple myeloma who developed acute COVID-19 infection following induction and chemomobilization, experienced protracted viral detection, then underwent autologous HCT with minimal early toxicity. His post-transplant course and later convalescence were complicated by a number of clinical problems. A 72-year-old man was diagnosed with multiple myeloma, lambda light chain subtype, Revised-International Staging System-2 (R-ISS-2), after presenting with fatigue and weight loss, and was found to have anemia, thrombocytopenia, renal insufficiency, proteinuria, hypercalcemia, and multiple lytic bone lesions. Marrow showed 45% abnormal plasma cells that were lambda light chain restricted and serum lambda free light chain was elevated to 15.450 gm/L. Fluorescence in situ hybridization (FISH) analysis showed gain of CKS1B at 1q21.3, monosomy 13, and loss of IgH at 14q32. He received a course of plasmapheresis along with 4 cycles of cyclophosphamide-bortezomib-dexamethasone (CyBorD) therapy with complete response as assessed by normalization of serum free light chains and marrow plasma cell percentage. Considering the high-risk profile of R-ISS-2, markedly elevated light chains, and amplification of 1q on FISH, 2 along

Otologic and vestibular symptoms in COVID‐19: A scoping review

“…Details of hearing loss were present in 23 published reports, comprised of 199 patients. 7 , 9 , 11 , 13 , 17 , 21 , 22 , 23 , 25 , 26 , 27 , 28 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 39 , 41 , 43 , 45 Almost 68% of these patients began experiencing hearing loss within a month from the onset of typical symptoms or from COVID‐19 diagnosis. Only three patients (1.5%) experienced hearing loss with no other symptom and were tested for COVID‐19 sometime later.…”

“…Three patients (1.5%) experienced hearing loss more than a month after being diagnosed with COVID‐19, ranging from 40 to 117 days. 7 , 41 , 45 The remaining 28.6% did not provide any details regarding onset.…”

“…Fifteen percent of patients reported complete recovery from tinnitus, 8 , 15 , 18 , 25 , 26 , 27 , 39 while around 4% reported persistence in symptoms at the time of assessment. 7 , 25 , 27 , 43 , 45 Timing of assessment were varied with two patients followed up 3 and 7 weeks after onset of tinnitus, 43 , 45 while two studies performed assessments around 2 weeks after a negative PCR. 25 , 27 Half of the patients who recovered completely did so within 2 weeks.…”

“…Details of hearing loss were present in 23 published reports, comprised of 199 patients 7,9,11,13,17,21–23,25–28,30–32,34–37,39,41,43,45 . Almost 68% of these patients began experiencing hearing loss within a month from the onset of typical symptoms or from COVID‐19 diagnosis.…”

“…One patient did not report hearing loss as a symptom but with significant audiometry findings. Three patients (1.5%) experienced hearing loss more than a month after being diagnosed with COVID‐19, ranging from 40 to 117 days 7,41,45 . The remaining 28.6% did not provide any details regarding onset.…”