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A study of three patients with multiple sclerosis undergoing autologous hematopoietic stem cell transplantation found that high-dose cyclophosphamide may have modulated the inflammatory response to SARS-CoV-2 infection, preventing the development of COVID-19 and worsening of multiple sclerosis symptoms.

  • Multiple sclerosis and SARS-CoV-2 infection share strong immune and inflammatory components.
  • High-dose cyclophosphamide might reduce the inflammatory response to SARS-CoV-2 infection.
  • Patients undergoing hematopoietic stem cell transplantation for multiple sclerosis remained asymptomatic despite high virus load, in this study.

Cyclophosphamide, a drug used in various settings, including autoimmune diseases and post-haploidentical stem cell transplants, has the potential to modulate the immune response by depleting cytotoxic and effector T cell populations while sparing regulatory T cells (Tregs). This immune modulation could help tip the balance away from an overly pro-inflammatory environment.

The Role of Cyclophosphamide in Autoimmune Diseases and Immune Response

According to a study published in the journal Hematology, cyclophosphamide has been shown to be effective in treating autoimmune diseases, such as multiple sclerosis, by suppressing the immune system and controlling inflammation. In the context of SARS-CoV-2 infection, the drug may also play a role in modulating the immune response, thereby reducing the risk of developing severe COVID-19. Its immunomodulatory effects could provide valuable insights into the development of new therapeutic strategies for managing both multiple sclerosis and COVID-19.

High-Dose Cyclophosphamide in Autotransplants for Multiple Sclerosis Patients

In the study, three patients with multiple sclerosis received high-dose cyclophosphamide as part of their autologous hematopoietic stem cell transplantation (HSCT) process. Despite being infected with SARS-CoV-2 during the procedure and having a high viral load, the patients remained asymptomatic, did not develop COVID-19, and did not experience worsening of their multiple sclerosis symptoms.

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Understanding the Mechanism of Cyclophosphamide’s Protective Effect

Further research is needed to better understand the mechanism through which cyclophosphamide exerts its protective effect against COVID-19 and multiple sclerosis exacerbation. Investigating the drug’s impact on inflammatory markers, such as interleukin-6 (IL-6) and C-reactive protein (CRP), could provide clues about how it modulates the immune response in the context of SARS-CoV-2 infection.

Cyclophosphamide’s Potential Protective Effect Against COVID-19 and Multiple Sclerosis Exacerbation

The data suggest that high-dose cyclophosphamide might have reduced the inflammatory response to SARS-CoV-2 infection, preventing the development of COVID-19 and the worsening of multiple sclerosis symptoms. This protective effect of cyclophosphamide contrasts with the adverse effect of rituximab, another immunosuppressive drug, in individuals with multiple sclerosis and SARS-CoV-2 infection. Further studies are needed to validate these findings and explore the potential of cyclophosphamide as a treatment option for patients with multiple sclerosis and COVID-19.


Olivares-Gazca, J. C., Gale, R. P., Sánchez-Bonilla, D., Gallardo-Pérez, M. M., Soto-Olvera, S., Ruiz-Delgado, G. J., & Ruiz-Argüelles, G. J. (2023). SARS-CoV-2-infection in the setting of autotransplants for multiple sclerosis. Hematology (Amsterdam, Netherlands), 28(1), 2164443. https://doi.org/10.1080/16078454.2022.2164443