Frontiers in Oncology (Jan 2023)

Prior COVID-19 infection may increase risk for developing endothelial dysfunction following hematopoietic cell transplantation

  • Sydney Ariagno,
  • Dristhi Ragoonanan,
  • Sajad Khazal,
  • Kris M. Mahadeo,
  • Gabriel Salinas Cisneros,
  • Matt S. Zinter,
  • Robyn A. Blacken,
  • Gopi Mohan,
  • Gopi Mohan,
  • Leslie E. Lehmann,
  • Asmaa Ferdjallah,
  • Kristin C. Mara,
  • Mira A. Kohorst

DOI
https://doi.org/10.3389/fonc.2022.1000215
Journal volume & issue
Vol. 12

Abstract

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Endothelial dysfunction underlies many of the major complications following hematopoietic cell transplantation (HCT), including transplant-associated thrombotic microangiopathy (TA-TMA), veno-occlusive disease/sinusoidal obstruction syndrome (VOD/SOS), and engraftment syndrome (ES). Emerging evidence similarly implicates endothelitis and microangiopathy in severe COVID-19-related multi-system organ dysfunction. Given the overlap in these two illness states, we hypothesize that prior COVID-19 infection may increase risk for HCT-related endotheliopathies. This retrospective, multicenter study included patients aged 0-25 years who underwent autologous or allogeneic HCT for any indication between January 1, 2020 and September 21, 2021, with close attention to those infected with COVID-19 in either the six months prior to transplant or twelve months following transplant. Incidences of TA-TMA, VOD/SOS, and ES were compared among patients with COVID-19 infection pre-HCT and post-HCT, as well as with historical controls who were never infected with SARS-CoV-2. Those who underwent HCT following COVID-19 infection displayed significantly increased rates of TA-TMA compared to those who were never infected. Additionally, our data suggests a similar trend for increased VOD/SOS and ES rates, although this did not reach statistical significance. Therefore, a history of COVID-19 infection prior to undergoing HCT may be a nonmodifiable risk factor for endothelial-related complications following HCT. Further studies are warranted to better clarify this relationship among larger cohorts and in the era of the Omicron SARS-CoV-2 variants.

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