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, Leslie E. Lehmann, Asmaa Ferdjallah, Kristin C. Mara, Mira A. Kohorst

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Article number1000215
JournalFrontiers in Oncology
Volume12
DOIs
StatePublished - Jan 17 2023

Keywords

  • COVID-19
  • endothelial dysfunction
  • engraftment syndrome
  • hematopoietic cell transplant
  • TA-TMA
  • VOD/SOS

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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