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

• Published in: Frontiers in oncology Vol. 12; p. 1000215
• Main Authors: Ariagno, Sydney, Ragoonanan, Dristhi, Khazal, Sajad, Mahadeo, Kris M, Cisneros, Gabriel Salinas, Zinter, Matt S, Blacken, Robyn A, Mohan, Gopi, Lehmann, Leslie E, Ferdjallah, Asmaa, Mara, Kristin C, Kohorst, Mira A
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 17-01-2023
• Subjects: COVID-19; endothelial dysfunction; engraftment syndrome; hematopoietic cell transplant; Oncology; TA-TMA; VOD/SOS; COVID-19; hematopoietic cell transplant; TA-TMA; VOD/SOS; endothelial dysfunction; engraftment syndrome
• ISSN: 2234-943X; 2234-943X
• DOI: 10.3389/fonc.2022.1000215

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.