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
Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, United States.
Division of Pediatrics, Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Oncol. 2023 Jan 17;12:1000215. doi: 10.3389/fonc.2022.1000215. eCollection 2022.
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.
内皮功能障碍是造血细胞移植（HCT）后许多主要并发症的基础，包括移植相关血栓性微血管病（TA-TMA）、静脉闭塞性疾病/窦性阻塞综合征（VOD/SOS）和植入综合征（ES）。新出现的证据同样表明，内皮炎症和微血管病与严重的COVID-19相关多系统器官功能障碍有关。鉴于这两种疾病状态存在重叠，我们推测既往COVID-19感染可能会增加HCT相关内皮病变的风险。这项回顾性多中心研究纳入了2020年1月1日至2021年9月21日期间因任何适应症接受自体或异体HCT的0至25岁患者，并密切关注那些在移植前六个月或移植后十二个月内感染COVID-19的患者。比较了移植前和移植后感染COVID-19的患者以及从未感染过SARS-CoV-2的历史对照者中TA-TMA、VOD/SOS和ES的发生率。与从未感染过的患者相比，COVID-19感染后接受HCT的患者TA-TMA发生率显著增加。此外，我们的数据表明VOD/SOS和ES发生率也有类似的上升趋势，尽管这未达到统计学显著性。因此，HCT前有COVID-19感染史可能是HCT后内皮相关并发症的一个不可改变的风险因素。有必要进行进一步研究，以在更大队列以及奥密克戎SARS-CoV-2变异株时代更好地阐明这种关系。
