The Development of Leukemia after a Sustained COVID-19 Infection

Abstract

The purpose of the study was to review the literature on cases of leukemia in healthy people after the COVID-19 infection with a description of our own observation. Materials and methods. 26 literature sources were reviewed and analyzed using the PubMed/MEDLINE database regarding diagnosis of the leukemic process in patients after COVID-19. Analytical and bibliosemantic methods were used in the research. Results and discussion. Many aspects of the COVID-19 infection, especially its complications and long-term health consequences, are still unknown. Various reactive changes in blood tests during COVID-19 have been published. Leukocytosis, leukopenia, neutrophilia, lymphocytosis and lymphocytopenia, thrombocytopenia and rarely thrombocytosis were most often detected. The detected changes were usually not observable in patients. There are reports of leukemia after a recent COVID-19. Therefore, studying the features of the clinical picture and hematopoiesis in such patients during a viral infection, as well as at the initial manifestations of leukemia, is relevant. Costa B. and co-authors report cases of the development of the leukemic process in previously healthy young patients. Patients are aged 31-35 years with normal blood tests, in whom the manifestation of leukemia appeared approximately 2-3 months after COVID-19. The course of COVID-19 was not severe in all. Mild microcytaria was detected in one case of hypochromic anemia. The development of malignant hematological diseases in these patients with an unfavorable prognosis for the course and response to treatment attracts attention. These was T-cell acute lymphoblastic leukemia, myelodysplastic syndrome, acute myeloid leukemia with trigeminal dysplasia in the bone marrow, suggesting previous myelodysplastic syndrome. Nekooghadam S. M. and co-authors presented a case of acute myeloid leukemia in a man after recovery from COVID-19 after 1.5 months. The course of the infection was severe. The blood test showed slight leukocytosis. Manifestations of the described cases of leukemia included clinical gastroenteropathy and anemic syndrome. Two- or three-fold severe pancytopenia and dysplasia were more common in the analysis of bone marrow hematopoiesis. Low blastemia was a feature. Some authors suggest that SARS-Cov-2 plays a role in leukogenesis. The leading role in this is attributed to the imbalance of the renin-angiotensin system caused by the virus, which triggers leukogenesis in several mechanisms. An abnormal immune response to a viral infection can trigger secondary mutational events, contributing to the clinical development of leukemia. In addition to the effect of SARS-CoV-2 on renin-angiotensin system, other mechanisms of the potential development of cancer may underlie it. In particular, COVID-19 has been associated with T-cell exhaustion and activation of oncogenic pathways, including JAK-STAT, MAPK, and NF-kB. The coronavirus non-structural protein stabilizes factors by increasing RCHY1-mediated apoptosis-associated degradation of p53. The case of an acute leukemic process described by us was distinguished by a rapid atypical course, neurological symptoms, pancytopenia in peripheral blood during hospitalization, and a changed linear morphology of blast cells. Conclusion. According to the literature, the leukemic process after a sustained COVID-19 more often has an acute myeloid variant with hematopoietic dysplasia and a severe atypical course. Hematological monitoring of patients who have undergone COVID-19 in the presence of an oncology history or changes in the blood test during recovery from it is necessary. It is advisable to have a control of the hemogram after 2-3 months