Subject(s)
COVID-19 , Myeloproliferative Disorders , Humans , Nitriles , Pyrimidines , Pyrazoles/therapeutic useSubject(s)
COVID-19 Vaccines/therapeutic use , COVID-19/immunology , Myeloproliferative Disorders/drug therapy , Myeloproliferative Disorders/immunology , Adult , Aged , Aged, 80 and over , COVID-19/genetics , COVID-19/prevention & control , COVID-19/virology , Female , Fusion Proteins, bcr-abl/genetics , Humans , Male , Middle Aged , Myeloproliferative Disorders/diagnosis , Myeloproliferative Disorders/virology , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purificationSubject(s)
Anticoagulants/administration & dosage , Atrial Fibrillation/drug therapy , Myeloproliferative Disorders/complications , Venous Thromboembolism/drug therapy , Administration, Oral , Atrial Fibrillation/etiology , Atrial Fibrillation/pathology , Humans , International Agencies , Venous Thromboembolism/etiology , Venous Thromboembolism/pathologySubject(s)
COVID-19/complications , Leukemia, Myeloid, Acute/complications , Lymphoma, Non-Hodgkin/complications , Myeloproliferative Disorders/complications , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/therapy , Female , Follow-Up Studies , Humans , Leukemia, Myeloid, Acute/mortality , Leukemia, Myeloid, Acute/therapy , Lymphoma, Non-Hodgkin/mortality , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Myeloproliferative Disorders/mortality , Myeloproliferative Disorders/therapy , SARS-CoV-2/isolation & purification , Treatment OutcomeABSTRACT
In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (-23.3%, p < 0.0001) than in PV (-16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
Subject(s)
Bone Marrow Neoplasms/epidemiology , COVID-19/epidemiology , Myeloproliferative Disorders/epidemiology , Thrombocythemia, Essential/epidemiology , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Aged , Aged, 80 and over , Bone Marrow Neoplasms/complications , COVID-19/complications , Cohort Studies , Europe/epidemiology , Female , Humans , Male , Middle Aged , Myeloproliferative Disorders/complications , Pandemics , Retrospective Studies , Risk Factors , SARS-CoV-2/physiology , Thrombocythemia, Essential/complicationsABSTRACT
We report the clinical presentation and risk factors for survival in 175 patients with myeloproliferative neoplasms (MPN) and COVID-19, diagnosed between February and June 2020. After a median follow-up of 50 days, mortality was higher than in the general population and reached 48% in myelofibrosis (MF). Univariate analysis, showed a significant relationship between death and age, male gender, decreased lymphocyte counts, need for respiratory support, comorbidities and diagnosis of MF, while no association with essential thrombocythemia (ET), polycythemia vera (PV), and prefibrotic-PMF (pre-PMF) was found. Regarding MPN-directed therapy ongoing at the time of COVID-19 diagnosis, Ruxolitinib (Ruxo) was significantly more frequent in patients who died in comparison with survivors (p = 0.006). Conversely, multivariable analysis found no effect of Ruxo alone on mortality, but highlighted an increased risk of death in the 11 out of 45 patients who discontinued treatment. These findings were also confirmed in a propensity score matching analysis. In conclusion, we found a high risk of mortality during COVID-19 infection among MPN patients, especially in MF patients and/or discontinuing Ruxo at COVID-19 diagnosis. These findings call for deeper investigation on the role of Ruxo treatment and its interruption, in affecting mortality in MPN patients with COVID-19.