tetano
Editor, Senior Moderator
Ther Adv Hematol
. 2023 Mar 11;14:20406207231154706.
doi: 10.1177/20406207231154706. eCollection 2023.
Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry
Monia Marchetti[SUP] 1 [/SUP], Jon Salmanton-García[SUP] 2 3 [/SUP], Shaimaa El-Ashwah[SUP] 4 [/SUP], Luisa Verga[SUP] 5 [/SUP], Federico Itri[SUP] 6 [/SUP], Zdeněk Ráčil[SUP] 7 [/SUP], Julio Dávila-Valls[SUP] 8 [/SUP], Sonia Martín-Pérez[SUP] 8 [/SUP], Jaap Van Doesum[SUP] 9 [/SUP], Francesco Passamonti[SUP] 10 [/SUP], Ghaith Abu-Zeinah[SUP] 11 [/SUP], Francesca Farina[SUP] 12 [/SUP], Alberto López-García[SUP] 13 [/SUP], Giulia Dragonetti[SUP] 14 [/SUP], Chiara Cattaneo[SUP] 15 [/SUP], Maria Gomes Da Silva[SUP] 16 [/SUP], Yavuz M Bilgin[SUP] 17 [/SUP], Pavel Žák[SUP] 18 [/SUP], Verena Petzer[SUP] 19 [/SUP], Andreas Glenthøj[SUP] 20 [/SUP], Ildefonso Espigado[SUP] 21 [/SUP], Caterina Buquicchio[SUP] 22 [/SUP], Valentina Bonuomo[SUP] 23 [/SUP], Lucia Prezioso[SUP] 24 [/SUP], Stef Meers[SUP] 25 [/SUP], Rafael Duarte[SUP] 26 [/SUP], Rui Bergantim[SUP] 27 [/SUP], Ozren Jaksic[SUP] 28 [/SUP], Natasha Čolović[SUP] 29 [/SUP], Ola Blennow[SUP] 30 [/SUP], Martin Cernan[SUP] 31 [/SUP], Martin Schönlein[SUP] 32 [/SUP], Michail Samarkos[SUP] 33 [/SUP], Maria Enza Mitra[SUP] 34 [/SUP], Gabriele Magliano[SUP] 35 [/SUP], Johan Maertens[SUP] 36 [/SUP], Marie-Pierre Ledoux[SUP] 37 [/SUP], Moraima Jiménez[SUP] 38 39 [/SUP], Fatih Demirkan[SUP] 40 [/SUP], Graham P Collins[SUP] 41 [/SUP], Alba Cabirta[SUP] 38 39 [/SUP], Stefanie K Gräfe[SUP] 42 2 3 [/SUP], Anna Nordlander[SUP] 30 [/SUP], Dominik Wolf[SUP] 19 [/SUP], Elena Arellano[SUP] 43 [/SUP], Raul Cordoba[SUP] 44 [/SUP], Michaela Hanakova[SUP] 7 [/SUP], Giovanni Paolo Maria Zambrotta[SUP] 5 [/SUP], Raquel Nunes Rodrigues[SUP] 16 [/SUP], Giulia Limberti[SUP] 1 [/SUP], Francesco Marchesi[SUP] 45 [/SUP], Oliver A Cornely[SUP] 2 46 47 48 49 [/SUP], Livio Pagano[SUP] 14 50 [/SUP]
Affiliations
Abstract
Background: Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk.
Objectives: The present study aims to assess the effect of immunosuppressive agents on clinical outcomes of MPN patients affected by the coronavirus disease 2019 (COVID-19).
Design: This is an observational study.
Methods: We specifically searched and analyzed MPN patients collected by EPICOVIDEHA online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.
Results: Overall, 398 patients with MPN were observed for a median of 76 days [interquartile range (IQR): 19-197] after detection of SARS-CoV2 infection. Median age was 69 years (IQR: 58-77) and 183 individuals (46%) had myelofibrosis (MF). Overall, 121 patients (30%) of the whole cohort received immunosuppressive therapies including steroids, immunomodulatory drugs, or JAK inhibitors. Hospitalization and consecutive admission to intensive care unit was required in 216 (54%) and 53 patients (13%), respectively. Risk factors for hospital admission were identified by multivariable logistic regression and include exposure to immunosuppressive therapies [odds ratio (OR): 2.186; 95% confidence interval (CI): 1.357-3.519], age ⩾70 years, and comorbidities. The fatality rate was 22% overall and the risk of death was independently increased by age ⩾70 years [hazard ratio (HR): 2.191; 95% CI: 1.363-3.521], previous comorbidities, and exposure to immunosuppressive therapies before the infection (HR: 2.143; 95% CI: 1.363-3.521).
Conclusion: COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.
Plain language summary: EPICOVIDEHA registry reports inferior outcomes of COVID-19 in patients with Philadelphia-negative chronic myeloproliferative neoplasms receiving immunosuppressive therapies. Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) incur high rates of infections during the course of their disease.The present study was aimed at assessing which patient characteristics predicted a worse outcome of SARS-COV-2 infection in individuals with MPN.To pursue this objective, the researchers analyzed the data collected by EPICOVIDEHA, an international online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.The database provided clinical data of 398 patients with MPN incurring COVID-19
atients were mostly elderly (median age was 69 years);Forty-six percent of them were affected by myelofibrosis, which is the most severe MPN;Moreover, 32% were receiving immunosuppressive therapies (JAK inhibitors, such as ruxolitinib, steroids, or immunomodulatory IMID drugs, such as thalidomide) before COVID-19.Hospitalization was required in 54% of the patients, and the risk of being hospitalized for severe COVID-19 was independently predicted byOlder age;Comorbidities;Exposure to immunosuppressive therapies.Overall, 22% of MPN patients deceased soon after COVID-19 and the risk of death was independently increased over twofold byOlder age;Comorbidities;Exposure to immunosuppressive therapies before the infection.In conclusion, COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents, including JAK inhibitors, or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.
Keywords: COVID-19; Philadelphia-negative chronic myeloproliferative neoplasms; SARS-CoV-2; essential thrombocytemia; hydroxyurea; myelofibrosis; polycythemia vera; ruxolitinib.
. 2023 Mar 11;14:20406207231154706.
doi: 10.1177/20406207231154706. eCollection 2023.
Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry
Monia Marchetti[SUP] 1 [/SUP], Jon Salmanton-García[SUP] 2 3 [/SUP], Shaimaa El-Ashwah[SUP] 4 [/SUP], Luisa Verga[SUP] 5 [/SUP], Federico Itri[SUP] 6 [/SUP], Zdeněk Ráčil[SUP] 7 [/SUP], Julio Dávila-Valls[SUP] 8 [/SUP], Sonia Martín-Pérez[SUP] 8 [/SUP], Jaap Van Doesum[SUP] 9 [/SUP], Francesco Passamonti[SUP] 10 [/SUP], Ghaith Abu-Zeinah[SUP] 11 [/SUP], Francesca Farina[SUP] 12 [/SUP], Alberto López-García[SUP] 13 [/SUP], Giulia Dragonetti[SUP] 14 [/SUP], Chiara Cattaneo[SUP] 15 [/SUP], Maria Gomes Da Silva[SUP] 16 [/SUP], Yavuz M Bilgin[SUP] 17 [/SUP], Pavel Žák[SUP] 18 [/SUP], Verena Petzer[SUP] 19 [/SUP], Andreas Glenthøj[SUP] 20 [/SUP], Ildefonso Espigado[SUP] 21 [/SUP], Caterina Buquicchio[SUP] 22 [/SUP], Valentina Bonuomo[SUP] 23 [/SUP], Lucia Prezioso[SUP] 24 [/SUP], Stef Meers[SUP] 25 [/SUP], Rafael Duarte[SUP] 26 [/SUP], Rui Bergantim[SUP] 27 [/SUP], Ozren Jaksic[SUP] 28 [/SUP], Natasha Čolović[SUP] 29 [/SUP], Ola Blennow[SUP] 30 [/SUP], Martin Cernan[SUP] 31 [/SUP], Martin Schönlein[SUP] 32 [/SUP], Michail Samarkos[SUP] 33 [/SUP], Maria Enza Mitra[SUP] 34 [/SUP], Gabriele Magliano[SUP] 35 [/SUP], Johan Maertens[SUP] 36 [/SUP], Marie-Pierre Ledoux[SUP] 37 [/SUP], Moraima Jiménez[SUP] 38 39 [/SUP], Fatih Demirkan[SUP] 40 [/SUP], Graham P Collins[SUP] 41 [/SUP], Alba Cabirta[SUP] 38 39 [/SUP], Stefanie K Gräfe[SUP] 42 2 3 [/SUP], Anna Nordlander[SUP] 30 [/SUP], Dominik Wolf[SUP] 19 [/SUP], Elena Arellano[SUP] 43 [/SUP], Raul Cordoba[SUP] 44 [/SUP], Michaela Hanakova[SUP] 7 [/SUP], Giovanni Paolo Maria Zambrotta[SUP] 5 [/SUP], Raquel Nunes Rodrigues[SUP] 16 [/SUP], Giulia Limberti[SUP] 1 [/SUP], Francesco Marchesi[SUP] 45 [/SUP], Oliver A Cornely[SUP] 2 46 47 48 49 [/SUP], Livio Pagano[SUP] 14 50 [/SUP]
Affiliations
- PMID: 36923264
- PMCID: PMC10009041
- DOI: 10.1177/20406207231154706
Abstract
Background: Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk.
Objectives: The present study aims to assess the effect of immunosuppressive agents on clinical outcomes of MPN patients affected by the coronavirus disease 2019 (COVID-19).
Design: This is an observational study.
Methods: We specifically searched and analyzed MPN patients collected by EPICOVIDEHA online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.
Results: Overall, 398 patients with MPN were observed for a median of 76 days [interquartile range (IQR): 19-197] after detection of SARS-CoV2 infection. Median age was 69 years (IQR: 58-77) and 183 individuals (46%) had myelofibrosis (MF). Overall, 121 patients (30%) of the whole cohort received immunosuppressive therapies including steroids, immunomodulatory drugs, or JAK inhibitors. Hospitalization and consecutive admission to intensive care unit was required in 216 (54%) and 53 patients (13%), respectively. Risk factors for hospital admission were identified by multivariable logistic regression and include exposure to immunosuppressive therapies [odds ratio (OR): 2.186; 95% confidence interval (CI): 1.357-3.519], age ⩾70 years, and comorbidities. The fatality rate was 22% overall and the risk of death was independently increased by age ⩾70 years [hazard ratio (HR): 2.191; 95% CI: 1.363-3.521], previous comorbidities, and exposure to immunosuppressive therapies before the infection (HR: 2.143; 95% CI: 1.363-3.521).
Conclusion: COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.
Plain language summary: EPICOVIDEHA registry reports inferior outcomes of COVID-19 in patients with Philadelphia-negative chronic myeloproliferative neoplasms receiving immunosuppressive therapies. Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) incur high rates of infections during the course of their disease.The present study was aimed at assessing which patient characteristics predicted a worse outcome of SARS-COV-2 infection in individuals with MPN.To pursue this objective, the researchers analyzed the data collected by EPICOVIDEHA, an international online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.The database provided clinical data of 398 patients with MPN incurring COVID-19
atients were mostly elderly (median age was 69 years);Forty-six percent of them were affected by myelofibrosis, which is the most severe MPN;Moreover, 32% were receiving immunosuppressive therapies (JAK inhibitors, such as ruxolitinib, steroids, or immunomodulatory IMID drugs, such as thalidomide) before COVID-19.Hospitalization was required in 54% of the patients, and the risk of being hospitalized for severe COVID-19 was independently predicted byOlder age;Comorbidities;Exposure to immunosuppressive therapies.Overall, 22% of MPN patients deceased soon after COVID-19 and the risk of death was independently increased over twofold byOlder age;Comorbidities;Exposure to immunosuppressive therapies before the infection.In conclusion, COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents, including JAK inhibitors, or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.Keywords: COVID-19; Philadelphia-negative chronic myeloproliferative neoplasms; SARS-CoV-2; essential thrombocytemia; hydroxyurea; myelofibrosis; polycythemia vera; ruxolitinib.