High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib

• Published in: Leukemia Vol. 35; no. 2; pp. 485 - 493
• Main Authors: Barbui, Tiziano, Vannucchi, Alessandro Maria, Alvarez-Larran, Alberto, Iurlo, Alessandra, Masciulli, Arianna, Carobbio, Alessandra, Ghirardi, Arianna, Ferrari, Alberto, Rossi, Giuseppe, Elli, Elena, Andrade-Campos, Marcio Miguel, Kabat, Mercedes Gasior, Kiladjian, Jean-Jaques, Palandri, Francesca, Benevolo, Giulia, Garcia-Gutierrez, Valentin, Fox, Maria Laura, Foncillas, Maria Angeles, Morcillo, Carmen Montoya, Rumi, Elisa, Osorio, Santiago, Papadopoulos, Petros, Bonifacio, Massimiliano, Cervantes, Keina Susana Quiroz, Serrano, Miguel Sagues, Carreno-Tarragona, Gonzalo, Sobas, Marta Anna, Lunghi, Francesca, Patriarca, Andrea, Elorza, Begona Navas, Angona, Anna, Mazo, Elena Magro, Koschmieder, Steffen, Ruggeri, Marco, Cuevas, Beatriz, Hernandez-Boluda, Juan Carlos, Abadia, Emma Lopez, Cirici, Blanca Xicoy, Guglielmelli, Paola, Garrote, Marta, Cattaneo, Daniele, Daffini, Rosa, Cavalca, Fabrizio, Bellosillo, Beatriz, Benajiba, Lina, Curto-Garcia, Natalia, Bellini, Marta, Betti, Silvia, De Stefano, Valerio, Harrison, Claire, Rambaldi, Alessandro
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2021; Nature Publishing Group
• Subjects: 692/699/1541/1990/2331; 692/699/255; Aged; Cancer Research; Coronaviruses; COVID-19; COVID-19 - complications; COVID-19 - mortality; COVID-19 - transmission; COVID-19 - virology; Critical Care Medicine; Diagnosis; Europe - epidemiology; Evaluation; Female; Follow-Up Studies; Forecasts and trends; Health risks; Hematology; Humans; Inhibitor drugs; Intensive; Internal Medicine; Italy; Lymphocytes; Male; Medicine; Medicine & Public Health; Middle Aged; Mortality; Myelofibrosis; Myeloproliferative disorders; Myeloproliferative Disorders - drug therapy; Myeloproliferative Disorders - epidemiology; Myeloproliferative Disorders - mortality; Myeloproliferative Disorders - virology; Neoplasms; Nitriles; Oncology; Patients; Physiological aspects; Polycythemia; Polycythemia vera; Prognosis; Pyrazoles - administration & dosage; Pyrimidines; Retrospective Studies; Risk analysis; Risk factors; SARS-CoV-2 - isolation & purification; Survival Rate; Tumors; Withholding Treatment - statistics & numerical data; Europe; Italy
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/s41375-020-01107-y

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.