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

Authors
  • Barbui, Tiziano1
  • Vannucchi, Alessandro Maria2
  • Alvarez-Larran, Alberto3
  • Iurlo, Alessandra4
  • Masciulli, Arianna1
  • Carobbio, Alessandra1
  • Ghirardi, Arianna1
  • Ferrari, Alberto1
  • Rossi, Giuseppe5
  • Elli, Elena6
  • Andrade-Campos, Marcio Miguel7
  • Kabat, Mercedes Gasior8
  • Kiladjian, Jean-Jaques9
  • Palandri, Francesca10
  • Benevolo, Giulia11
  • Garcia-Gutierrez, Valentin12
  • Fox, Maria Laura13
  • Foncillas, Maria Angeles14
  • Morcillo, Carmen Montoya15
  • Rumi, Elisa16
  • And 31 more
  • 1 Papa Giovanni XXIII Hospital,
  • 2 Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
  • 3 Hospital Clinic de Barcelona,
  • 4 Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico,
  • 5 Spedali Civili,
  • 6 Ospedale San Gerardo, ASST Monza,
  • 7 Hospital del Mar,
  • 8 Hospital Universitario la Paz,
  • 9 Hospital Saint-Louis,
  • 10 Azienda Ospedaliero-Universitaria di Bologna,
  • 11 AOU Città della Salute e della Scienza di Torino,
  • 12 Hospital Ramon y Cajal, IRYCIS,
  • 13 Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus,
  • 14 Hospital Universitario Infanta Leonor,
  • 15 Hospital General Universitario de Albacete,
  • 16 University of Pavia,
  • 17 Hospital Gregorio Maranon,
  • 18 Hospital Clinico San Carlos,
  • 19 Ospedale Policlinico “G.B. Rossi”, Borgo Roma,
  • 20 Hospital Universitario de Mostoles,
  • 21 ICO L’Hospitalet-Hospital Moises Broggi, Sant Joan Despì,
  • 22 Hospital Universitario 12 de Octubre,
  • 23 Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University,
  • 24 IRCCS Ospedale San Raffaele,
  • 25 AOU Maggiore della Carità, Novara, Italy
  • 26 Hospital Moncloa, Madrid, Spain
  • 27 ICO Girona Hospital Josep Trueta,
  • 28 Hospital Universitario Principe de Asturias, Alcalà de Henares,
  • 29 Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University,
  • 30 Ospedale San Bortolo,
  • 31 Hospital Universitario de Burgos,
  • 32 Hospital Clinico Universitario, INCLIVA,
  • 33 Hospital General de Elche,
  • 34 Hospital Germans Trias i Pujol,
  • 35 Guy’s and St. Thomas’ NHS Foundation Trust,
  • 36 ASST Papa Giovanni XXIII, Bergamo, Italy
  • 37 Fondazione Policlinico “A. Gemelli” IRCCS,
  • 38 Università degli Studi di Milano,
Type
Published Article
Journal
Leukemia
Publisher
Springer Nature
Publication Date
Jan 07, 2021
Pages
1–9
Identifiers
DOI: 10.1038/s41375-020-01107-y
PMID: 33414483
PMCID: PMC7789078
Source
PubMed Central
Keywords
License
Unknown

Abstract

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.

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