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

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MPN experts appointed by the American Society of Hematology (ASH) are continually updating some frequently asked clinical questions (https://www.hematology.org/COVID-19/COVID-19-and-myeloproliferative-neoplasms) as soon as new information emerges on the management of patients with myeloproliferative neoplasms (MPN) and COVID-19.

However, it should be acknowledged that these recommendations are derived from a consensus among experts in the MPN field, and that information on the real-world clinical practice of these patients is very limited in terms of the main outcomes’ frequency, such as survival, thrombosis and bleeding, and the corresponding risk factors, in the single MPN phenotype.

On behalf of the European Leukemia Net (ELN), we launched an observational study in Europe involving 38 centers from Italy, Spain, Germany, Poland, France and United Kingdom and collected 175 patients with MPN and COVID-19, diagnosed during the first wave of pandemic between February and June 2020.

After a median follow-up of 20 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. In multivariable analysis, we found no effect of Ruxolitinib alone on mortality of patients who did not discontinue Ruxolitinib during the acute phase of the infection whereas an increased risk of death was revealed in the 11 out of 45 patients who discontinued this drug. These findings were also confirmed in a propensity score matching analysis. These findings call for deeper investigation on the role of Ruxolitinib treatment and its interruption, in affecting mortality in MPN patients with COVID-19 (ClinicalTrials.gov identifier: NCT04385160).

Full article online: https://www.nature.com/articles/s41375-020-01107-y 

Kaplan Meier curves of survival stratified by use and discontinuation of Ruxolitinib (N=175)

Tiziano Barbui

Professor of Hematology, Scientific Director, FROM Research Foundation, Bergamo's Hospital