1. Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry
- Author
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Monia Marchetti, Jon Salmanton-García, Shaimaa El-Ashwah, Luisa Verga, Federico Itri, Zdeněk Ráčil, Julio Dávila-Valls, Sonia Martín-Pérez, Jaap Van Doesum, Francesco Passamonti, Ghaith Abu-Zeinah, Francesca Farina, Alberto López-García, Giulia Dragonetti, Chiara Cattaneo, Maria Gomes Da Silva, Yavuz M. Bilgin, Pavel Žák, Verena Petzer, Andreas Glenthøj, Ildefonso Espigado, Caterina Buquicchio, Valentina Bonuomo, Lucia Prezioso, Stef Meers, Rafael Duarte, Rui Bergantim, Ozren Jaksic, Natasha Čolović, Ola Blennow, Martin Cernan, Martin Schönlein, Michail Samarkos, Maria Enza Mitra, Gabriele Magliano, Johan Maertens, Marie-Pierre Ledoux, Moraima Jiménez, Fatih Demirkan, Graham P. Collins, Alba Cabirta, Stefanie K. Gräfe, Anna Nordlander, Dominik Wolf, Elena Arellano, Raul Cordoba, Michaela Hanakova, Giovanni Paolo Maria Zambrotta, Raquel Nunes Rodrigues, Giulia Limberti, Francesco Marchesi, Oliver A. Cornely, Livio Pagano, Institut Català de la Salut, [Marchetti M] Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. [Salmanton-García J] Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. Cologne Excellence Cluster on Cellular Stress Responses in AgingAssociated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. [El-Ashwah S] Oncology Center, Mansoura University, Mansoura, Egypt. [Verga L] Azienda Ospedaliera San Gerardo–Monza, Monza, Italy. Università MilanoBicocca, Milan, Italy. [Itri F] San Luigi Gonzaga Hospital–Orbassano, Orbassano, Italy. [Ráčil Z] Institute of Hematology and Blood Transfusion, Prague, Czech Republic. [Jiménez M, Cabirta A] Servei d’Hematologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Experimental Hematology, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain, and Vall d'Hebron Barcelona Hospital Campus
- Subjects
SARS-CoV-2 ,ruxolitinib ,COVID-19 ,enfermedades hematológicas y linfáticas::enfermedades hematológicas::enfermedades de la médula ósea::trastornos mieloproliferativos [ENFERMEDADES] ,Otros calificadores::Otros calificadores::/farmacoterapia [Otros calificadores] ,diagnóstico::pronóstico::resultado del tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS] ,myelofibrosis ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Hematology ,Medicaments immunosupressors - Ús terapèutic ,Other subheadings::Other subheadings::/drug therapy [Other subheadings] ,Diagnosis::Prognosis::Treatment Outcome [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT] ,COVID-19 (Malaltia) ,hydroxyurea ,Trastorns mieloproliferatius - Tractament ,Settore MED/15 - MALATTIE DEL SANGUE ,polycythemia vera ,Philadelphia-negative chronic myeloproliferative neoplasms ,Avaluació de resultats (Assistència sanitària) ,Hemic and Lymphatic Diseases::Hematologic Diseases::Bone Marrow Diseases::Myeloproliferative Disorders [DISEASES] ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Antineoplastic Agents [CHEMICALS AND DRUGS] ,essential thrombocytemia ,acciones y usos químicos::acciones farmacológicas::efectos fisiológicos de los fármacos::factores inmunitarios::inmunosupresores [COMPUESTOS QUÍMICOS Y DROGAS] - 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: Patients 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 by Older 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 by Older 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.
- Published
- 2023