Breakthrough infections in MPN-COVID vaccinated patients - Report - MDSpire

Breakthrough infections in MPN-COVID vaccinated patients

  • By

  • Tiziano Barbui

  • Alessandra Carobbio

  • Arianna Ghirardi

  • Alessandra Iurlo

  • Valerio De Stefano

  • Marta Anna Sobas

  • Elisa Rumi

  • Elena Maria Elli

  • Francesca Lunghi

  • Mercedes Gasior Kabat

  • Beatriz Cuevas

  • Paola Guglielmelli

  • Massimiliano Bonifacio

  • Monia Marchetti

  • Alberto Alvarez-Larran

  • Laura Fox

  • Marta Bellini

  • Rosa Daffini

  • Giulia Benevolo

  • Gonzalo Carreno-Tarragona

  • Andrea Patriarca

  • Haifa Kathrin Al-Ali

  • Maria Marcio Miguel Andrade-Campos

  • Francesca Palandri

  • Claire Harrison

  • Maria Angeles Foncillas

  • Santiago Osorio

  • Steffen Koschmieder

  • Elena Magro Mazo

  • Jean-Jacques Kiladjian

  • Estefanía Bolaños Calderón

  • Florian H. Heidel

  • Keina Quiroz Cervantes

  • Martin Griesshammer

  • Valentin Garcia-Gutierrez

  • Alberto Marin Sanchez

  • Juan Carlos Hernandez-Boluda

  • Emma Lopez Abadia

  • Giuseppe Carli

  • Miguel Sagues Serrano

  • Rajko Kusec

  • Blanca Xicoy Cirici

  • Margarita Guenova

  • Begona Navas Elorza

  • Anna Angona

  • Edyta Cichocka

  • Anna Kulikowska de Nałęcz

  • Daniele Cattaneo

  • Cristina Bucelli

  • Silvia Betti

  • Oscar Borsani

  • Fabrizio Cavalca

  • Sara Carbonell

  • Natalia Curto-Garcia

  • Lina Benajiba

  • Alessandro Rambaldi

  • Alessandro Maria Vannucchi

  • November 15, 2022

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Infections After COVID-19 Vaccination in Myeloproliferative Neoplasm Patients

Overview

This study analyzed COVID-19 infections in patients with myeloproliferative neoplasms (MPNs) following vaccination, including those with prior COVID-19 (hybrid vaccination) and those without. Reinfections and breakthrough infections occurred predominantly during Delta and Omicron variant waves, with vaccination providing limited protection, especially in myelofibrosis patients on ruxolitinib. Hospitalization rates post-vaccination were higher than in the general population, with severity mostly mild but increased in older, male, and myelofibrosis patients.

Background

Patients with MPNs, including polycythemia vera, essential thrombocythemia, prefibrotic and overt myelofibrosis, experienced severe COVID-19 with high mortality during the first pandemic wave. Vaccination has been effective in the general population to reduce severity and death, but data in MPN patients are limited, particularly due to poor antibody responses in myelofibrosis patients on ruxolitinib. The study evaluated COVID-19 infections across four variant waves in a large European MPN cohort, assessing vaccination impact on reinfections and breakthrough infections.

Data Highlights

ParameterVaccinated with prior COVID-19Unvaccinated with prior COVID-19Breakthrough infections (vaccinated, no prior COVID-19)
Number of patients287131231
Reinfections10 (3.5%)8 (6.1%)N/A
Hospitalization rate (breakthrough)N/AN/A11%
Median age hospitalized (breakthrough)N/AN/A76 years
MF patients hospitalized (breakthrough)N/AN/A39%
Deaths in breakthrough infectionsN/AN/A5 (2.2%)
Vaccine doses (1–2 vs 3–4)77% vs 23%N/A~42% fully vaccinated

Key Findings

  • Reinfection rates in vaccinated MPN patients with prior COVID-19 were 3.5%, not significantly lower than 6.1% in unvaccinated patients.
  • Reinfections predominantly occurred during the Omicron wave, with longer intervals between infections in vaccinated patients, suggesting waning immunity.
  • Breakthrough infections in vaccinated MPN patients without prior COVID-19 had an 11% hospitalization rate, higher than general population cohorts.
  • Hospitalized breakthrough cases were older, mostly male, had higher prevalence of myelofibrosis, and prior ruxolitinib exposure.
  • Severity of reinfections and breakthrough infections was mostly mild, but moderate to severe illness was more common among hospitalized breakthrough cases.
  • Adverse events from vaccination were rare and mild, with no serious events reported.

Clinical Implications

Vaccination in MPN patients, especially those with myelofibrosis and on ruxolitinib, may confer less protection against reinfection and breakthrough COVID-19 compared to the general population. Clinicians should monitor these patients closely, particularly older males and those with myelofibrosis, as they are at higher risk for hospitalization. Booster vaccinations remain important given waning immunity and variant circulation.

Conclusion

COVID-19 vaccination in MPN patients offers limited protection against reinfections and breakthrough infections, with higher hospitalization rates than in the general population, particularly among myelofibrosis patients on ruxolitinib. Ongoing surveillance and tailored vaccination strategies are needed to improve outcomes in this vulnerable group.

References

  1. LeukemiaNet European MPN-COVID Registry Study
  2. NIH COVID-19 Treatment Guidelines
  3. Italian and US Cohort Data on COVID-19 Reinfections and Breakthroughs

Original Source(s)

Breakthrough infections in MPN-COVID vaccinated patients

  • by Tiziano Barbui, Alessandra Carobbio, Arianna Ghirardi, Alessandra Iurlo, Valerio De Stefano, Marta Anna Sobas, Elisa Rumi, Elena Maria Elli, Francesca Lunghi, Mercedes Gasior Kabat, Beatriz Cuevas, Paola Guglielmelli, Massimiliano Bonifacio, Monia Marchetti, Alberto Alvarez-Larran, Laura Fox, Marta Bellini, Rosa Daffini, Giulia Benevolo, Gonzalo Carreno-Tarragona, Andrea Patriarca, Haifa Kathrin Al-Ali, Maria Marcio Miguel Andrade-Campos, Francesca Palandri, Claire Harrison, Maria Angeles Foncillas, Santiago Osorio, Steffen Koschmieder, Elena Magro Mazo, Jean-Jacques Kiladjian, Estefanía Bolaños Calderón, Florian H. Heidel, Keina Quiroz Cervantes, Martin Griesshammer, Valentin Garcia-Gutierrez, Alberto Marin Sanchez, Juan Carlos Hernandez-Boluda, Emma Lopez Abadia, Giuseppe Carli, Miguel Sagues Serrano, Rajko Kusec, Blanca Xicoy Cirici, Margarita Guenova, Begona Navas Elorza, Anna Angona, Edyta Cichocka, Anna Kulikowska de Nałęcz, Daniele Cattaneo, Cristina Bucelli, Silvia Betti, Oscar Borsani, Fabrizio Cavalca, Sara Carbonell, Natalia Curto-Garcia, Lina Benajiba, Alessandro Rambaldi, Alessandro Maria Vannucchi

  • November 15, 2022

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