Determinants of Covid19 disease and of survival after Covid19 in MPN patients treated with ruxolitinib - Report - MDSpire

Determinants of Covid19 disease and of survival after Covid19 in MPN patients treated with ruxolitinib

  • By

  • Francesca Palandri

  • Elena M. Elli

  • Giuseppe Auteri

  • Massimiliano Bonifacio

  • Giulia Benevolo

  • Florian H. Heidel

  • Simona Paglia

  • Malgorzata M. Trawinska

  • Costanza Bosi

  • Elena Rossi

  • Mario Tiribelli

  • Alessia Tieghi

  • Alessandra Iurlo

  • Nicola Polverelli

  • Giovanni Caocci

  • Gianni Binotto

  • Francesco Cavazzini

  • Eloise Beggiato

  • Daniela Cilloni

  • Caterina Tatarelli

  • Francesco Mendicino

  • Maurizio Miglino

  • Monica Bocchia

  • Monica Crugnola

  • Camilla Mazzoni

  • Andrea D. Romagnoli

  • Giovanni Rindone

  • Sara Ceglie

  • Alessandra D’Addio

  • Eleonora Santoni

  • Daniele Cattaneo

  • Daniela Bartoletti

  • Roberto M. Lemoli

  • Mauro Krampera

  • Antonio Cuneo

  • Gianpietro C. Semenzato

  • Roberto Latagliata

  • Elisabetta Abruzzese

  • Nicola Vianelli

  • Michele Cavo

  • Alessandro Andriani

  • Valerio De Stefano

  • Giuseppe A. Palumbo

  • Massimo Breccia

  • May 3, 2023

  • 0 min

Share

Factors Influencing Covid-19 Outcomes in MPN Patients on Ruxolitinib

Overview

In a cohort of 560 myeloproliferative neoplasm (MPN) patients treated with ruxolitinib, 14.2% contracted Covid-19 with a 25.3% mortality rate. Vaccination significantly reduced infection risk, and older age, lower platelet counts, and higher neutrophil-to-lymphocyte ratios were associated with increased hospitalization and mortality.

Background

Patients with Philadelphia-negative MPNs such as essential thrombocythemia, polycythemia vera, and myelofibrosis are at increased risk of severe Covid-19 outcomes. Ruxolitinib, a JAK1/2 inhibitor used in MF and PV, modulates immune responses and may influence susceptibility and prognosis of SARS-CoV-2 infection. Prior studies included heterogeneous treatment groups; this study focuses on a large cohort uniformly treated with ruxolitinib to identify risk factors for infection and survival.

Data Highlights

ParameterValue
Patients analyzed560 (413 MF, 147 PV)
Covid-19 infections83 (14.2%)
Infection incidence rate10.5 per 100 patient-years
Infections by waveFirst: 15 (6.5/100 pt-yrs), Second: 41 (7.8/100 pt-yrs), Third: 27 (7.3/100 pt-yrs)
Infection severityAsymptomatic/mild: 25.3%, Moderate: 20.5%, Severe: 21.7%, Critical: 7.2%, Fatal: 25.3%
Vaccinated patients371/467 (79.4%) received ≥1 dose
Hospitalization rate (severe/critical/fatal)54.2%
Hospitalization by waveFirst/Second: ~67%, Third: 26%
Median platelet count (hospitalized vs outpatient)150 vs 226 ×10⁹/L (p=0.02)

Key Findings

  • Covid-19 infection occurred in 14.2% of ruxolitinib-treated MPN patients with a 25.3% mortality rate.
  • Vaccination significantly reduced the risk of SARS-CoV-2 infection in both MF and PV patients (p<0.001 and p=0.003 respectively).
  • Older age (≥70 years) and lower platelet counts were associated with increased hospitalization risk.
  • Hospitalization rates were higher during the first two pandemic waves compared to the third (p=0.002).
  • Neutrophil-to-lymphocyte ratio cut-offs of 5.5 and 6.8 were predictive for hospitalization and death, respectively.

Clinical Implications

Clinicians should prioritize Covid-19 vaccination in MPN patients receiving ruxolitinib to reduce infection risk. Monitoring platelet counts and neutrophil-to-lymphocyte ratios may help identify patients at higher risk for severe disease and hospitalization. Awareness of increased vulnerability in older patients can guide early intervention and management strategies.

Conclusion

Ruxolitinib-treated MPN patients exhibit significant risk for severe Covid-19 outcomes, but vaccination and clinical parameters such as age and hematologic indices can inform prognosis and guide care. These findings support tailored preventive and therapeutic approaches in this vulnerable population.

References

  1. Passamonti et al. 2020 -- High mortality in MPN patients with Covid-19
  2. IRCCS Azienda Ospedaliero-Universitaria S. Orsola-Malpighi Studies -- RUX-MF and PV-ARC Cohorts
  3. NIH Guidelines 2020 -- Covid-19 Severity Classification

Original Source(s)

Determinants of Covid19 disease and of survival after Covid19 in MPN patients treated with ruxolitinib

  • by Francesca Palandri, Elena M. Elli, Giuseppe Auteri, Massimiliano Bonifacio, Giulia Benevolo, Florian H. Heidel, Simona Paglia, Malgorzata M. Trawinska, Costanza Bosi, Elena Rossi, Mario Tiribelli, Alessia Tieghi, Alessandra Iurlo, Nicola Polverelli, Giovanni Caocci, Gianni Binotto, Francesco Cavazzini, Eloise Beggiato, Daniela Cilloni, Caterina Tatarelli, Francesco Mendicino, Maurizio Miglino, Monica Bocchia, Monica Crugnola, Camilla Mazzoni, Andrea D. Romagnoli, Giovanni Rindone, Sara Ceglie, Alessandra D’Addio, Eleonora Santoni, Daniele Cattaneo, Daniela Bartoletti, Roberto M. Lemoli, Mauro Krampera, Antonio Cuneo, Gianpietro C. Semenzato, Roberto Latagliata, Elisabetta Abruzzese, Nicola Vianelli, Michele Cavo, Alessandro Andriani, Valerio De Stefano, Giuseppe A. Palumbo, Massimo Breccia

  • May 3, 2023

Related Content

Beyond Antibodies: Influenza Vaccine Induced T-Cell Response in Hematological Malignancy— Commentary on Insights From Hall et al

The 49th Annual Meeting of the European Society for Blood and Marrow Transplantation: Physicians Award Winners (O001-O008)

  • November 9, 2023

Deliberations on Government Spending Priorities: Listen to the People