Breakthrough infections in MPN-COVID vaccinated patients - Scorecard - 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

  • 0 min

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Clinical Scorecard: Infections Following Vaccination Against COVID-19 in Patients with Myeloproliferative Neoplasms

At a Glance

CategoryDetail
ConditionMyeloproliferative neoplasms (MPN) including polycythemia vera, essential thrombocythemia, prefibrotic myelofibrosis, and overt myelofibrosis
Key MechanismsPoor neutralizing antibody response to COVID-19 vaccines, especially in myelofibrosis patients on ruxolitinib; waning immunity over time; variant-specific infection waves
Target PopulationPatients with MPN infected or vaccinated against SARS-CoV-2
Care SettingHematology and infectious disease clinical settings managing MPN patients during COVID-19 pandemic

Key Highlights

  • MPN patients had higher COVID-19 mortality (28.5%) during first wave compared to general population.
  • Vaccination elicited poor neutralizing antibody titers in MPN, especially in myelofibrosis patients on ruxolitinib.
  • Reinfections and breakthrough infections occurred predominantly during Delta and Omicron waves with mostly mild severity.

Guideline-Based Recommendations

Diagnosis

  • COVID-19 diagnosis confirmed by positive RT-PCR from nasal swab and compatible symptoms.
  • Severity categorized per NIH COVID-19 Treatment Guidelines as asymptomatic, mild, moderate, or severe/critical.

Management

  • Vaccination with mRNA vaccines (Pfizer/BioNTech) recommended, with booster doses important to extend immunity.
  • Close monitoring and hospitalization considered for older patients, males, those with myelofibrosis, and prior ruxolitinib exposure.
  • Manage mild adverse events post-vaccination conservatively; no serious vaccine-related adverse events reported.

Monitoring & Follow-up

  • Monitor inflammatory markers such as C-reactive protein and neutrophil to lymphocyte ratio at COVID-19 diagnosis to assess severity risk.
  • Follow-up for reinfections especially during Omicron variant period.
  • Assess time interval since last vaccine dose to evaluate waning immunity.

Risks

  • Higher risk of severe COVID-19 and hospitalization in MPN patients, particularly with myelofibrosis and ruxolitinib treatment.
  • Reduced vaccine protection in MPN patients compared to general population, with 10-fold lower protection against reinfection.
  • Waning immunity over time necessitates booster vaccinations.

Patient & Prescribing Data

MPN patients vaccinated against COVID-19, including those with prior infection and those without previous COVID-19.

Majority received 1–2 vaccine doses; 23% received 3–4 doses. Mild vaccine adverse events were rare. Reinfections occurred more frequently in myelofibrosis and ruxolitinib-exposed patients. Hospitalization rates post-vaccination were higher than general population, especially in older males with myelofibrosis.

Clinical Best Practices

  • Administer COVID-19 mRNA vaccines with booster doses to MPN patients to prolong immunity.
  • Monitor high-risk patients (older age, male sex, myelofibrosis, ruxolitinib exposure) closely for severe COVID-19.
  • Use inflammatory markers (CRP, NLR) at diagnosis to stratify hospitalization risk.
  • Educate patients on mild vaccine adverse events and reinforce importance of vaccination despite reduced antibody response.
  • Continue longitudinal follow-up to assess durability of vaccine protection and reinfection risk.

References

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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