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

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Clinical Scorecard: Factors Influencing Covid-19 Outcomes and Survival in MPN Patients Undergoing Ruxolitinib Therapy

At a Glance

CategoryDetail
ConditionPhiladelphia-negative chronic myeloproliferative neoplasms (MPN) including essential thrombocythemia (ET), polycythemia vera (PV), and myelofibrosis (MF)
Key MechanismsRuxolitinib, a JAK1/2 inhibitor, modulates immune response by reducing pro-inflammatory cytokines and altering immune cell functions; impacts Covid-19 infection risk and vaccine response
Target PopulationMPN patients (PV and MF) treated with ruxolitinib
Care SettingHematology outpatient and inpatient settings during Covid-19 pandemic

Key Highlights

  • MPN patients on ruxolitinib have increased risk of SARS-CoV-2 infection and higher Covid-19 mortality, especially in MF patients.
  • Ruxolitinib treatment and its discontinuation are risk factors for Covid-19 infection and related death.
  • Vaccination with mRNA vaccines significantly reduces Covid-19 infection rates in ruxolitinib-treated MPN patients.

Guideline-Based Recommendations

Diagnosis

  • Classify Covid-19 severity according to NIH Guidelines.
  • Monitor neutrophil to lymphocyte ratio (NLR) as a prognostic marker (cut-offs: 5.5 for hospitalization, 6.8 for death).

Management

  • Continue ruxolitinib therapy cautiously, considering risks of discontinuation.
  • Prioritize Covid-19 vaccination (mRNA vaccines) in MPN patients on ruxolitinib.
  • Assess platelet counts and age (≥70 years) to guide hospitalization decisions.

Monitoring & Follow-up

  • Regularly evaluate hematologic parameters including platelet count and hemoglobin at infection.
  • Monitor for Covid-19 symptoms and severity, especially during pandemic waves with different viral variants.
  • Track vaccination status and immune response in ruxolitinib-treated patients.

Risks

  • Higher mortality observed in MF patients (up to 48%) compared to overall MPN patients (~30%).
  • Ruxolitinib discontinuation increases risk of Covid-19-related death.
  • Lower serological response to vaccination in ruxolitinib-treated patients.

Patient & Prescribing Data

886 MF and 172 PV patients treated with ruxolitinib outside clinical trials; 560 patients on ruxolitinib at pandemic start included in analysis.

Median ruxolitinib dose ranged from 5–10 mg BID in PV and about half of MF patients; higher doses (15–20 mg BID) used in remaining MF patients. Vaccination status strongly influenced infection rates.

Clinical Best Practices

  • Maintain ruxolitinib therapy during the pandemic unless contraindicated to avoid increased mortality risk.
  • Encourage and administer mRNA Covid-19 vaccines to all eligible MPN patients on ruxolitinib.
  • Use NLR and platelet counts as part of risk stratification for hospitalization and mortality.
  • Consider patient age and comorbidities in clinical decision-making for Covid-19 management.
  • Monitor patients closely during different pandemic waves due to variant-specific risks.

References

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

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