Covid-19 in Philadelphia-negative myeloproliferative neoplasms: a GIMEMA survey on incidence, clinical management and vaccine

Breccia, Massimo; Piciocchi, Alfonso; Messina, Monica; Soddu, Silvia; Stefano, Valerio De; Bellini, Marta; Iurlo, Alessandra; Martino, Bruno; Siragusa, Sergio; Albano, Francesco; Mora, Barbara; Fazi, Paola; Vignetti, Marco; Guglielmelli, Paola; Palandri, Francesca

doi:10.1038/s41375-022-01675-1

Cited by 5 publications

(7 citation statements)

References 13 publications

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“…Furthermore, treatment initiation should be delayed until at least two doses of vaccine have been administered, when clinically possible. For those subjects in which the therapy could not be delayed, newer JAKi, with less immunosuppressive activity, could be considered ( 28 ), while for those who are already under ruxolitinib treatment and mount a blunted response, a treatment with Cilgavimab plus Tixagevimab Monoclonal Antibody Cocktail for COVID-19 Prophylaxis could be proposed ( 23 , 60 , 61 ). Anyhow, doctors should be informed that this high-risk group may not be fully protected by vaccination and that risk mitigation, such as social distancing and hygiene measures, should be always implemented by the patients and their caregivers.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, in a small number of myeloproliferative patients treated with ruxolitinib, a blunted response to the first ( 19 , 29 ) and second dose of vaccine ( 21 , 30 , 31 ) was reported. As little data were available in myeloproliferative patients treated with ruxolitinib who had completed the vaccination cycle (2 doses) and a third booster dose, in this study, we investigated whether these patients could reach a protective antibody level against the SARS-CoV-2 virus, as in Italy these patients were granted a fast-track vaccination with BNT162b2 ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

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Ruxolitinib treatment in myelofibrosis and polycythemia vera causes suboptimal humoral immune response following standard and booster vaccination with BNT162b2 mRNA COVID-19 vaccine

Palumbo

Cambria²,

Spina³

et al. 2023

Front. Oncol.

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Patients affected by myelofibrosis (MF) or polycythemia vera (PV) and treated with ruxolitinib are at high risk for severe coronavirus disease 2019. Now a vaccine against the virus SARS-CoV-2, which is responsible for this disease, is available. However, sensitivity to vaccines is usually lower in these patients. Moreover, fragile patients were not included in large trials investigating the efficacy of vaccines. Thus, little is known about the efficacy of this approach in this group of patients. In this prospective single-center study, we evaluated 43 patients (30 MF patients and 13 with PV) receiving ruxolitinib as a treatment for their myeloproliferative disease. We measured anti-spike and anti-nucleocapsid IgG against SARS-CoV2 15-30 days after the second and the third BNT162b2 mRNA vaccine booster dose. Patients receiving ruxolitinib showed an impaired antibody response to complete vaccination (2 doses), as 32.5% of patients did not develop any response. After the third booster dose with Comirnaty, results slightly improved, as 80% of these patients produced antibodies above the threshold positivity. However, the quantity of produced antibodies was well below that reached than those reported for healthy individuals. PV patients elicited a better response than patients affected by MF. Thus, different strategies should be considered for this high-risk group of patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ruxolitinib treatment in myelofibrosis and polycythemia vera causes suboptimal humoral immune response following standard and booster vaccination with BNT162b2 mRNA COVID-19 vaccine

Palumbo

Cambria²,

Spina³

et al. 2023

Front. Oncol.

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“…There were 22 cases of significant thrombosis (n=15) and significant haemorrhages (n=7) that occurred during the acute phase of coronavirus infection [14,15]. [16]. In our study group, according to the severity of the course, most of the patients had COVID 19 with mild or moderate-severe symptoms.…”

Section: Discussionmentioning

confidence: 76%

“…77.1% of the vaccinated are from the first category with MF. After the vaccine, 1.5% of MPN patients tested positive for COVID 19, and 3.4% of them had MF [16]. According to other studies, it is not recommended to stop treatment with a JAK inhibitor if you test positive for coronavirus.…”

Section: Discussionmentioning

confidence: 99%

Severity of SARS-CoV-2 infection in myelofibrosis patients treated with ruxolitinib: Observational, prospective, of the case-control type study

Stoeva¹,

Tachkov²

2023

GSC Biol. Pharm. Sci.

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The aim of the present study is to investigate the course and outcome of the disease in MF patients infected with SARS-CoV-2 with special attention to patients on ruxolitinib therapy. The study is observational, prospective, conducted in real life settings, of the case-control type. SARS-CoV-2 were followed as an active group, and MF patients who were not infected as a control group. The subject of the study are patients with MF treated with ruxolitinib during the period 03.2020. until 03.2022. Sources of data for the studied indicators are the patients, their health files, or their relatives. To estimate the risk of adverse outcomes in COVID 19 disease in patients with MF and fatal outcome, a number of risks were calculated. Of the monitored patients with MF, a total of 5 (14.3%) died during this period. Of these, 3 patients died as a result of progression of the haematological disease or a complication of another concomitant disease. 2 (12.5%) patients died from COVID 19 infection or its complications. Both had a severe infection. A thrombotic event was reported in 1 patient. During this period, 9 (25.7%) of the monitored patients were vaccinated. The treatment was stopped due to COVID 19 in 4 of the sick patients. In the rest, it was continued without a change in the dose. Disease progression is a more important factor, as the chance of death after progression is 33% more likely than after COVID 19. Among MF patients, the probability of getting COVOD 19 is 45%, but the results show that they will successfully recover from it (30% higher probability). Patients with MF have COVID 19 more often than the general population. Mortality in the observation group was higher compared to the general population but comparable to published data for patients with MF. The disease is more often mild or medium-severe.

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“…Of them, about 10% required hospitalization, with two patients admitted to an ICU. As demonstrated in other hematological, 47 , 48 or rheumatological diseases, 49 , 50 although the incidence Covid-19 in ITP patients is not significantly increased compared with the general population, 35 a severe infection seems to be more frequent.…”

Section: Discussionmentioning

confidence: 77%

Immune Thrombocytopenia Onset and Relapse During the Covid19 Pandemic. A Monocenter Study.

Auteri

Paglia

Mazzoni

et al. 2023

Mediterr J Hematol Infect Dis

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BACKGROUND AND OBJECTIVES Several infections and vaccinations can provoke immune thrombocytopenia (ITP) onset or relapse. Information on ITP epidemiology and management during the Covid19 pandemic is scarce. In a large monocenter ITP cohort, we assessed incidence of and risk factors for: 1) ITP onset/relapse after Covid19 vaccination/ infection; 2) Covid19 infection. METHODS Information on date/type of anti-Covid19 vaccine, platelet count before and within 30 days from vaccine and date/grade of Covid19, was collected via phone call or during hematological visits. ITP relapse was defined as a drop in PLT count within 30 days from vaccination, compared to PLT count before vaccination that required a rescue therapy OR a dose increase of an ongoing therapy OR a PLT count <30 x109/L with ≥20% decrease from baseline. RESULTS Between February 2020 and January 2022, 60 new ITP diagnosis were observed (30% related to Covid19 infection or vaccination). Younger and older age were associated to higher probability of ITP related to Covid19 infection (p=0.02) and vaccination (p=0.04), respectively. Compared to Covid19-unrelated ITP, Infection- and vaccine-related ITP had lower response rates (p=0.03) and required more prolonged therapy (p=0.04), respectively. Among the 382 patients with known ITP at pandemic start, 18.1% relapsed; relapse was attributed to Covid19 infection/vaccine in 52.2% of the cases. The risk of relapse was higher in patients with active disease (p<0.001) and previous vaccine-related relapse (p=0.006). Overall, 18.3% of ITP patients acquired Covid19 (severe in 9.9%); risk was higher in unvaccinated patients (p<0.001). CONCLUSIONS All ITP patients should receive ≥1 vaccine dose and laboratory follow-up after vaccination, with case-by-case evaluation of completion of vaccine program if vaccine-related ITP onset/relapse, and with tempestive initiation of antiviral therapy in unvaccinated patients.

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Covid-19 in Philadelphia-negative myeloproliferative neoplasms: a GIMEMA survey on incidence, clinical management and vaccine

Cited by 5 publications

References 13 publications

Ruxolitinib treatment in myelofibrosis and polycythemia vera causes suboptimal humoral immune response following standard and booster vaccination with BNT162b2 mRNA COVID-19 vaccine

Ruxolitinib treatment in myelofibrosis and polycythemia vera causes suboptimal humoral immune response following standard and booster vaccination with BNT162b2 mRNA COVID-19 vaccine

Severity of SARS-CoV-2 infection in myelofibrosis patients treated with ruxolitinib: Observational, prospective, of the case-control type study

Immune Thrombocytopenia Onset and Relapse During the Covid19 Pandemic. A Monocenter Study.

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