Risk factors for infections and secondary malignancies in patients with a myeloproliferative neoplasm treated with ruxolitinib: a dual-center, propensity score-matched analysis

Tremblay, Douglas; King, Amber C.; Li, Lihua; Moshier, Erin; Coltoff, Alexander; Koshy, Anita G.; Kremyanskaya, Marina; Hoffman, Ronald; Mauro, Michael J.; Rampal, Raajit K.; Mascarenhas, John

doi:10.1080/10428194.2019.1688323

Cited by 20 publications

(11 citation statements)

References 21 publications

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“…Susceptibility to opportunistic infections in patients under ruxolitinib therapy has already been documented, with many reports of mycobacterial and viral infections. [3][4][5] Recent data also warn of a possible increased risk of developing aggressive lymphomas with JAK inhibitors, with a delay of several months between the initiation of JAK inhibitor and the diagnosis of lymphoma, 6 which is consistent with our case and assumes a role of ruxolitinibinduced immune suppression in the pathogenesis of these lymphomas. Reactive lymphocytosis secondary to EBV reactivation in a patient under ruxolitinib has been described elsewhere, 7 and one of the aggressive lymphomas described in patients under ruxolitinib was positive for EBV 6 , but no CHL-like EBV-associated lymphoproliferative disorder has been described in patients under ruxolitinib.…”

supporting

confidence: 89%

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

et al. 2020

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supporting

confidence: 89%

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

et al. 2020

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“…14 The change in infectious rate is not always obvious. 15,16 We note that the incidence of herpes zoster infection is significantly increased in the rux group, while other infections are not. 2 Revealing the same outcome, a systematic review suggested a clinical relevance to the risk.…”

Section: Dovepressmentioning

confidence: 72%

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

Peng

et al. 2020

IDR

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Background: The selective Janus-activated kinase inhibitor ruxolitinib (rux) is now widely used to treat myelofibrosis and polycythemia vera due to its remarkable effect of reducing splenomegaly and improving constitutional symptoms. With opportunistic infections secondary to rux constantly reported; however, an increasing number of studies have begun to investigate the mechanism and underlying immunosuppressive effect of rux. Case Presentation: We report two cases of tuberculosis (TB) in primary myelofibrosis patients during rux therapy. The first patient received rux soon after diagnosis, and tracheobronchial TB (TBTB) and bronchoesophageal fistula were found after 4 months. After discontinuation of rux, antituberculosis therapy (ATT) was introduced. The second patient initiated rux due to progressive splenomegaly after 7.5 years of interferon therapy and was diagnosed with disseminated TB after 2 months. He received ATT as well. His rux was maintained due to the high burden of systematic symptoms and splenomegaly. Both myelofibrosis and TB were well controlled in these patients. Conclusion: This is the first case report that describes rux-related TBTB accompanied by a bronchoesophageal fistula. Through a review of the literature, we provide supporting evidence to the finding that intrinsic disorders of myeloproliferative neoplasms and rux-induced immunologic deregulation together lead to TB. We highlight the importance of screening for latent TB infection and timely chemoprophylaxis before rux therapy. Once TB is diagnosed during treatment, rux is recommended to be stopped and active ATT should begin quickly.

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“…A propensity score weighted competing risk analysis revealed a statistically significant increased risk of second malignancy (HR 10.81 [95% CI 2.54-45.92], p=0.001) with ruxolitinib treatment. 23 However, such data should be interpreted with caution, because of the very low prevalence of secondary malignancy. Of note, the use of JAK1/2 inhibitor seems to be associated with a higher frequency of aggressive B-cell lymphomas.…”

Section: Discussionmentioning

confidence: 99%

<p>Essential Thrombocythaemia with Concomitant Waldenström Macroglobulinaemia: Case Report and Literature Review</p>

Neoh

Ruan

et al. 2020

OTT

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Essential thrombocythaemia (ET) and Waldenström macroglobulinaemia (WM) are two distinct disorders. Studies have reported several cases of myeloproliferative neoplasms (MPNs) with concomitant plasma cell dyscrasia. However, there were no reported cases of ET with concomitant WM to date. Here, we present a 55-year-old Chinese man with thrombocytosis and raised immunoglobulin level. Further investigations led to a diagnosis of ET and coexistent WM. Next-generation sequencing (NGS) of his bone marrow identified 3 mutated genes: JAK2 V617F, MYD88 L265P, and ATM F1036L. After being treated with pegylated interferon and low-dose aspirin, his platelet count normalized and immunoglobulin M (IgM) level reduced. To the best of our knowledge, this is the first reported case of dual pathology ET with WM.

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Risk factors for infections and secondary malignancies in patients with a myeloproliferative neoplasm treated with ruxolitinib: a dual-center, propensity score-matched analysis

Cited by 20 publications

References 21 publications

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

First case of classical Hodgkin‐like EBV‐positive lymphoproliferative disorder under ruxolitinib therapy

<p>Tuberculosis in Patients with Primary Myelofibrosis During Ruxolitinib Therapy: Case Series and Literature Review</p>

<p>Essential Thrombocythaemia with Concomitant Waldenström Macroglobulinaemia: Case Report and Literature Review</p>

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