Marchetti Monia, Salmanton-García Jon, El-Ashwah Shaimaa, Verga Luisa, Itri Federico, Ráčil Zdeněk, Dávila-Valls Julio, Martín-Pérez Sonia, Van Doesum Jaap, Passamonti Francesco, Abu-Zeinah Ghaith, Farina Francesca, López-García Alberto, Dragonetti Giulia, Cattaneo Chiara, Gomes Da Silva Maria, Bilgin Yavuz M, Žák Pavel, Petzer Verena, Glenthøj Andreas, Espigado Ildefonso, Buquicchio Caterina, Bonuomo Valentina, Prezioso Lucia, Meers Stef, Duarte Rafael, Bergantim Rui, Jaksic Ozren, Čolović Natasha, Blennow Ola, Cernan Martin, Schönlein Martin, Samarkos Michail, Mitra Maria Enza, Magliano Gabriele, Maertens Johan, Ledoux Marie-Pierre, Jiménez Moraima, Demirkan Fatih, Collins Graham P, Cabirta Alba, Gräfe Stefanie K, Nordlander Anna, Wolf Dominik, Arellano Elena, Cordoba Raul, Hanakova Michaela, Zambrotta Giovanni Paolo Maria, Nunes Rodrigues Raquel, Limberti Giulia, Marchesi Francesco, Cornely Oliver A, Pagano Livio
Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Department I of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Ther Adv Hematol. 2023 Mar 11;14:20406207231154706. doi: 10.1177/20406207231154706. eCollection 2023.
Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk.
The present study aims to assess the effect of immunosuppressive agents on clinical outcomes of MPN patients affected by the coronavirus disease 2019 (COVID-19).
This is an observational study.
We specifically searched and analyzed MPN patients collected by EPICOVIDEHA online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.
Overall, 398 patients with MPN were observed for a median of 76 days [interquartile range (IQR): 19-197] after detection of SARS-CoV2 infection. Median age was 69 years (IQR: 58-77) and 183 individuals (46%) had myelofibrosis (MF). Overall, 121 patients (30%) of the whole cohort received immunosuppressive therapies including steroids, immunomodulatory drugs, or JAK inhibitors. Hospitalization and consecutive admission to intensive care unit was required in 216 (54%) and 53 patients (13%), respectively. Risk factors for hospital admission were identified by multivariable logistic regression and include exposure to immunosuppressive therapies [odds ratio (OR): 2.186; 95% confidence interval (CI): 1.357-3.519], age ⩾70 years, and comorbidities. The fatality rate was 22% overall and the risk of death was independently increased by age ⩾70 years [hazard ratio (HR): 2.191; 95% CI: 1.363-3.521], previous comorbidities, and exposure to immunosuppressive therapies before the infection (HR: 2.143; 95% CI: 1.363-3.521).
COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.
Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) incur high rates of infections during the course of their disease.The present study was aimed at assessing which patient characteristics predicted a worse outcome of SARS-COV-2 infection in individuals with MPN.To pursue this objective, the researchers analyzed the data collected by EPICOVIDEHA, an international online registry, which includes individuals with hematological malignancies diagnosed with COVID-19 since February 2020.The database provided clinical data of 398 patients with MPN incurring COVID-19:Patients were mostly elderly (median age was 69 years);Forty-six percent of them were affected by myelofibrosis, which is the most severe MPN;Moreover, 32% were receiving immunosuppressive therapies (JAK inhibitors, such as ruxolitinib, steroids, or immunomodulatory IMID drugs, such as thalidomide) before COVID-19.Hospitalization was required in 54% of the patients, and the risk of being hospitalized for severe COVID-19 was independently predicted byOlder age;Comorbidities;Exposure to immunosuppressive therapies.Overall, 22% of MPN patients deceased soon after COVID-19 and the risk of death was independently increased over twofold byOlder age;Comorbidities;Exposure to immunosuppressive therapies before the infection.In conclusion, COVID-19 infection led to a particularly dismal outcome in MPN patients receiving immunosuppressive agents, including JAK inhibitors, or reporting multiple comorbidities. Therefore, specific preventive strategies need to be tailored for such individuals.
费城染色体阴性的慢性骨髓增殖性肿瘤（MPN）患者通常感染率较高，药物和合并症均可调节感染风险。
本研究旨在评估免疫抑制剂对2019冠状病毒病（COVID-19）感染的MPN患者临床结局的影响。
这是一项观察性研究。
我们专门检索并分析了EPICOVIDEHA在线登记处收集的MPN患者，该登记处包括自2020年2月以来被诊断为COVID-19的血液系统恶性肿瘤患者。
总体而言，398例MPN患者在检测到SARS-CoV2感染后中位观察76天[四分位间距（IQR）：19 - 197]。中位年龄为69岁（IQR：58 - 77），183例（46%）患者患有骨髓纤维化（MF）。总体而言，整个队列中有121例患者（30%）接受了免疫抑制治疗，包括类固醇、免疫调节药物或JAK抑制剂。分别有216例（54%）和53例患者（13%）需要住院和连续入住重症监护病房。通过多变量逻辑回归确定了住院的危险因素，包括接受免疫抑制治疗[比值比（OR）：2.186；95%置信区间（CI）：1.357 - 3.519]、年龄≥70岁和合并症。总体死亡率为22%，年龄≥70岁[风险比（HR）：2.191；95% CI：1.363 - 3.521]、既往合并症以及感染前接受免疫抑制治疗（HR：2.143；95% CI：1.363 - 3.521）独立增加死亡风险。
COVID-19感染在接受免疫抑制剂治疗或有多种合并症的MPN患者中导致了特别糟糕的结局。因此，需要为这类患者制定特定的预防策略。
费城染色体阴性的慢性骨髓增殖性肿瘤（MPN）患者在病程中感染率较高。本研究旨在评估哪些患者特征预示着MPN患者感染SARS-CoV-2的结局更差。为实现这一目标，研究人员分析了国际在线登记处EPICOVIDEHA收集的数据，该登记处包括自2020年2月以来被诊断为COVID-19的血液系统恶性肿瘤患者。该数据库提供了398例发生COVID-19的MPN患者的临床数据：患者大多为老年人（中位年龄为69岁）；其中46%受骨髓纤维化影响，这是最严重的MPN；此外，32%的患者在COVID-19之前接受免疫抑制治疗（JAK抑制剂，如鲁索替尼，类固醇，或免疫调节IMID药物，如沙利度胺）。54%的患者需要住院，年龄较大、合并症、接受免疫抑制治疗可独立预测因严重COVID-19住院的风险。总体而言，22%的MPN患者在感染COVID-19后不久死亡，年龄较大、合并症、感染前接受免疫抑制治疗使死亡风险独立增加两倍以上。总之，COVID-19感染在接受包括JAK抑制剂在内的免疫抑制剂治疗或有多种合并症的MPN患者中导致了特别糟糕的结局。因此，需要为这类患者制定特定的预防策略。
