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Multicenter Study
. 2021 Feb;35(2):485-493.
doi: 10.1038/s41375-020-01107-y. Epub 2021 Jan 7.

High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib

Tiziano Barbui  1 , Alessandro Maria Vannucchi  2 , Alberto Alvarez-Larran  3 , Alessandra Iurlo  4 , Arianna Masciulli  5 , Alessandra Carobbio  5 , Arianna Ghirardi  5 , Alberto Ferrari  5 , Giuseppe Rossi  6 , Elena Elli  7 , Marcio Miguel Andrade-Campos  8 , Mercedes Gasior Kabat  9 , Jean-Jaques Kiladjian  10 , Francesca Palandri  11 , Giulia Benevolo  12 , Valentin Garcia-Gutierrez  13 , Maria Laura Fox  14 , Maria Angeles Foncillas  15 , Carmen Montoya Morcillo  16 , Elisa Rumi  17 , Santiago Osorio  18 , Petros Papadopoulos  19 , Massimiliano Bonifacio  20 , Keina Susana Quiroz Cervantes  21 , Miguel Sagues Serrano  22 , Gonzalo Carreno-Tarragona  23 , Marta Anna Sobas  24 , Francesca Lunghi  25 , Andrea Patriarca  26 , Begona Navas Elorza  27 , Anna Angona  28 , Elena Magro Mazo  29 , Steffen Koschmieder  30 , Marco Ruggeri  31 , Beatriz Cuevas  32 , Juan Carlos Hernandez-Boluda  33 , Emma Lopez Abadia  34 , Blanca Xicoy Cirici  35 , Paola Guglielmelli  2 , Marta Garrote  3 , Daniele Cattaneo  4 , Rosa Daffini  6 , Fabrizio Cavalca  7 , Beatriz Bellosillo  8 , Lina Benajiba  10 , Natalia Curto-Garcia  36 , Marta Bellini  37 , Silvia Betti  38 , Valerio De Stefano  38 , Claire Harrison  36 , Alessandro Rambaldi  37   39
Affiliations
Multicenter Study

High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib

Tiziano Barbui et al. Leukemia. 2021 Feb.

Abstract

We report the clinical presentation and risk factors for survival in 175 patients with myeloproliferative neoplasms (MPN) and COVID-19, diagnosed between February and June 2020. After a median follow-up of 50 days, mortality was higher than in the general population and reached 48% in myelofibrosis (MF). Univariate analysis, showed a significant relationship between death and age, male gender, decreased lymphocyte counts, need for respiratory support, comorbidities and diagnosis of MF, while no association with essential thrombocythemia (ET), polycythemia vera (PV), and prefibrotic-PMF (pre-PMF) was found. Regarding MPN-directed therapy ongoing at the time of COVID-19 diagnosis, Ruxolitinib (Ruxo) was significantly more frequent in patients who died in comparison with survivors (p = 0.006). Conversely, multivariable analysis found no effect of Ruxo alone on mortality, but highlighted an increased risk of death in the 11 out of 45 patients who discontinued treatment. These findings were also confirmed in a propensity score matching analysis. In conclusion, we found a high risk of mortality during COVID-19 infection among MPN patients, especially in MF patients and/or discontinuing Ruxo at COVID-19 diagnosis. These findings call for deeper investigation on the role of Ruxo treatment and its interruption, in affecting mortality in MPN patients with COVID-19.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Overall survival.
Kaplan Meier estimates for the overall survival (A), stratified by Country (B). P-values are calculated by log-rank test. CI confidence interval.
Fig. 2
Fig. 2. Survival by MPN phenotypes and patients disposition.
Kaplan Meier survival estimates stratified by MPN phenotypes (A) and patients disposition (B). P-values are calculated by log-rank test. MF myelofibrosis, MPNs myeloproliferative neoplasms, ICU intensive care unit.
Fig. 3
Fig. 3. Survival by Ruxolitinib exposure and discontinuation.
Kaplan Meier survival estimates stratified by the use and discontinuation of Ruxo in the full analysis set (A) and after PS matching (B). P-values are calculated by log-rank test. PS propensity score, Ruxo ruxolitinib.
See this image and copyright information in PMC

Comment in

References

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