Examining Outcomes in Patients With Myeloproliferative Neoplasms and COVID-19 Infection

An analysis from the MPN-COVID study suggests that patients with myeloproliferative neoplasms (MPNs) – particularly those with myelofibrosis – had higher rates of mortality compared with the general population. The study, which was published in Leukemia, also recommends against discontinuing MPN-directed treatment at the time of COVID-19 diagnosis, as individuals who discontinued ruxolitinib had significantly higher mortality rates.

The MPN-COVID study is a retrospective, multicenter cohort study that included patients from 38 hematology units in Europe. Eligible patients had MPNs (including ET, MF, and polycythemia vera [PV]) and a diagnosis of COVID-19 between February and May 2020.

In this report, a group of researchers led by Tiziano Barbui, MD, of the United Hospitals of Bergamo in Italy, evaluated data from 175 patients with MPNs and COVID-19. The most common MPN diagnosis was myelofibrosis, followed by essential thrombocythemia, polycythemia vera, and prefibrotic myelofibrosis.

Patients were followed for a median of 50 days. During that time, 50 patients died (28.6%). The median time from diagnosis to death was 9.5 days. Looking at phenotype, the only MPN that correlated with survival was myelofibrosis, with a mortality rate of 48% (compared with 28.8% in other MPNs; p=0.016). Other factors associated with higher mortality rates included treatment in the intensive care unit, versus treatment in the regular ward or at home.

When researchers evaluated MPN-directed treatment patterns in this group, they found that the most common treatments at the time of COVID-19 diagnosis were hydroxyurea (45.1%) and ruxolitinib (25.7%), and approximately one-fifth of patients were not receiving any MPN-directed therapy. Following COVID-19 diagnosis, 11.4% of patients receiving hydroxyurea and 24.4% of patients receiving ruxolitinib discontinued their respective treatments.

The authors used a logistic multivariable model to determine factors potentially associated with a higher risk of death after COVID-19 diagnosis. Abrupt discontinuation of ruxolitinib significantly increased the risk of mortality (odds ratio [OR] = 8.4; p=0.04). Only one other factor had a greater association with mortality risk: the need for respiratory support (OR=10.4; p<0.001).