A recent study of patients with myeloproliferative neoplasms (MPN) revealed factors that may be linked to higher mortality risk in the presence of coronavirus disease 2019 (COVID-19), including discontinuation of ruxolitinib therapy. The study results were published in the journal Leukemia.

In this observational, retrospective study (MPN-COVID), 175 patients with MPN and COVID-19 were assessed from multiple countries across Europe. Most patients had tested positive for SARS-CoV-2 infection using real-time reverse transcriptase polymerase chain reaction analysis of nasopharyngeal samples. In a subset of 20 patients who were unable to be tested, the infection was diagnosed based on strongly suggestive symptoms. The study outcome of interest was all-cause mortality.

The median study follow-up occurred at 50 days. Most (77%) patients in this study had become hospitalized, 59.2% of all patients received respiratory support, and 11% required intensive care. Slightly more than one-fourth (28.6%) of patients in this study died, with fatalities occurring at a median of 9.5 days after diagnosis. Patients with myelofibrosis showed a mortality rate of 48%. Across the total population, multiorgan failure was the leading cause of death (42%), followed by pneumonia (33%).

A multivariate analysis revealed statistically significant risk factors for mortality that included age, male sex, use of respiratory support, intensive care unit admission, and discontinuation of ruxolitinib. In this multivariate analysis, there was not a significant relationship between mortality and use of ruxolitinib (P =.154); rather, increased mortality risk appeared linked to its discontinuation (P =.040). This result was confirmed in a propensity score-matching analysis.


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The researchers considered the finding regarding ruxolitinib discontinuation to be striking but indicated it warrants further analysis. “This preliminary observation is, in our opinion, worthy of dissemination amongst patients and clinician communities, although it needs to be confirmed in a study with a longer follow-up and a sample size adequate to test the hypothesis,” the researchers concluded in their report.

Reference

Barbui T, Vannucchi AM, Alvarez-Larran A, et al. High mortality rate in COVID-19 patients with myeloproliferative neoplasms after abrupt withdrawal of ruxolitinib. Leukemia. Published online January 7, 2021. doi:10.1038/s41375-020-01107-y