Immunosuppressive Therapies, Comorbidities Heighten COVID-19 Risk in People With MPNs

People with myeloproliferative neoplasms (MPN) who contract COVID-19 have particularly poor outcomes, according to a new study, especially if they have a history of taking immunotherapies or are older than 70 years of age.

The report, published in Therapeutic Advances in Hematology, suggests better strategies are needed to help protect this patient group if they are exposed to viruses such as SARS-CoV-2.

Corresponding author Jon Salmanton-García, of the University of Cologne, and colleagues, noted that people with Philadelphia-negative MPN face a higher risk of infections generally, but they said factors such as medications and comorbidities can affect a patient’s level of risk.

Previous research has suggested that people with MPN face 3 times the risk of infection compared to the general population, and the investigators said that data point alone suggests patients with MPN could be more likely to experience severe cases of COVID-19.

In the new study, Salmanton-García and colleagues wanted to better understand how a patient’s previous therapies and other clinical characteristics might affect their disease course when they were diagnosed with COVID-19. To find out, they turned to an international cooperative registry, dubbed EPICOVIDEHA, which was launched in February 2020 by a working group of the European Hematology Association.

The team identified a total of 398 patients with MPN who were diagnosed with COVID-19 since the start of the database. Those patients had a median age of 69 years, and they were followed for a median follow-up period of 76 days.

The largest proportion of the cohort was diagnosed with myelofibrosis (MF; 46%), while 28.4% had essential thrombocythemia (ET), and 25.6% of patients had a diagnosis of polycythemia vera (PV).

In terms of medication history, 37.2% of patients had most recently received hydroxyurea as therapy for their cancer, and 27.9% had most recently taken Janus kinase (JAK) inhibitors. Other types of therapies reported by patients included immunomodulating agents and steroids.

A majority of patients in the cohort eventually required hospitalization for their COVID-19 (54%). Of those hospitalized, one quarter were admitted to the intensive care unit, and 29 patients required mechanical ventilation, the investigators said.

Patients with exposure to immunosuppressive therapies prior to COVID-19 onset had a higher risk of hospitalization (odds ratio [OR], 2.186; 95% CI, 1.357-3.519), as did people who were over the age of 70 years (OR, 2.636; 95% CI, 1.683-4.129).

Nearly one-quarter (22.4%) of the cohort died during the follow-up period. Again, older age and exposure to immunosuppressive therapies increased the risk to patients, as did previous comorbidities.

Turning toward potential strategies to improve outcomes for these patients, Salmanton-García and colleagues noted that COVID-19 vaccines have helped to reduce the risk of severe disease, but they said the risks remain high in patients with blood cancers.

The authors said they believe their study to be the first to find that previous exposure to immunosuppressive agents are an independent risk factor for hospitalization and death in patients with COVID-19.

“Specific preventative strategies need, thus, to be tailored for these individuals at risk, including application of potentially protective preventative antibody cocktails as well as meaningful tapering strategies for MPN patients pretreated with JAK inhibitors,” they wrote.

The authors said more data will be needed to more fully understand the interplay of certain therapies, MPNs, and COVID-19 risk, including data on how vaccination might affect risk.

In the meantime, they said clinicians should carefully consider these factors when making therapeutic decisions related to patients with MPNs.

Reference

Marchetti M, Salmanton-García J, El-Ashwah S, et al. Outcomes of SARS-CoV-2 infection in Ph-neg chronic myeloproliferative neoplasms: results from the EPICOVIDEHA registry. Ther Adv Hematol. Published online March 11, 2023. doi:10.1177/20406207231154706