BACKGROUND: Patients with Philadelphia-negative chronic myeloproliferative neoplasms (MPN) typically incur high rates of infections and both drugs and comorbidities may modulate infection risk. OBJECTIVES: 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). DESIGN: This is an observational study. METHODS: 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. RESULTS: 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). CONCLUSION: 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. PLAIN LANGUAGE SUMMARY: EPICOVIDEHA registry reports inferior outcomes of COVID-19 in patients with Philadelphia-negative chronic myeloproliferative neoplasms receiving immunosuppressive therapies. 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.

ASST Grande Ospedale Metropolitano Niguarda Milan Italy

AZ KLINA Brasschaat Belgium

Azienda Ospedaliera Nazionale SS Antonio e Biagio e Cesare Arrigo Alessandria Italy

Azienda Ospedaliera San Gerardo Monza Monza Italy; Università Milano Bicocca Milan Italy

Center for Molecular Medicine Cologne Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Centro Hospitalar e Universitário São João Porto Portugal

Chair Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Clinical Trials Centre Cologne Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Departament de Medicina Universitat Autònoma de Barcelona Bellaterra Spain

Department 1 of Internal Medicine Excellence Center for Medical Mycology Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Department of Hematology and Oncology Medical University of Innsbruck Innsbruck Austria

Department of Hematology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Hematology University Hospital Virgen Macarena Seville Spain

Department of Hematology University Hospital Virgen Macarena University Hospital Virgen del Rocío Instituto de Biomedicina de Sevilla and Departamento de Medicina Universidad de Sevilla Seville Spain

Department of Hematology Vall d'Hebron Hospital Universitari Experimental Hematology Vall d'Hebron Institute of Oncology Vall d'Hebron Barcelona Hospital Campus Barcelona Spain

Department of Infectious Diseases Karolinska University Hospital Stockholm Sweden

Department of Internal Medicine ADRZ Goes The Netherlands

Department of Oncology Hematology and Bone Marrow Transplantation with Section of Pneumology University Medical Center Hamburg Eppendorf Hamburg Germany

Division of Hematology and Oncology Weill Cornell Medicine New York NY USA

Division of Hematology Dokuz Eylul University Izmir Turkey

Ematologia con Trapianto Ospedale Dimiccoli Barletta Barletta Italy

German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Health Research Institute IIS FJD Fundacion Jimenez Diaz University Hospital Madrid Spain

Health Research Institute IIS FJD Fundación Jimenez Diaz University Hospital Madrid Spain

Hematology and Bone Marrow Unit Hospital University of Parma Parma Italy

Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Rome Italy

Hematology Unit ASST Spedali Civili Brescia Italy

Hematology Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

Hematology Unit Università Cattolica del Sacro Cuore Rome Italy

Hospital Nuestra Señora de Sonsoles Ávila Spain

Hospital Universitario Puerta de Hierro Majadahonda Spain

ICANS Strasbourg France

Institute of Hematology and Blood Transfusion Prague Czech Republic

IRCCS Ospedale San Raffaele Milan Italy

KU Leuven Leuven Belgium

Laikon Hospital Athens Greece

NIHR Oxford Biomedical Research Centre Churchill Hospital Oxford UK

Oncology Center Mansoura University Mansoura Egypt

Portuguese Institute of Oncology Lisbon Portugal

San Luigi Gonzaga Hospital Orbassano Orbassano Italy

Section of Hematology Department of Medicine University of Verona Verona Italy

Universitätsklinikum Hamburg Eppendorf Hamburg Germany

University Clinical Center Serbia Medical Faculty University Belgrade Belgrade Serbia

University Hospital Dubrava Zagreb Croatia

University Hospital Hradec Králové Hradec Králové Czech Republic

University Hospital Olomouc Olomouc Czech Republic

University Insubria Varese Italy

University Medical Center Groningen Groningen The Netherlands

UO Ematologia AOUP P Giaccone Palermo Italy

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