Abstract
Simple SummaryLittle information has been reported about the impact of the COVID-19 pandemic in Philadelphia-negative chronic myeloproliferative neoplasms (MPN). In this review, we summarize the knowledge about MPN clinical management, including cytoreductive and antiplatelet/anticoagulant therapy, thrombotic risk, prognosis, and vaccination strategies at the time of COVID-19.An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) started in December 2019 in China and then become pandemic in February 2020. Several publications investigated the possible increased rate of COVID-19 infection in hematological malignancies. Based on the published data, strategies for the management of chronic Philadelphia-negative chronic myeloproliferative neoplasms (MPNs) are provided. The risk of severe COVID-19 seems high in MPN, particularly in patients with essential thrombocythemia, but not negligible in myelofibrosis. MPN patients are at high risk of both thrombotic and hemorrhagic complications and this must be accounted in the case of COVID-19 deciding on a case-by-case basis. There are currently no data to suggest that hydroxyurea or interferon may influence the risk or severity of COVID-19 infection. Conversely, while the immunosuppressive activity of ruxolitinib might pose increased risk of infection, its abrupt discontinuation during COVID-19 syndrome is associated with worse outcome. All MPN patients should receive vaccine against COVID-19; reassuring data are available on efficacy of mRNA vaccines in MPNs.
Highlights
essential thrombocythemia (ET) patients are at higher risk of thrombosis and need special clinical surveillance; the benefit of a combined treatment of low molecular weight heparin (LMWH) and aspirin, given the possible role of platelets, should be investigated by ad hoc studies
The COVID-19 pandemic induced a rapid reorganization of healthcare facilities and greatly influenced the management of patients with cancer, who had to face a reduced possibility to perform laboratory tests and hospital visits; some specific therapies have been interrupted or postponed
myeloproliferative neoplasms (MPNs) and MF patients may be at increased risk of severe SARS-CoV-2 infection
Summary
Alpha and beta Coronaviruses (CoVs) are a subfamily of large and enveloped viruses that are known to infect humans, mainly through respiratory transmission [1,2]. The SARSCoV-2 infection may be responsible for different outcomes ranging from asymptomatic infection (6.4%), mild to moderate cases (79.6%), severe (5.3%), critical (7.3%) and fatal cases (1.4%) [7]. Mild and moderate cases are mainly characterized by symptoms related to upper airways infection (fever, fatigue and dry cough, sore throat) and inflammation (myalgia, arthralgia and headache). Severe and critical cases are characterized by multiple complications including respiratory distress, thromboses, sepsis, acute kidney injury, acute cardiac injury and multi-organ dysfunction. Stage 1 (mild infection) is characterized by mildly systemic coagulopathy. Stage 2 includes moderate and severe cases and is characterized by pulmonary inflammation and coagulopathy with localized microthrombi. Stage 3 includes critical and fatal cases and is characterized by a severe hyperimmune syndrome and systemic coagulopathy associated with thrombocytopenia and high risk of severe thrombosis (pulmonary embolism, deep vein thrombosis) [8]
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