Philadelphia-Negative Chronic Myeloproliferative Neoplasms during the COVID-19 Pandemic: Challenges and Future Scenarios

Simple Summary: Little 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.

Automated summary

MPN patients, especially those with essential thrombocythemia, seem to have a high risk of severe COVID-19, while the risk is not negligible in myelofibrosis patients. These patients are at high risk for both thrombotic and hemorrhagic complications, which should be taken into account on a case-by-case basis when determining the likelihood of COVID-19 infection. There is currently no evidence to suggest that hydroxyurea or interferon affects COVID-19 risk or severity. On the other hand, while ruxolitinib's immunosuppressive activity may increase the risk of infection, abruptly stopping its use during COVID-19 is associated with worse outcomes. Vaccination against COVID-19 is recommended for all MPN patients, with reassuring data available on the efficacy of mRNA vaccines.