LONG-TERM FOLLOW-UP OF RECOVERED MPN PATIENTS WITH COVID-19
Author(s): ,
Tiziano Barbui
Affiliations:
FROM Research Foundation, Papa Giovanni XXIII Hospital,Bergamo,Italy
,
Alessandra Iurlo
Affiliations:
Hematology Division,Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico,Milan,Italy
,
Arianna Masciulli
Affiliations:
FROM Research Foundation, Papa Giovanni XXIII Hospital,Bergamo,Italy
,
Alessandra Carobbio
Affiliations:
FROM Research Foundation, Papa Giovanni XXIII Hospital,Bergamo,Italy
,
Arianna Ghirardi
Affiliations:
FROM Research Foundation, Papa Giovanni XXIII Hospital,Bergamo,Italy
,
Giuseppe Rossi
Affiliations:
ASST-Spedali Civili,Brescia,Italy
,
Claire Harrison
Affiliations:
Guy's and St. Thomas' NHS Foundation Trust,London,United Kingdom
,
Alberto Alvarez Larran
Affiliations:
Hospital Clinic de Barcelona,Barcelona,Spain
,
Elena Elli
Affiliations:
Hematology Division and Bone Marrow Transplant Unit,San Gerardo Hospital, ASST Monza,Monza,Italy
,
Jean-Jacques Kiladjian
Affiliations:
Hospital Saint-Louis,Paris,France
,
Mercedes Gasior Kabat
Affiliations:
Hospital Universitario La Paz,Madrid,Spain
,
Alberto Marin Sanchez
Affiliations:
Hospital General Universitario de Albacete,Albacete,Spain
,
Francesca Palandri
Affiliations:
IRCCS Azienda Ospedaliero-Universitaria di Bologna,Bologna,Italy
,
Marcio-Miguel Andrade-Campos
Affiliations:
Hospital del Mar,Barcelona,Spain
,
Alessandro Maria Vannucchi
Affiliations:
Department of Experimental and Clinical Medicine,Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliera Universitaria Careggi, University of Florence,Florence,Italy
,
Gonzalo Carreno-Tarragona
Affiliations:
Hospital Universitario 12 de Octubre,Madrid,Spain
,
Petros Papadopoulos
Affiliations:
Hospital Clinico San Carlos,Madrid,Spain
,
Keina Susana Quiroz Cervantes
Affiliations:
Hospital Universitario de Mostoles,Madrid,Spain
,
Maria Angeles Foncillas
Affiliations:
Hospital Universitario Infanta Leonor,Madrid,Spain
,
Maria Laura Fox
Affiliations:
Department of Hematology,Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Universitary, Vall d'Hebron Barcelona Hospital Campus,Barcelona,Spain
,
Miguel Sagues Serrano
Affiliations:
ICO L'Hospitalet-Hospital Moises Broggi, Sant Joan Despì, Barcelona,Spain
,
Elisa Rumi
Affiliations:
Department of molecular medicine, University of Pavia,Pavia,Italy
,
Santiago Osorio
Affiliations:
Hospital Gregorio Maranon,Madrid,Spain
,
Giulia Benevolo
Affiliations:
AOU Città della Salute e della Scienza di Torino,Torino,Italy
,
Andrea Patriarca
Affiliations:
AOU Maggiore della Carità,Novara,Italy
,
Begona Navas Elorza
Affiliations:
Hospital Moncloa,Madrid,Spain
,
Valentin Garcia-Gutierrez
Affiliations:
Hospital Ramon y Cajal, IRYCIS,Madrid,Spain
,
Elena Magro Mazo
Affiliations:
Hospital Universitario Principe de Asturias,Alcalà de Henares, Madrid,Spain
,
Francesca Lunghi
Affiliations:
IRCCS Ospedale San Raffaele,Milan,Italy
,
Massimiliano Bonifacio
Affiliations:
Ospedale Policlinico 'G.B.Rossi', Borgo Roma,Verona,Italy
,
Valerio De Stefano
Affiliations:
Fondazione Policlinico 'A. Gemelli' IRCCS,Rome,Italy
,
Juan Carlos Hernandez-Boluda
Affiliations:
Hospital Clinico Universitario, INCLIVA,Valencia,Spain
,
Emma Lopez Abadia
Affiliations:
Hospital General de Elche,Elche,Spain
,
Anna Angona
Affiliations:
ICO Girona Hospital Josep Trueta,Girona,Spain
,
Blanca Xicoy Cirici
Affiliations:
Hospital Germans Trias i Pujol,Badalona,Spain
,
Marco Ruggeri
Affiliations:
Ospedale San Bortolo,Vicenza,Italy
,
Steffen Koschmieder
Affiliations:
Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine,RWTH Aachen University,Aachen,Germany
,
Marta Anna Sobas
Affiliations:
Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation,Wroclaw Medical University,Wroclaw,Poland
,
Cuevas Beatriz
Affiliations:
Hospital Universitario de Burgos,Burgos,Spain
,
Daniele Cattaneo
Affiliations:
Hematology Division,Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico,Milan,Italy
,
Rosa Daffini
Affiliations:
ASST-Spedali Civili,Brescia,Italy
,
Marta Bellini
Affiliations:
ASST-Papa Giovanni XXIII,Bergamo,Italy
,
Natalia Curto-Garcia
Affiliations:
Guy's and St. Thomas' NHS Foundation Trust,London,United Kingdom
,
Marta Garrote
Affiliations:
Hospital Clinic de Barcelona,Barcelona,Spain
,
Fabrizio Cavalca
Affiliations:
Hematology Division and Bone Marrow Transplant Unit,San Gerardo Hospital, ASST Monza,Monza,Italy
,
Lina Benjiba
Affiliations:
Hospital Saint-Louis,Paris,France
,
Beatriz Bellosillo
Affiliations:
Hospital del Mar,Barcelona,Spain
,
Guglielmelli Paola
Affiliations:
Department of Experimental and Clinical Medicine,Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Azienda Ospedaliera Universitaria Careggi, University of Florence,Florence,Italy
,
Silvia Betti
Affiliations:
Fondazione Policlinico 'A. Gemelli' IRCCS,Rome,Italy
Alessandro Rambaldi
Affiliations:
ASST-Papa Giovanni XXIII,Bergamo,Italy;Università degli Studi di Milano,Milan,Italy
EHA Library. Barbui T. 06/09/21; 324812; EP1089
Tiziano Barbui
Tiziano Barbui
Contributions
Abstract
Presentation during EHA2021: All e-poster presentations will be made available as of Friday, June 11, 2021 (09:00 CEST) and will be accessible for on-demand viewing until August 15, 2021 on the Virtual Congress platform.

Abstract: EP1089

Type: E-Poster Presentation

Session title: Myeloproliferative neoplasms - Clinical

Background

To our knowledge, there is no information on long-term follow-up of recovered patients with chronic myeloproliferative neoplasms (MPN) with COVID-19. It can be hypothesized that cytokine storm of the acute phase and the post-COVID persistence of a residual inflammatory state may contribute to elicit hematopoietic stem cell insults and continuous vascular endothelial damage, leading to MPN disease progression and persistent high risk of thrombosis.

Aims

To describe sequelae of COVID-19 in surviving patients with MPN following COVID-19.

Methods

MPN-COVID study involved 38 European blood centers, and accrued 180 patients with MPN diagnosed with COVID-19 from Feb to Jun 2020, assessing mortality and incidence of thrombosis and bleeding during the acute phase of the pandemic [Barbui T et al. Leukemia. 2021;35(2):485-493. Barbui T et al. Blood Cancer J. 2021;11(2):21]. One-hundred-twenty-five (69%) of these patients survived and were followed up for at least 6 months. Centers were asked to update symptoms, treatments, hematological changes, major outcomes (i.e., thrombosis, disease evolution and death).

Results

Among the 125 surviving patients, all eligible for the follow-up update, with a median age 70 years (IQR: 58-79), the following phenotypes were registered: PV (n=38, 30%), ET (n=37, 30%), early PMF (n=14, 11%) and MF (n=36, 29%). During the acute phase of infection, 38 (30%) were managed at home, 80 (64%) in a regular ward and 7 (6%) in ICU.


Symptoms


(i)The 3 prevalent symptoms during the acute phase of the disease were fever (79%), cough (56%) and dyspnea (53%), while gastrointestinal, neurological, musculoskeletal symptoms, as well as fatigue and anosmia/dysgeusia, were present in a minor proportion, ranging from 1.6% to 17%.


(ii) In the post-acute COVID-19 phase, 36 of 125 patients (32%) declared the persistence of some of these symptoms, fatigue being the most frequent (19%), while none presented persistence of fever and only 10% of dyspnea.


Major outcomes


(i) Major thrombosis was documented in 5 patients and involved 3 patients with MF (one fatal intestinal ischemia, two non-fatal events: splenic infarction and peripheral artery thrombosis), one case in PV (acute myocardial infarction) and one with ET (DVT of the legs with pulmonary embolism). Age varied from 61 to 80 years. The first event occurred five months after COVID-19 recovery and the Kaplan Meier thrombosis-free survival probability after 9 months was 82%.


(ii) Acute myelogenous leukemia (AML) was ascertained in 3 patients (1 in MF, 1 in early-PMF, 1 in ET); one was fatal and occurred in a 49-year-old patient, the other 2 in 78- and 82-year-old patients, respectively. One non-Hodgkin´s lymphoma (in ET) and one progression of a previous parotid carcinoma (in MF) were seen in two patients aged 60 and 77 years, respectively.


(iii) Deaths were reported in 8 patients (6.4%), due to AML (n=1), thrombosis (n=1), progression to prior carcinoma (n=2, 1 suspected), multi organ failure (n=1) and heart failure (n=2); the cause was unknown in a single patient. Five deaths (63%) occurred in MF patients.


(iv) Overall, the event-free survival pooling together thrombosis, disease evolution and death reached 66% after 9 months from COVID-19 recovery, indicating that, during this time of observation, 1 out of 3 patients died or have experienced at least one of the other two severe events.

Conclusion
These results indicate that MPN patients who have survived SARS-CoV-2 infection continue to experience severe events suggesting an increased vigilance in the post-COVID period.

Keyword(s): COVID-19, Long-term follow-up, Myeloproliferative disorder

Presentation during EHA2021: All e-poster presentations will be made available as of Friday, June 11, 2021 (09:00 CEST) and will be accessible for on-demand viewing until August 15, 2021 on the Virtual Congress platform.

Abstract: EP1089

Type: E-Poster Presentation

Session title: Myeloproliferative neoplasms - Clinical

Background

To our knowledge, there is no information on long-term follow-up of recovered patients with chronic myeloproliferative neoplasms (MPN) with COVID-19. It can be hypothesized that cytokine storm of the acute phase and the post-COVID persistence of a residual inflammatory state may contribute to elicit hematopoietic stem cell insults and continuous vascular endothelial damage, leading to MPN disease progression and persistent high risk of thrombosis.

Aims

To describe sequelae of COVID-19 in surviving patients with MPN following COVID-19.

Methods

MPN-COVID study involved 38 European blood centers, and accrued 180 patients with MPN diagnosed with COVID-19 from Feb to Jun 2020, assessing mortality and incidence of thrombosis and bleeding during the acute phase of the pandemic [Barbui T et al. Leukemia. 2021;35(2):485-493. Barbui T et al. Blood Cancer J. 2021;11(2):21]. One-hundred-twenty-five (69%) of these patients survived and were followed up for at least 6 months. Centers were asked to update symptoms, treatments, hematological changes, major outcomes (i.e., thrombosis, disease evolution and death).

Results

Among the 125 surviving patients, all eligible for the follow-up update, with a median age 70 years (IQR: 58-79), the following phenotypes were registered: PV (n=38, 30%), ET (n=37, 30%), early PMF (n=14, 11%) and MF (n=36, 29%). During the acute phase of infection, 38 (30%) were managed at home, 80 (64%) in a regular ward and 7 (6%) in ICU.


Symptoms


(i)The 3 prevalent symptoms during the acute phase of the disease were fever (79%), cough (56%) and dyspnea (53%), while gastrointestinal, neurological, musculoskeletal symptoms, as well as fatigue and anosmia/dysgeusia, were present in a minor proportion, ranging from 1.6% to 17%.


(ii) In the post-acute COVID-19 phase, 36 of 125 patients (32%) declared the persistence of some of these symptoms, fatigue being the most frequent (19%), while none presented persistence of fever and only 10% of dyspnea.


Major outcomes


(i) Major thrombosis was documented in 5 patients and involved 3 patients with MF (one fatal intestinal ischemia, two non-fatal events: splenic infarction and peripheral artery thrombosis), one case in PV (acute myocardial infarction) and one with ET (DVT of the legs with pulmonary embolism). Age varied from 61 to 80 years. The first event occurred five months after COVID-19 recovery and the Kaplan Meier thrombosis-free survival probability after 9 months was 82%.


(ii) Acute myelogenous leukemia (AML) was ascertained in 3 patients (1 in MF, 1 in early-PMF, 1 in ET); one was fatal and occurred in a 49-year-old patient, the other 2 in 78- and 82-year-old patients, respectively. One non-Hodgkin´s lymphoma (in ET) and one progression of a previous parotid carcinoma (in MF) were seen in two patients aged 60 and 77 years, respectively.


(iii) Deaths were reported in 8 patients (6.4%), due to AML (n=1), thrombosis (n=1), progression to prior carcinoma (n=2, 1 suspected), multi organ failure (n=1) and heart failure (n=2); the cause was unknown in a single patient. Five deaths (63%) occurred in MF patients.


(iv) Overall, the event-free survival pooling together thrombosis, disease evolution and death reached 66% after 9 months from COVID-19 recovery, indicating that, during this time of observation, 1 out of 3 patients died or have experienced at least one of the other two severe events.

Conclusion
These results indicate that MPN patients who have survived SARS-CoV-2 infection continue to experience severe events suggesting an increased vigilance in the post-COVID period.

Keyword(s): COVID-19, Long-term follow-up, Myeloproliferative disorder

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