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Barbui T, De Stefano V, Alvarez-Larran A, Iurlo A, Masciulli A, Carobbio A, Ghirardi A, Ferrari A, Cancelli V, Elli EM, Andrade-Campos MM, Kabat MG, Kiladjian JJ, Palandri F, Benevolo G, Garcia-Gutierrez V, Fox ML, Foncillas MA, Morcillo CM, Rumi E, Osorio S, Papadopoulos P, Bonifacio M, Cervantes KSQ, Serrano MS, Carreno-Tarragona G, Sobas MA, Lunghi F, Patriarca A, Elorza BN, Angona A, Mazo EM, Koschmieder S, Carli G, Cuevas B, Hernandez-Boluda JC, Abadia EL, Cirici BX, Guglielmelli P, Garrote M, Cattaneo D, Daffini R, Cavalca F, Bellosillo B, Benajiba L, Curto-Garcia N, Bellini M, Betti S, Harrison C, Rambaldi A, Vannucchi AM. Among classic myeloproliferative neoplasms, essential thrombocythemia is associated with the greatest risk of venous thromboembolism during COVID-19. Blood Cancer J 2021; 11:21. [PMID: 33563901 PMCID: PMC7871138 DOI: 10.1038/s41408-021-00417-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/15/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
In a multicenter European retrospective study including 162 patients with COVID-19 occurring in essential thrombocythemia (ET, n = 48), polycythemia vera (PV, n = 42), myelofibrosis (MF, n = 56), and prefibrotic myelofibrosis (pre-PMF, n = 16), 15 major thromboses (3 arterial and 12 venous) were registered in 14 patients, of whom all, but one, were receiving LMW-heparin prophylaxis. After adjustment for the competing risk of death, the cumulative incidence of arterial and venous thromboembolic events (VTE) reached 8.5% after 60 days follow-up. Of note, 8 of 12 VTE were seen in ET. Interestingly, at COVID-19 diagnosis, MPN patients had significantly lower platelet count (p < 0.0001) than in the pre-COVID last follow-up.This decline was remarkably higher in ET (-23.3%, p < 0.0001) than in PV (-16.4%, p = 0.1730) and was associated with higher mortality rate (p = 0.0010) for pneumonia. The effects of possible predictors of thrombosis, selected from those clinically relevant and statistically significant in univariate analysis, were examined in a multivariate model. Independent risk factors were transfer to ICU (SHR = 3.73, p = 0.029), neutrophil/lymphocyte ratio (SHR = 1.1, p = 0.001) and ET phenotype (SHR = 4.37, p = 0.006). The enhanced susceptibility to ET-associated VTE and the associated higher mortality for pneumonia may recognize a common biological plausibility and deserve to be delved to tailor new antithrombotic regimens including antiplatelet drugs.
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Affiliation(s)
- Tiziano Barbui
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Valerio De Stefano
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Arianna Masciulli
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Arianna Ghirardi
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Alberto Ferrari
- FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Elena Maria Elli
- Hematology Division and Bone Marrow Transplant, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | | | | | - Francesca Palandri
- Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italia
| | - Giulia Benevolo
- AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | | | - Maria Laura Fox
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, C/ Natzaret, 115-117, 08035, Barcelona, Spain
| | | | | | - Elisa Rumi
- Department of molecular medicine, University of Pavia, Pavia, Italy
| | | | | | | | | | | | | | - Marta Anna Sobas
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland
| | | | | | | | - Anna Angona
- ICO Girona Hospital Josep Trueta, Girona, Spain
| | - Elena Magro Mazo
- Hospital Universitario Principe de Asturias, Alcalà de Henares, Madrid, Spain
| | - Steffen Koschmieder
- Department of Hematology, Oncology, Hemostaseology, and Stem Cell Transplantation, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
| | | | | | | | | | - Blanca Xicoy Cirici
- Institut Català d'Oncologia-Hospital Germans Trias i Pujol, Joseo Carreras Leukemia Research Institute, Badalona (Barcelona) Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paola Guglielmelli
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Fabrizio Cavalca
- Hematology Division and Bone Marrow Transplant, San Gerardo Hospital, ASST Monza, Monza, Italy
| | | | | | | | | | - Silvia Betti
- Section of Hematology, Department of Radiological and Hematological Sciences, Catholic University, Fondazione Policlinico "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandro Rambaldi
- ASST Papa Giovanni XXIII, Bergamo, Italy
- Università degli Studi di Milano, Milano, Italy
| | - Alessandro Maria Vannucchi
- Center Research and Innovation of Myeloproliferative Neoplasms (CRIMM), Department of Experimental and Clinical Medicine, Azienda Ospedaliera Universitaria Careggi, University of Florence, Florence, Italy
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