How the coronavirus pandemic has affected the clinical management of Philadelphia-negative chronic myeloproliferative neoplasms in Italy—a GIMEMA MPN WP survey

In asymptomatic patients treated with tyrosine kinase inhibitors, the EHA Infectious Disease Scientific Working Group recommended continuing the therapy unmodified. In case of severe COVID-19, the Authors would consider the JAK1/2 inhibitor (JAKi) ruxolitinib as therapy for hyperinflammation. By JAK1 inhibition, ruxolitinib had demonstrated to exert a broad anti-inflammatory activity against the myeloproliferative neoplasms (MPNs) cytokine storm and has been used in the setting of COVID-19 infection with positive results [2]. Conversely, ruxolitinib may affect the immune response by different effects on immune cells, including inhibition of differentiation, function, and migration of dendritic cells, reduced in vivo T-cell (regulatory, Th1 and Th17) frequency and cytokine production, inhibition of NK cells killing activity, proliferation, and cytokine production [3]. Philadelphia-negative MPNs include polycythemia vera (PV), essential thrombocythemia (ET), and myelofibrosis (MF) [4] and are characterized by increased thrombotic risk, progressive splenomegaly/symptoms, and reduced survival [5]. In MF and PV, infections represent a frequent complication, due to disease-related factors and use of ruxolitinib [6]. To understand how the behavior of Italian hematologists towards MPN has changed during the COVID-19 pandemic, and how ruxolitinib was managed, the GIMEMA (Gruppo Italiano Malattie EMatologiche dell’Adulto) MPN Working Party e‐mailed to 239 hematologists, belonging to 102 Italian hematology institutions, an anonymous online questionnaire (Supplementary Table) of 28 multiple choice questions. The survey was completed by 92 (38.5%) hematologists from 63 different Centers.