Humoral and cellular responses after third dose of SARS-CoV-2 vaccine in myeloproliferative neoplasms patients on ruxolitinib therapy
Ce dossier présente un ensemble d'articles concernant la prise en charge des cancers durant la crise sanitaire liée à la COVID-19
Patients with hematological malignancies, especially if on an immunosuppressive treatment, carry an increased risk to develop severe COVID-19 compared to healthy individuals [1], [2], [3]. Myeloproliferative neoplasms (MPNs) are characterized by an enhanced activity of the JAK/STAT pathway, due to the acquisition of somatic gain-of-function mutations in the hematopoietic stem cell. Patients with MPN, particularly those affected by myelofibrosis, are at a significantly higher risk of severe infections, probably due to aberrant expansion of the myeloid compartment and impaired proliferation and maturation of dendritic, NK and T cells [4], [5]. Ruxolitinib is a JAK1/2 inhibitor (JAKi) approved for the treatment of patients with myelofibrosis and those with hydroxyurea resistant/refractory polycythemia vera. The immunosuppressive activity of ruxolitinib has been associated to an increased rate of infections in MPN patients and therefore concerns were raised on whether it could have detrimental effects in subjects infected by SARS-CoV-2 or on the efficacy of the vaccine. As to the first issue, even though observational studies documented an increased risk of severe COVID-19 and death in MPN compared to healthy subjects, treatment with ruxolitinib was not associated with worse outcome and some studies even supported its effectiveness in treating COVID-19 hyper inflammatory reaction in the general population, like it has been lately demonstrated for baricitinib [6], [7], [8]. Moreover, 75 % of deaths occurring in ruxolitinib-treated patients were related to discontinuation syndrome following its abrupt suspension (...)
Leukemia Research , article en libre accès, 2023