FLORIAN HEIDEL (GREIFSWALD)
INFECTIONS IN MPN – PATIENTS SURVEY
Florian H. Heidel, University Medicine Greifswald, Germany
Recently, several studies have documented immunosuppression and infectious complications
in patients undergoing Janus kinase (JAK) inhibitor therapy with myeloproliferative neoplasms
(MPN). These datasets included analyses of large multicenter trials comparing JAK inhibitor
therapy with best available therapy or placebo control. Specific infections such as herpes virus
reactivation appear to be more prevalent in patients treated with the JAK inhibitor ruxolitinib
(RUX) and opportunistic infections have been described also outside of clinical trials. However,
it is not known to which extent the underlying malignancy (MPN) contributes to
immunosuppression and susceptibility to infection. Studies from a registry provided early
evidence that the risk of MPN patients to die from infections may be increased when
compared with normal population controls and this finding was most recently underpinned
by a large dataset of 8363 MPN patients. MPN patients were at higher risk for severe bacterial
and viral infections judged by hospital admissions and deaths from infection. Molecular and
clinical heterogeneity of MPN, its impact on cellular signaling, immune function and the
inflammatory phenotype may vary depending on the type of driver mutation and disease
burden. Here, we show data on a patient-reported, multicenter pilot study aimed to assess
for the overall incidence of infections as well as prophylactic and therapeutic measures in MPN
patients in an unbiased manner. In total, questionnaires from 948 patients with a median age
of 67.0 years (range 18–99) and balanced gender distribution (425 males and 431 females)
were collected. Consistent with previous reports, diagnosis of MF (57.4% ≥1 infection; p =
0.022) as well as JAK inhibitor (RUX) treatment (68.2% ≥1 infection; p = 0.01) resulted in a
significantly increased risk of infections. Even more pronounced patients receiving
combinations including RUX were at higher risk in bivariate (69.8% ≥1 infection; p = 0.04) and
multivariate analysis (odds ratio 1.307; 95% Wald CI: 0.860–4.327; p = 0.042). Interestingly,
older patients above the age of 60 showed lower infection rates, which may be attributed to
the higher rate of individuals having received vaccinations against pneumococci and herpes
virus infections, according to the national recommendations.
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