Ask The Experts About COVID-19 and Myeloproliferative Neoplasms (MF - PV - ET)

MedMaven

The Personalized Medicine Foundation and CancerConnect are pleased to provide patients and caregivers the opportunity to ask questions about the management of MPN's during COVID-19. We have put together a panel of leading experts to answer questions and publish a forum for the exchange of information.

  • Rami Komrokji, MD is a Senior Member & Professor of Oncologic Sciences and the Section Head- Leukemia and MDS, Vice Chair-Malignant Hematology Department, Moffitt Cancer Center, a NCI Designated Cancer Center.
  • Srdan Verstovsek MD, PhD is the United Energy Resources, Inc., Professor of Medicine and hematologist-oncologist at MD Anderson. Dr. Verstovsek is a global leader in myeloproliferative neoplasms (MPN) and the Founder/Director of the largest MPN Clinical Research Center worldwide

Click here to submit your question. Dr Komrokji's answers to submitted questions….

I have read that the death rate for blood cancer patients who contract covid is about 28% and that in MPN patients it is even higher, is this true?

Early on in the pandemic, a high death rate was reported in patients who had a COVID-19 infection and who were undergoing active treatment for a hematologic malignancy. In general, with more knowledge about the management of COVID infections along with the use of therapies including steroids, remdesivir, monoclonal antibodies and convalescent serum this death rate appears to be getting lower than initially reported.

Unfortunately death rate for patients with hematological (blood and bone marrow) cancers is very high. There is no solid information to suggest that MPN patients have an even higher risk of death. Very recent meta-analysis (study that evaluates all published reports on this matter together) reported no major differences among patients with different hematological cancers. Of course, risk of serious complications in patients with MPN may depend on many factors, for example, age of the patient, other medical problems, already present complications for MPN itself, and others. Best is to prevent getting infected, and if infected, report to your oncologist/hematologist to be closely monitored.

Is interferon immunotherapy safe to take if you test positive for COVID?

Interferon is biological agent that is used as therapy for some patients with MPNs. Its many activities include activity on the immune system; interferon is an immune booster, and therefore, one should not stop taking it during COVID infection (the same applies to any other therapy, indeed, no therapy that is in place to control signs and symptoms of MPN should be stopped or modified unless absolutely necessary and under strict monitoring of treating physician).

I am looking for treatment options for Intermediate Myelofibrosis with SRFS2 gene mutation other than a bone marrow transplant that have demonstrated some clonal reversal. I don't want to get a transplant during the pandemic. I know that the Momentum study is one as is a trial with interferon and Jakafi.

SRSF2 is regarded high risk mutation , transplant is only curative option , most of the treatments have not be shown to alter natural history of disease. Interferon if not severe fibrosis maybe the only drug that can alter natural history. We have been doing transplants safely during pandemic but it is not emergent to go to transplant

I have PV and am struggling with side effects from Jakafi. I am afraid to discontinue the medication during the pandemic. Are there any new meds easier to tolerate? I have sensitivity reactions and gut issues. Also, any way to address my low iron?

Ropeg the pegylated interferon is probably the only drug that may alter natural history of disease, different side effect profile, low iron is needed to prevent over production of red blood cells so we usually don’t recommend replacing iron. For patients needing phlebotomy there is a study with a hepcidin mimetic drug that eliminates needs for phlebotomy and improves iron.

Can breast silicone implants cause blood cancers like polycythemia vera?

A particular type of breast implants referred to as textured silicone implants have been associated with the development of a subtype of lymphoma in the breast known as anaplastic large cell lymphoma. This remains a rare entity with only 1000-2000 cases reported worldwide. The lymphoma can often be treated by removal of the implants which can lead to regression of the lymphoma. I am not aware of a relationship between silicone implants and polycythemia. Breast Implants and anaplastic large cell lymphoma.

Are you recommending the vaccine to your patients with PV or MF?

Having cancer regardless of treatment status is a risk factor for worse outcome from infections including influenza and COVID-19. The short answer is yes once COVID-19 vaccines become more widely available. In terms of prioritization, and according to CDC guidelines, cancer patients will be part of the phase II wave of vaccination which will occur sometime in February. The vaccine is given in 2 doses at 21 days interval and we expect patients receiving the vaccine to be immune 2-3 weeks after their second dose of vaccine. Learn more about vaccination here.

​I have a blood cancer and am taking hydroxyurea and have compromised immune system and take prolia for bones, is it ok to get covid vaccine. I am 83 yrs old in ok health.

The short answer is yes, the vaccines however were not evaluated in patients with blood disorders and compromised immune systems so we are not certain how effective they will be - the CDC is recommending cancer patients should get the vaccine. You should however discuss vaccination with the doctor managing your CMML. Here is a summary of what is known thus far about vaccination in patients with cancer.

I am concerned about the safety of the two RNA vaccines in general. Are they continued to be studied for safety even as people are getting them. Are there any studies on the safety and efficacy in MPN patients and these vaccines.

So far data shows excellent safety, most of vaccines adverse events occur on short term historically and there had been no concerns with the mRNA vaccines and enough follow up now in terms of safety, we don’t have data on efficacy among patients with MPN, there is zero harm as the vaccine does not contain any virus killed or attenuated.

What is your approach to timing of the Covid vaccination for patients with MF who have not have had prior Covid 19, and are about to start chemotherapy?

If possible to delay, is it advised to delay starting chemo until 2 weeks after completing the Covid 19 vaccine series in order to max out the protective benefit from the vaccine. If starting Jakafi maybe delay starting Jakafi if possible by 2 weeks because it does affect T cell function.

When should the COVID vaccine be given before starting chemo or after chemo? Is their data to support this recommendation?

When chemotherapy is mentioned as a therapeutic choice for patients with MPN, then we typically think about hydroxyurea or Jakafi. These are commonly used to control elevated blood count in patients with essential thrombocythemia or polycythemia vera, or to control enlarged spleen in patients with myelofibrosis (these days JAK inhibitor ruxolitinib has been preferred for this task). hydroxyurea is very mild chemotherapy agent and is not considered immunosuppressive, therefore, not affecting immune system (good immune system is needed in a patient given a vaccine). Therefore, a COVID vaccine can be administered to patient before starting hydroxyurea, while on hydroxyurea, or after hydroxyurea; simply there is no connection between hydroxyurea use and vaccination. Other forms of chemotherapy are very rarely used in MPN and discussion about vaccination in such unusual situation require individual counseling.

Is it safe to get the vaccine during radiation therapy ?

Radiation therapy in patients with myeloproliferative neoplasms is extremely rarely used, and this would be in myelofibrosis patients that have terribly enlarged spleen not responding to any other therapy, in which case radiation is given over limited number of days (e.g. 7-10 days) to the spleen specifically (not to the whole body). while there is no experience giving vaccine to such patients while receiving radiation, one may wait for 10 days and provide vaccine once radiation has been done.

My friend says that the Pfizer mRNA vaccine may cause covid19 illness in some people, is it true?

Absolutely not , there is no virus in the vaccine​.

Here is a summary of what is known thus far about vaccination in patients with cancer.

Has anyone with ET on hydrea and aspirin been advised not to get the COVID vaccine?

No there is no contraindication to get the vaccine

The "Ask The Experts About COVID-19 and Cancer" Series

Previously from the PMF and Cancer Connect

The Ask The Expert Series is made possible by support from The Personalized Medicine Foundation, Incyte Oncolgy, Abbvie, and CancerConnect. The "Ask The Expert" series is not medical advice nor is it a substitute for your doctor. It should serve as a guide to facilitate access to additional information and enhancement of a shared decision making process with your treating physician.
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