People with blood cancer who contract Covid-19 infection risk a lot, both for the direct consequences of the virus and for the greater chance of facing complications that require hospitalization in intensive care. Their danger is higher not only compared to the healthy population, but also when compared with that of other categories of sick people. Furthermore, chemo-immunotherapy treatments appear to increase the probability of contracting the virus and increase its lethality, through a decrease in the immune response. Those who suffer from polycythemia vera, essential thrombocythemia and idiopathic myelofibrosis are very anxious about the possible more serious consequences of Covid-19: chronic myeloproliferative neoplasms, little-known and little-known pathologies, of which about 2 thousand Italians get sick every year. To help these rare patients find the answers to their doubts, a group of expert hematologists worked on the drafting of a document, available on the Gimema website (Italian Group of Adult Hematological Diseases), which attempts to answer the most frequent questions and practices of patients in relation to SARS-CoV-2 infection.
Always speak to the hematologist about any decision
First of all, it is fundamental, on the one hand, that patients do not interrupt their treatments, risking to compromise the efficacy of anti-cancer treatments which today, in a high percentage of cases, allow to achieve healing or to live with the disease for many years. neoplasm; on the other hand, that this category of “fragile” people should be rapidly vaccinated against the virus. And the dialogue with the reference hematologist is the starting point even in the case of contracting the virus underlines Alessandro Maria Vannucchi, full professor of hematology at the University of Florence and director of hematology at the Careggi university hospital in Florence, coordinator of the working group that elaborated the document. It is also important to remember that what is suggested in the text, with 30 questions and answers, has no value as a medical-therapeutic indication which is referred to the single haematologist specialist, the only point of reference before any decision.
Covid Risks?
Who suffers from chronic myeloproliferative neoplasms greater risk of getting Covid? To date, no scientific reports are available on an increased incidence of SARs-CoV-2 infections in oncohematological patients. instead it is clear that the mortality rate is 2.4 times higher than the general population that contracts the virus, replies Vannucchi.
Work exemption
Do the sick have the right to be exempted from work? The Ministry of Labor and Health issued, on 4 September 2020, a joint Circular on health surveillance in the workplace and the containment of the risk of contagion in order to identify fragile workers – he says. Francesco Passamonti, Professor of Hematology at the University of Insubria in Varese and director of Hematology at the ASST Sette Laghi di Varese, among the authors of the document -. the competent doctor who identifies the fragile patient who can obtain the exemption from work or request the employer to activate specific measures. The fragility present in the higher age groups of the population and must be understood together with the presence of more comorbidities. Therefore, a diagnosis of chronic myeloproliferative neoplasm is not sufficient if it is not accompanied by multiple comorbidities.
Positive buffer
What to do if a chronic myeloproliferative neoplasm patient has a positive swab for Covid? After informing the general practitioner, it is necessary to contact the reference hematologist for information on the management of the oncological therapy he is taking – explains Passamonti -. In most cases it can be maintained, only in some situations it may be advisable to reduce the dosage or discontinue it. Furthermore, in relation to the symptoms in progress, it may be necessary to take drugs for SARS-COV2 and consequently modify the anti-cancer treatment. Absolutely no changes or decisions should be made in the absence of indications from the specialist.
Contraindications to the vaccine?
Vaccine against the new Coronavirus: is there any contraindication for those suffering from these neoplasms?In general, the diagnosis of polycythemia, myelofibrosis and thrombocythemia does not exclude the possibility of being vaccinated for Covid-19 – underlines Vannucchi -. The priority will depend on the state of health, any other ongoing comorbidities (frailty) and the type of therapy. There are specific cases, such as patients who have recently undergone allogeneic transplantation, those enrolled in clinical trials with drugs not yet approved or those suffering from systemic mastocytosis in which the risk of allergic reactions to the administration of the vaccine remains unknown.
Right to vaccination
Are these patients entitled to priority vaccination or do they have to wait their turn based on age like everyone else? The ministerial document of February 8, 2021 (interim recommendations on the target groups of anti-SARS-CoV-2 / COVID-19 vaccination) indicates that “onco-haematological patients treated with immunosuppressive drugs, myelosuppressive drugs or less than 6 months after suspension of treatment and cohabitants “are considered” particularly vulnerable subjects “and, therefore, included among those who will have high priority in the administration of the vaccine, actually entering phase 2 of the vaccination plan – replies Passamonti -. As suggested by the indications of the Italian Society of Hematology, vaccination is indicated substantially in all haematological patients, including those with chronic myeloproliferative neoplasms.
Precautions
With regard to vaccines, are there any special precautions to be taken? These patients were not included in clinical studies with the different vaccines, so we do not have detailed data on the quality and duration of the immune response to the vaccine, nor on potential differences related to the type of product. We cannot therefore precisely estimate its effectiveness, but there is no concern in terms of safety – explains Vannucchi -. In particular, patients with chronic myeloproliferative neoplasms are a heterogeneous group as regards their immunological competence, ranging from cases that can be considered only minimally immunocompromised compared to subjects of the same age and sex (such as those suffering from polycythemia vera or essential thrombocythemia) , up to more fragile cases due to the disease or the necessary treatments (such as those with intermediate-2 or high-risk forms of frank myelofibrosis or treated with prolonged steroid therapy). While bearing in mind these differences, globally the vaccine recommended in all.
Types of vaccines
Are there any differences regarding the brand and type of vaccine?The vaccines currently approved by all the regulatory bodies in charge have been fired without any absolute contraindication – concludes Vannucchi -. Therefore their administration is also recommended in patients with chronic myeloproliferative neoplasms. However, for patients on therapy with ruxolitinib, interferon and other potentially immunosuppressive drugs, the advice remains to share the choice of vaccination with the haematologist specialist in treatment who has the task of identifying potential problems between the therapy in course and vaccination.After vaccination it will still be necessary to continue to follow the social rules applied to the circumstance of the pandemic: distancing, use of the mask, frequent disinfection of the hands.
April 12, 2021 (change April 13, 2021 | 09:31)
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