Published on August 19, 2020
Does Having ET Mean I'm at Risk For COVID-19 Complications?
Are essential thrombocythemia patients at a higher risk of developing complications from COVID-19 because of the clotting nature of their myeloproliferative neoplasm? In this segment from a recent MPN Answers Now program, host Andrew Schorr talks to Dr. Ellen Ritchie from Weill Cornell Medicine about the risk for COVID-19 complications and if a vaccine would work for essential thrombocythemia patients.
This is Part 1 of a 4-part series. Watch the complete series below:
- Part 2: What Essential Thrombocythemia Treatments Are Available?
- Part 3: Current Research on Essential Thrombocythemia
- Part 4: Can Diet and Exercise Help Essential Thrombocythemia?
This program is sponsored by Bristol Myers Squibb. This organization has no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.
Transcript | Essential Thrombocythemia and COVID-19 Complication Risk
COVID-19 Risks for Essential Thrombocythemia Patients
Greetings from San Diego County, California. I'm Andrew Schorr. Welcome to this MPN Answers Now program, supported financially by Bristol Myers Squibb and produced in association with Bag It Cancer. This is your opportunity to hear the latest about essential thrombocythemia. I have myelofibrosis, another MPN, but this one is really focused on ET.
There's our expert joining us, and that is Dr. Ellen Ritchie, and Dr. Ritchie is an associate professor and an MPN specialist, and she's at Weill Cornell in New York City at New York Presbyterian Hospital. She joins us today from out on Long Island; if you know the geography there, Amagansett. So thanks for taking the time as we approach the weekend, Dr. Ritchie, to be with us and take questions. Thanks for joining us.
Happy to be here.
We are doing this program now during the coronavirus pandemic. People with ET understand, with higher platelets, they are more at risk for clotting issues, that could be heart attack and stroke. They've known about that, but they also know that there are clotting issues that could go with the COVID-19 disease. There you are in New York where you guys have seen a lot of it; hopefully not much with MPN patients, but still... so that's the question we're getting from many people right now, is, “Doctor, please tell us if we have ET and we're at risk of clotting, are we at higher risk of complications of COVID-19?” What do we know?
I don't think a lot is known yet. The Italians, who were really the first European country that was really hit with COVID, are compiling data and now looking at their MPN patients; so are the Spaniards and so are the French, and I think that with that international data set, we will have some early answers.
We have really anecdotal data about our patients, really, with MPNs. What's interesting about MPNs is, if you are on certain therapies for myeloproliferative diseases, they may be protective against your developing severe disease with COVID. Both interferon and ruxolitinib (Jakafi) are both being used in clinical trials to decrease the severity of COVID-19 infection to try and keep those people who had infections from ending up on ventilators. It may be that some of the medications that we place patients on who have myeloproliferative disease will be protected against developing severe COVID disease.
The other aspect of the myeloproliferative diseases is most of them are already on some degree of anti-coagulation, either an anti-platelet agent or an anti-coagulant, and those also might be protective against the development of blood clots in COVID. We have a lot to learn, really, about COVID and its pathophysiology, but some of the things we do in myeloproliferative diseases might protect you from ending up having a negative course on a ventilator.
Right. My understanding is, I think you're involved in a study related to a JAK inhibitor.
Ruxolitinib. We have written a clinical trial at Cornell to treat patients who are sick enough to be in the hospital with COVID to try and prevent them from developing disease so severe that they need to go on a ventilator. The Incyte corporation is also looking at its own Phase 3 trial, looking at patients on ventilators to see if we can get them off ventilators sooner and have a better overall survival, so we'll have to see how these all play out.
Will a COVID-19 Vaccine Work for ET Patients?
Right, well, that's what research is all about and getting hard data. Now, let's go into one other area before we leave our COVID part of the discussion, and that is... turn on the news, every 10 minutes you hear about vaccine development. And so, ET patients are saying, "Well, okay, I have this condition. Will the vaccine work for me?"
So that's really... there's a lot of difficult questions with the vaccine. First of all, we had never successfully made a vaccine against an RNA virus, and the coronavirus is an RNA virus. Another famous RNA virus is the HIV virus, and we've been working to try and develop a vaccine that would be successful against the HIV virus for many, many years and have not found one that will protect patients and not have a lot of toxicity.
So while it sounds, when you read the Wall Street Journal and the New York Times, like we're totally on the cusp of having this vaccine and it's going to be ready in a couple of months, and we're all going to be protected, it's completely unclear whether we really are going to have an effective vaccine without toxicity, and since we have never created an RNA vaccine that's been successful before, it's a major undertaking.
That being said, like any vaccine, even a flu vaccine, everyone can get that vaccine, but not everyone creates an immune response to the vaccine, and that's a very personal way that your immune system actually reacts to what is in the vaccine. So, it's hard to know how well any of us will be protected; whether there's some groups that will be better protected than others; that what the impact of the vaccine will be on the population as a whole, and not only the MPN patients.
So, worry is not just about whether they develop antibodies, but whether it would have a negative effect on their platelets, which is the scary part of ET.
Well, that short moment of when your platelets soar after you get a vaccine might mean that you're having an actual response to the vaccine, and it may not be long-lived, so having that response actually may be somewhat reassuring that you have actually created a response to the vaccine. So, momentary increases in your platelet counts are concerning, but if you are cooperating with your hematologist and you follow their advice... maybe extra hydroxyurea (Hydrea) during that time, or potentially anti-coagulation, whatever is deemed necessary by your hematologist during that brief period of time where your platelets may climb, that's a reasonable thing to do.
Your ability to clot is not necessarily correlated with the new number of your platelets... that it's a little bit arbitrary as to what platelet count is and what your risk of clotting is.
Okay. So, just to sum up the COVID part of our discussion, you don't have, with MPNs and with ET, specifically yet, worldwide global data to know if you have ET, what your risk is of complications of COVID-19. You don't have that yet.
And also, you have questions about vaccines generally, but we definitely don't know how it will work for one ET patient or another.
From one patient to another, not just ET patients, but from one person to another.
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