Table 4.

Risk factors, treatment considerations, and challenges during COVID-19 for treatment of MDS and MPN

Disease	Risk factors for increased mortality	Treatment considerations	Challenges
MDS	• Older age at diagnosis • Myelosuppression due to underlying disease and treatment • Transfusion needs • Impaired neutrophil and T-cell function • Lymphopenia in high-risk patients • Comorbid renal, cardiovascular, or pulmonary dysfunction • Baseline inflammatory cytokine milieu	• Risk stratification per usual guidelines • Growth factors to prevent neutropenia • Lenalidomide and HMA are myelosuppressive • Delay definite therapy if indicated	• Delaying allo-SCT • Differentiate COVID-19 from other infections • Leukemoid reaction and fatal cytokine storm in CMML patients
MPN	• Prothrombotic state additive with COVID-19 infection • Impaired neutrophil and T-cell function • Baseline inflammatory cytokine milieu	• Follow usual cytoreduction goals • Avoid abrupt discontinuation of JAK2 inhibitors • Avoid G-CSF in patients with splenomegaly	• Need to reduce clinic visits • Increased risk of both thromboses and hemorrhage

MDS, myelodysplastic syndrome; HMA, hypomethylating agent; allo-SCT, allogenic stem cell transplantation; CMML, chronic myelomonocytic leukemia; MPN, myeloproliferative neoplasms; JAK2, janus kinase 2; G-CSF, granulocyte colony-stimulating factor