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CLL Monthly MinutesLeukemia

Treatment of Chronic Lymphocytic Leukemia During the COVID-19 Pandemic

The COVID-19 pandemic has resulted in several changes in how patients with chronic lymphocytic leukemia (CLL) are treated.
Web Exclusives – May 17, 2021

For patients with cancer, and especially those with leukemia, the risk of contracting an infectious disease can be much higher than for healthy individuals.1-3 Although regular handwashing, avoiding large crowds, and even wearing a face mask over the mouth and nose have been among the traditional recommendations made by doctors to prevent common infections, cancer care has faced even greater challenges with the emergence of COVID-19.2,3

Patients with chronic lymphocytic leukemia (CLL) are at higher risk for life-threatening COVID-19 infections because their immune system has been compromised by the disease. In addition, many patients with CLL are older and some have complicating medical conditions that also increase their risk.4 To protect these patients, published recommendations for CLL management during COVID-19 include minimizing the number of in-person medical visits, postponing the start of treatment as long as possible, and choosing anticancer treatments that are less impactful to the patient’s immune system.4

In agreement with these guidelines, some doctors report that they have seen increased use of Bruton tyrosine kinase (BTK) inhibitors, like ibrutinib and acalabrutinib, over other CLL treatments.5 The key benefit of using BTK inhibitors is that they are oral treatments that require fewer clinic visits than other therapies.5 Nevertheless, 1 year into the pandemic, most clinics have adopted effective safety protocols to protect their patients, and intravenous approaches like venetoclax-based regimens are still available for appropriate patients.5

Today, doctors report being more comfortable now than they were at the start of the pandemic and are approaching treatment of CLL similarly to how they were prior to the emergence of COVID-19.6 Generally, this means starting patients on one of the novel targeted therapies mentioned above, rather than chemotherapy.5 It should be noted, however, that for a very small minority of patients who are young, fit, and have a specific genetic signature (mutated immunoglobulin heavy chain), chemotherapy still may be considered.5

With the first approval and distribution of several COVID-19 vaccines at the end of 2020, most doctors and public health officials recommend that everyone, including patients with CLL, receive whichever COVID-19 vaccination is available to them.6,7 Questions do remain, however, about whether cancer treatment schedules should be modified to accommodate vaccination.6

It is known that cancer treatment can affect how well a patient’s immune system responds to vaccination, and a recently published clinical study has shown that patients receiving treatment for their CLL show a decreased response to COVID-19 vaccination.7,8 It is therefore highly recommended that patients with CLL discuss vaccination with their healthcare team, and continue to wear masks, practice social distancing, maintain good hand hygiene, and encourage vaccination of their close contacts, even after they, themselves, are vaccinated.7,8


References

  1. Pemmaraju N. Reflections on caring for cancer patients during the COVID-19 pandemic. Published April 21, 2020. www.mdanderson.org/cancerwise/leukemia-oncologist-doctor-reflections-on-caring-for-cancer-patients-during-the-coronavirus-covid-19-pandemic.h00-159381156.html. Accessed February 1, 2021.
  2. Leukemia & Lymphoma Society. Infections. www.lls.org/treatment/managing-side-effects/infections. Accessed April 19, 2021.
  3. American Cancer Society. Watching for and preventing infections in people with cancer. Revised April 10, 2020. www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/low-blood-counts/infections/preventing-infections-in-people-with-cancer.html. Accessed April 19, 2020.
  4. Rossi D, Shadman M, Condoluci A, et al. How we manage patients with chronic lymphocytic leukemia during the SARS-CoV-2 pandemic. Hemasphere. 2020;4:e432.
  5. Skarbnik AP, Coombs CC, Brander DM. CLL treatment approaches during COVID-19. Published January 8, 2021. www.onclive.com/view/cll-treatment-approaches-during-covid-19. Accessed April 19, 2021.
  6. Kittai AS. CancerCare Connect Education Workshop: update on chronic lymphocytic leukemia (CLL). March 25, 2021. https://edge.media-server.com/mmc/p/vngzdx5x. Accessed April 18, 2021.
  7. Leukemia & Lymphoma Society. COVID-19 vaccines FAQ for patients and caregivers. Updated May 13, 2021. www.lls.org/covid-19-vaccines-faq. Accessed May 17, 2021.
  8. Herishanu Y, Avivi I, Aharon A, et al. Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood. 2021;blood.2021011568.

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Last modified: May 17, 2021

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