Understanding the Management of CLL in the Time of COVID-19

The threat of COVID-19 is particularly heightened for patients who are immunosuppressed as a result of various diseases or treatments for disease, such as chemo-immunotherapy for cancer. As a result, research over the last year has tried to determine tailored recommendations for treating these diseases in the time of the pandemic. In a recent review article, a researcher outlined current guidance for the management of patients with chronic lymphocytic leukemia (CLL).

In these patients, similar to patients with other types of cancer, it has been recommended to reduce the number clinical visits, wait times, and the duration of treatment, as well as to delay treatment, if possible. However, this isn’t feasible in all cases, such as for those requiring immediate initiation of treatment.

“If patients require immediate initiation of therapy, it is advisable to offer them the best therapy scheme, which is adapted to the patient's distinct characteristics,” the review author wrote. “When there are therapeutic options, it is preferred to use drugs which can be administered in an outpatient setting and requires as few controls as possible in the clinic and laboratory tests.”

For example, the researcher notes that it is recommended to avoid venetoclax treatment, which requires frequent and extensive clinical visits and examinations.

For patients without COVID-19, recommendations suggest they continue intravenous immunoglobulin if they have a history of hypogammaglobulinemia and have active or numerous severe infections. In these cases, infusions should be less frequent and should target IgG levels of 400 to 500 mg/dl. In the case that a patient with CLL has COVID-19, they should continue immunoglobulin therapy, with the decision taking into account increased risk of thrombosis associated with COVID-19.

In general, it is recommended that patients with COVID-19 remain on CLL therapy so long as they have mild symptoms. For patients with more severe cases, the decision should be made based on several factors, including the aggressiveness of the disease, the patient’s history of infections, and the patient’s risk of more serious complications.

“There is not yet sufficient clinical evidence to allow a different approach for the classes of chemotherapeutics used for CLL therapy. The continuation or cessation of the treatment is established according to the particularities of each case,” wrote the researcher. “There is a consensus to stop the administration of monoclonal antibodies in patients with COVID‐19. Discontinuation of therapy with a B‐cell receptor signaling inhibitor may promote the onset of a CLL flare and the release of pro‐inflammatory cytokines, which may mimic the clinical and laboratory manifestations of COVID‐19.”

As understanding of appropriate treatment for patients with CLL continues to expand, several groups have created registries of these types of patients. For example, the American Society of Hematology has initiated a registry for patients with hematologic malignancies.

Reference

Mihaila R. Management of patients with chronic lymphocytic leukemia during the SARS‐CoV‐2 pandemic (review). Oncol Lett. 2021;22(2):636.doi:10.3892/ol.2021.12897