Recently published reports suggest a possible benefit from the BTKis (ibrutinib and acalabrutinib) in the setting of severe COVID-19 infection. Generally, resumption of the BCR signaling inhibitor results in resolution of these symptoms in a relatively short period of time. When there is more than one option, preference should be given to treatments that can be provided in the outpatient setting and require fewer clinic visits and lab assessments. Would your approach be different for patients who call and report symptoms vs. those who have symptoms while in the clinic? This activity is intended for hematology/oncology specialists, internal medicine physicians, and emergency medicine physicians, and other healthcare providers involved in the care of patients with novel coronavirus disease 2019 (COVID-19) and chronic lymphocytic leukemia (CLL). CLL-directed treatment with BTKi's at COVID-19 diagnosis did not impact survival (case fatality rate, 34% vs 35%), though the BTKi was held during the COVID-19 course for most patients. All rights reserved. As an alternative, we consider home subcutaneous infusion of IVIG when possible. We've been working collaboratively to capture the experience of CLL patients who are shielding . Because you have chronic lymphocytic leukemia or CLL, you may be at higher risk for COVID-19, the illness caused by the new coronavirus. If needed, you may be given treatment to boost your immune system. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. When the COVID-19 pandemic is under control per local authorities, we follow standard treatment guidelines for CLL treatment and would not use COVID-19 as a factor in decision making. In patients without COVID-19, we only continue IVIG treatments for highly selected patients with a history of hypogammaglobulinemia and active or recurrent severe infections where the potential benefits are outweighed by the risks of coming to clinic for the infusion. COVID-19 disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that has brought the world … When follow-up is necessary, utilizing laboratories closer to home and using telemedicine is recommended. Use soap and water or hand sanitizer that’s at least 60% alcohol. Stay home as much as you can and avoid anyone who’s sick. Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Stay connected to our resources page for the latest information and support. (WASHINGTON, April 16, 2021) — Two new studies published in Blood suggest that the mRNA COVID-19 vaccine may have reduced efficacy in individuals with chronic lymphocytic leukemia (CLL) and multiple myeloma, two types of blood cancer. Wear a cloth face cover when you go out in public. Because of this, CLL patients are considered to have a high risk for infection with SARS-CoV-2 and for significant symptoms from COVID-19 disease (see figure). ... and severe complications related to COVID-19. CLL leaves you … Chronic lymphocytic leukemia (CLL) is a type of cancer that attacks white blood cells, affecting your body’s ability to fight off infection. However, two large multicenter studies have shown a high mortality rate in patients with CLL and severe COVID-19 in the range of ~ 30%. One of our highest priorities is the well-being of our employees, volunteers, donors, partners, and the patients we serve – especially as many blood cancer patients are immunocompromised. Are you changing anything for patients without COVID-19 who are already on therapy for CLL? It mostly affects people … Reviewed by Arefa Cassoobhoy, MD, MPH on April 23, 2020, American Society of Clinical Oncology: “Leukemia - Chronic Lymphocytic - CLL: Introduction,” “Leukemia - Chronic Lymphocytic - CLL: Symptoms and Signs,” “Leukemia - Chronic Lymphocytic - CLL: Types of Treatment,” “Common Questions About COVID-19 and Cancer: Answers for Patients and Survivors.”, National Institutes of Health: “People who are at higher risk for severe illness.”, American Cancer Society: “Watching for and Preventing Infections.”, CDC: “How to Protect Yourself & Others,” “What to Do If You Are Sick,” “Symptoms of Coronavirus.”. Chronic lymphocytic leukaemia is a type of cancer that affects the white blood cells and tends to progress slowly over many years. To characterize immune response to COVID-19 in patients with CLL, we identified all patients who receive care for an antecedent diagnosis of CLL at … However, two large multicenter studies have shown a high mortality rate in patients with CLL and severe COVID-19 in the range of ~ 30%. In general, patients with CLL are considered high-risk for infections, mainly bacterial and herpes virus family (HSV, VZV, CMV, EBV) due to underlying immunodeficiency and inadequate immune response to infections. This high-mortality rate was reported in patients with severe COVID-19 in both “watch and wait” and treated groups. Being diagnosed with CLL can be very distressing and difficult to take in at first, particularly as it cannot necessarily be cured and you may be advised to wait for it to get worse before starting treatment. Call 911 right away if you have: Be sure to tell the 911 operator that you have CLL and think you might have COVID-19. Chronic lymphocytic leukemia (CLL) is a disease of the elderly, characterized by immunodeficiency. Don’t touch your eyes, nose, or mouth with unwashed hands. Are you changing your approach to initiating therapy for CLL during the pandemic? We try to avoid or skip treatment with monoclonal antibodies (rituximab, obinutuzumab) especially when given in combination with targeted agents. Target Audience and Goal Statement. Fewer than 40% of patients with chronic lymphocytic leukemia (CLL) had an adequate immune response to two doses of the Pfizer/BioNTech COVID-19 vaccine, a … Most continue ongoing CLL-directed therapies in unaffected patients with exceptions being monoclonal anti-CD20 antibodies. Related Videos. Initiation of venetoclax requires multiple and extended clinic visits with lab testing and should be avoided if possible unless considered the most appropriate treatment for a particular patient. Whether you are newly diagnosed, currently receiving treatment or are a lymphoma survivor, this webinar will provide you with information about the impacts of COVID-19 … UK CLL Forum CLL/SLL and COVID-19 patient experience survey findings from surveys 1 and 2. 3:22. We also test patients before admission to hospitals. ©2005-2019 WebMD LLC. Chronic lymphocytic leukemia (CLL) is a type of cancer that attacks white blood cells, affecting your ability to fight infection. Sign up for email updates to stay abreast of the latest COVID-19 resources recommended by the American Society of Hematology. 2021 L Street NW, Suite 900,Washington, DC 20036, Phone 202-776-0544Toll Free 866-828-1231Fax 202-776-0545, Copyright © 2021 by American Society of Hematology, Support Opportunities|Privacy Policy|Terms of Service|Contact Us, Helping hematologists conquer blood diseases worldwide. For outpatients with mild symptoms, we don’t modify therapy. Hence, patients with CLL might be considered more susceptible to severe complications from COVID-19. Diagnosing and Managing COVID-19 in Patients With CLL COVID-19 in patients with CLL manifested as fever in 87% of patients, respiratory symptoms in 49%, and dyspnea in 48%. Most cases of COVID-19 are mild, and if that happens, you can stay home and recover there. Because patients with chronic lymphocytic leukemia (CLL) have many risk factors that predispose them to a more severe course of COVID-19– related illness, … According to researchers, these studies could help inform the ideal time for vaccination of these populations. Keep at least 6 feet from other people. Note: Please review ASH's disclaimer regarding the use of the following information. … The CLL research community has already developed a COVID-19/CLL consortium and presented inferior outcomes in this population. With better access to the PCR test, we recommend testing any symptomatic patient for SARS-CoV-2 even if symptoms are mild. For patients who require immediate therapy, we still offer the best treatment option considering disease and patient-specific factors. The COVID-19 pandemic's impact is being felt all throughout the cancer community, and experts from the CLL Society hosted a webinar to discuss the specific impacts of the pandemic on patients with chronic lymphocytic leukemia. In a patient on treatment for CLL who tested positive for SARS-COV2, do you change/modify therapy? If you’re not getting treatment, call your primary care doctor. In areas with a high prevalence of COVID-19, we try to minimize the number of visits for those who are stable and doing well. In areas where COVID-19 is active, it is our recommendation to postpone treatment initiation if possible. This makes it easier for you to get infections, including with the new coronavirus. We undertook this retrospective international Given the higher risk of thromboembolic (TE) events with COVID-19, we recommend assessment of risks vs. benefits in each patient and close monitoring for TE symptoms. Even in these cases, less frequent infusions should be considered when possible (e.g., every 6-8 weeks) targeting an IgG level of 400-500 mg/dl. The Leukemia & Lymphoma Society (LLS) is closely monitoring the coronavirus (COVID-19) pandemic. If the patient is on a BCR signaling inhibitor (ibrutinib, acalabrutinib, idelalisib, duvelisib), particularly if recently started or still with substantial disease burden, discontinuation can sometimes result in CLL flare and cytokine release that can mimic some of the symptoms of COVID-19. Cover your nose and mouth with your elbow or a tissue when you cough or sneeze. A case report out of China suggested that clinical and biochemical data of COVID-19 might have been partly masked in a patient with chronic lymphocytic leukemia (CLL). Here’s why and what you can do about it. or the severity of their viral infection? See additional information. Put a cloth cover over your mouth and nose before the paramedics arrive. If you’re getting treatment for your CLL, call your cancer doctor. They’re an important part of your immune system. During influenza season, any patient tested for influenza should have concomitant testing for SARS-CoV-2 as symptoms may overlap. In order to be clinically informative, such a database should include (1) patient characteristics, (2) specifics of the … Will your approach be different based on the type of therapy (BTKi, PI3Ki, venetoclax, antibodies, chemoimmunotherapy etc.)