How We Manage Patients With Chronic Lymphocytic Leukemia During the SARS‐CoV‐2 Pandemic

Abstract

Infections are a major cause of morbidity and mortality in patients with chronic lymphocytic leukemia (CLL). These can be exacerbated by anti-leukemic treatments. In addition, the typical patients with CLL already have fragilities and background risk factors that apply to the general population for severe COVID-19. On these bases, patients with CLL may experience COVID-19 morbidity and mortality. Recurrent seasonal epidemics of SARS-CoV-2 are expected, and doctors taking care of patients with CLL must be prepared for the possibility of substantial resurgences of infection and adapt their approach to CLL management accordingly. In this Guideline Article, we aim at providing clinicians with a literature-informed expert opinion on the management of patients with CLL during SARS-CoV-2 epidemic.

Acute Immune Signatures and Their Legacies in Severe Acute Respiratory Syndrome Coronavirus-2 Infected Cancer Patients

“…These findings may explain conflicting clinical observations over the impact of anti-CD20 therapy on COVID-19 + patients ( Gianfrancesco et al., 2020 ). Our data support caution in the use of anti-CD20 mab in chronic lymphocytic leukemia ( Rossi et al., 2000 ) or in indolent lymphomas, especially in those situations where the risk benefit ratio is already established as only marginal. Where such treatments are essential to ensure optimal treatment, patient management should accommodate the potential for prolonged virus infection and transmission.…”

COVID-19 severity and mortality in patients with chronic lymphocytic leukemia: a joint study by ERIC, the European Research Initiative on CLL, and CLL Campus

“…The presence of three or more comorbidities was not significantly different in patients hospitalized with severe versus nonsevere disease; moreover, the presence of hypogammaglobulinemia, a frequent laboratory finding in CLL, did not show a relevant impact on the clinical course of COVID-19 patients, probably underscoring the relevance of the inflammatory reaction rather than the viral replication (and the capacity to clear it by antibody-mediated immune response) in shaping the severity of the disease. The potential impact of CLL-specific treatments on the course of COVID-19 still needs to be fully elucidated, with international guidelines suggesting careful evaluation of pros/cons of treatment interruption, in particular in patients on targeted agents [20]. Taking into consideration the potential long-term effect on the immune system and the risk of infections (up to 12 months) particularly for patients treated with CIT, we grouped together patients who were on ongoing or had received recent (<12 months) therapies vs patients with no treatments in their lifetime or in the past previous year.…”

Immune Dysfunction in Patients with Chronic Lymphocytic Leukemia and Challenges during COVID-19 Pandemic

“…When treatment is indicated as defined by IWCLL guidelines, the treatment should not be postponed, but individual considerations during pandemic may justify a deferral [ 36 ]. As proposed by an expert panel, the decision about delivering treatment should be primarily influenced by the tempo of SARS-CoV-2 epidemiology (measured by the reproduction number), the local situation of the hospital, and the potential therapeutic benefit of the antileukemic therapy [ 89 ].…”