CLL Coverage from Every Angle

Expert Recommendations for CLL Management During the COVID-19 Pandemic

By: Julia Fiederlein
Posted: Tuesday, August 31, 2021

Romeo Gabriel Mihaila, MD, PhD, of the Lucian Blaga University of Sibiu, Romania, outlined expert recommendations for managing patients with chronic lymphocytic leukemia (CLL) during the COVID-19 pandemic. The literature review, published in the journal Oncology Letters, highlighted those therapeutic decisions should be personalized to each patient.

The American Society for Hematology recommended testing patients with mild clinical manifestations of COVID-19 infection. It is common for treatment to be delayed, if possible. In patients who require immediate initiation of therapy, the treatment scheme should be adapted to their distinct characteristics; it is recommended to use drugs that can be administered in an outpatient setting. Treatment with monoclonal antibodies and venetoclax should be avoided in these patients.

For patients who are not infected with COVID-19, it is recommended to continue administering intravenous immunoglobulin if they have a history of hypogammaglobulinemia and active or numerous severe infections. Patients with COVID-19 may continue intravenous immunoglobulin therapy; however, they should be closely monitored for possible thromboembolic events, Dr. Mihaila suggested. For monitoring, stable patients with CLL should use the laboratories closest to their home and telemedicine to reduce the number of visits to the clinic.

If outpatients with COVID-19 experience mild symptoms, it is not recommended to change the CLL therapy. In patients with more severe clinical manifestations, the individual’s personal history of CLL and potential risk of serious COVID-19 complications should be considered before changing treatment. The decision to continue or cease treatment should be established according to the particularities of each case. Patients with COVID-19 should discontinue monoclonal antibody therapies.

“[The American Society for Hematology] has developed a COVID-19 registry for [patients with onco-hematologic diseases],” the investigators commented. “[This] may assist in improving the treatment of these patients.”

Disclosure: The study authors reported no conflicts of interest.

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