Posted: Tuesday, November 8, 2022
According to research presented at the 2022 Society of Hematologic Oncology (SOHO) Annual Meeting (Abstract EXABS-181-CLL), supportive therapy may strengthen the immune system of patients with chronic lymphocytic leukemia (CLL), but it does not eliminate their risk of developing complications. Although immunizations and other targeted therapies may mitigate the risk of infection, patients remain vulnerable to conditions for which there are no therapies, such as second primary malignancies and autoimmune cytopenias.
“As treatment options continue to improve, the morbidity and mortality associated with immune dysregulation may eventually outweigh [those] caused directly by CLL,” noted Clare Sun, MD, of the Hematology Branch of the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Vaccinations, passive immunizations, and prophylactic antimicrobial treatments are used to improve patients’ immune systems. Passive immunizations, such as immunoglobulin replacement therapy, monoclonal antibodies, and convalescent plasma, may also bolster immune responses to specific infection types, such as SARS–CoV-2 or infections resulting from hypogammaglobulinemia. This approach is useful because of the poor antibody response patients may experience after receiving a vaccine, noted Dr. Sun.
Except for live attenuated vaccines, which have the possibility of resulting in viral replication and infection, vaccine schedules are recommended for patients regardless of typical age-based timelines. However, vaccines generally result in a weaker immune response among patients receiving treatment such as Bruton’s tyrosine kinase inhibitors than in those who are treatment-naive or on active surveillance. For this reason, vaccine deferral may be considered for some patients based on the type of treatment they are actively receiving. Patients on active treatment may undergo prophylactic antimicrobial treatment for infections related to certain treatment types, such as herpes zoster, which is associated with fludarabine therapy, Dr. Sun continued. Prophylaxis is also recommended for patients who receive anti-CD20 monoclonal antibody treatment, which can result in fatal reactivation of hepatitis B, and other high-risk patients.
Disclosure: Dr. Sun is supported by the Intramural Research Program of the National Heart, Lung, and Blood Institute, National Institutes of Health.