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Managing CLL in the Era of COVID-19: Guidance From Global Experts

By: Joshua D. Madera, MS
Posted: Wednesday, September 30, 2020

The ongoing COVID-19 pandemic may require clinicians to modify their management strategies for patients with chronic lymphocytic leukemia (CLL), according to an article published by global experts from the United States, UK, Switzerland, Germany, Spain, and Italy in HemaSphere. This patient population is at an increased risk of developing SARS-CoV-2–related morbidity and mortality; therefore, appropriate intervention is necessary, according to Paolo Ghia, MD, PhD, of the IRCCS San Raffaele Hospital, Milan, and colleagues.

To minimize the risk of community and nosocomial infection by SARS-CoV-2 in patients with CLL, the experts recommended delaying cancer treatment until the COVID-19 pandemic is better controlled. However, for patients who require immediate treatment, systemic therapy that requires fewer visits to the clinic would be preferred. Bruton’s tyrosine kinase inhibitors should be administered as first-line treatment, but patients who cannot tolerate them should be given ibrutinib or acalabrutinib and venetoclax.

For patients currently undergoing antileukemic therapy amid the pandemic, they should be consistently monitored for the development of COVID-19–related symptoms. These symptoms may include myalgia, chills, shortness of breath, coryza, cough, fever, or sore throat. If these symptoms are observed, patients should immediately be transported to isolation and evaluated accordingly. A positive COVID-19 diagnosis should lead to termination of therapy and administration of remdesivir, the experts indicated. When patients are asymptomatic for 48 hours, have received two negative real-time polymerase chain reaction tests 1 week apart, and 2 weeks have passed since the beginning of symptoms, treatment for CLL should be resumed.

“Doctors taking care of patients with CLL must be prepared for possible outbreaks of the infection and adapt the management of patients with CLL accordingly, by reintroducing strict preventive measures during SARS-CoV-2 reappearance, while relaxing them during the post-epidemic period until virus extinction,” advised the study authors.

Disclosure: For full disclosures of the study authors, visit journals.llw.com.



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