CML and COVID-19: ASH Offers Answers to Frequently Asked Questions
Posted: Monday, April 13, 2020
To provide accurate information regarding the coronavirus disease 2019 (COVID-19) for patients with chronic myeloid leukemia (CML) and the health-care providers who care for them, the American Society of Hematology (ASH) has provided some answers to frequently asked questions regarding COVID-19 and CML.
- Treatment for newly diagnosed patients with CML should not be changed during the COVID-19 pandemic. According to ASH, there is no current evidence that any of the tyrosine kinase inhibitors (TKIs) approved as first-line treatments pose a higher or lower risk of acquiring SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) or worse outcomes.
- For patients who are asymptomatic and do not have documented infection with SARS-Cov-2, treatment for CML should not be changed. To date, there is no substantive evidence of immune suppression, increased risk of viral infection, or other effects that would increase risk from SARS-CoV-2 with TKIs used to treat CML. However, should patients develop pulmonary side effects such as pleural effusion and pulmonary arterial hypertension from TKI therapy and experience symptoms consistent with SARS-CoV-2 and/or test positive for the infection, recommendations suggest considering stopping CML therapy.
- If patients with accelerated phase CML are responding well to TKI therapy, they can continue treatment with proper monitoring. For patients with blast phase CML at higher risk of SARS-CoV-2 infection and complications (eg, older age and/or significant comorbidities), it may be advisable to use a TKI as a single agent, to minimize the risk of severe immunosuppression.
- Regular polymerase chain reaction monitoring (typically every 3 months) should continue for patients in remission. To minimize patient travel and exposure, remote testing (ie, a sample kit sent to patient or local provider, drawn, and returned by courier) is an option. However, patients with long-standing deep remission, especially those at higher risk for SARS-CoV-2 complications, can be considered for less frequent monitoring on a case-by-case basis.
- If patients with CML who are in treatment-free remission become infected with SARS-CoV-2, they should be managed the same way as the general population. Interruption of TKI treatment is not necessary for those with nonsevere confirmed SARS-CoV-2 or symptoms compatible with nonsevere SARS-CoV-2. TKI therapy should be stopped until the infection and adverse events are resolved in patients with cardiopulmonary toxicity due to a TKI who develop SARS-CoV-2 infection.
Disclosure: For a disclaimer from ASH regarding COVID-19 resources and the continual updating of accurate information, see hematology.org/covid-19.