How COVID-19 May Affect Patients on TKI Therapy for Chronic Myeloid Leukemia
Posted: Monday, April 20, 2020
On behalf of the European Haematology Association CML Scientific Working Group and the International Chronic Myeloid Leukemia Foundation, Delphine, Rea, MD, of Saint-Louis University Hospital, Paris, stated there are no data suggesting that chronic phase chronic myeloid leukemia (CML) or BCR-ABL tyrosine kinase inhibitors (TKIs) promote a higher risk of coronavirus disease 2019 (COVID-19) infection when compared with the general population. In addition, Dr. Rea advised against discontinuing TKI therapy—regardless of treatment status—to avoid adverse outcomes.
Patients who are newly diagnosed with CML are advised against delaying TKI therapy. Immediately starting TKI treatment may avoid disease progression to an advanced stage and worsening lung damage. However, patients should be monitored for the first 3 months to avoid cytopenia, which can increase the risk for severe COVID-19 infection. Patients currently on TKI treatment should not discontinue treatment for fear of relapse. Additionally, patients resistant or intolerant to current TKI therapy should be immediately switched to another regimen. Patients who are in treatment-free remission and have discontinued TKI therapy for less than 6 to 12 months are advised to consult with their oncologist to immediately resume treatment until the end of the pandemic. Routine monitoring schedules for patients on long-term therapy should be adjusted on a case-by-case basis, with decision factors incorporating time spent in therapy, response stability to treatment, low polymerase chain reaction results, prior resistance to TKI therapy, patient preferences, and incidence of COVID-19 cases in their area.
Exceptions to discontinuing TKI therapy include cases of severe cytopenia during early treatment stages, TKI-induced pneumonitis, and other types of iatrogenic lung damage. “In the presence of nonsevere confirmed COVID-19 or symptoms compatible with nonsevere COVID-19, systematic interruption of TKI treatment is not recommended. In case of severe COVID-19, TKI interruption should be discussed on a case-by-case basis,” Dr. Rea recommended.