Published on August 31, 2020
What Does Treatment for Acute Lymphoblastic Leukemia (ALL) Look Like During the COVID-19 Pandemic?
For people undergoing treatment for leukemia, what does treatment currently look like? Can people with acute leukemia go into the hospital or clinic for in-person care? What safety protocols are in place to reduce risk of exposure? Dr. Gail Roboz from Weill Cornell in NYC and Patient Power host and advocate Ruth Fein discuss the early days of the COVID-19 pandemic in New York City and how cancer patients were kept safe. Dr. Roboz discusses how in-person treatments and clinical trials are moving forward safely during the pandemic. Watch to hear the full discussion.
Transcript | Acute Lymphoblastic Leukemia Treatment During Coronavirus Outbreak
Hi and welcome. I'm Ruth Fein. I'm a patient advocate for Patient Power and I'm here with Dr. Gail Roboz to talk about an acute blood cancer, adult ALL and COVID. ALL is acute lymphoblastic leukemia or lymphocytic leukemia. Dr. Roboz is Director of the Clinical and Translational Leukemia Program at Weill Cornell Medical Center in New York. So first, welcome Dr. Roboz.
Thank you very much. Great to be here.
Thanks. Give us a hint, since we'll get into COVID in a minute, but give us a hint... what's it like? You were in the epicenter of chaos for so long. What was it like and what is it like?
March and April were horrible, scary, diehard New Yorker here watching pop-up hospitals go up in Central Park, watching the streets be deserted, everything closed. It felt like we had a patient on a ventilator in every bathroom in the hospital. It was horrible. I'm happy to say that things are looking much better now. The number of COVID cases has dropped down dramatically. We are back to up and running in all of our other clinical programs. Clinical trials are back up and running again, and generally much, much, much better in New York, thank God.
How has COVID-19 Affected Treatment for ALL Patients?
COVID-19 is obviously on everybody's mind. What's your COVID experience been like with ALL patients?
I've been asked throughout the pandemic, I've probably done I don't even know how many webinars and informational sessions on COVID because obviously we have been the epicenter, and everybody wanted to know what to do. And there have been some very important shifts in thinking. So, I think at the beginning when we really were unsure, is this Ebola? Does this have a 97% death rate? What are we looking at here? I think the thinking was that there might be a need for paradigm changes in cancer therapy. And actually, I think that's no longer the case. We want to cure the curable. If we have patients with ALL or with other types of cancer who have curable diseases, we want to do everything possible to stay on that curable path. And I think that even in the height of the pandemic we were trying to do that, but we definitely made adjustments in bringing people into the centers.
So for example, with ALL patients, for older patients who were in remission already, we absolutely did do some delays and in post-remission cycles to avoid bringing them into the hospital, because again, we feel that for older patients we really had to be careful about, what are we offering for a cure versus the chances of getting infected? For the younger patients what we noticed was many of the patients actually had persistent COVID positivity for weeks after having been diagnosed with the virus. So, we didn't really know what to make of that. And there were some delays in therapy because the patients were persistently PCR positive. This is an interesting area because we didn't know back then whether it would be safe to start the next round of chemotherapy versus not. For right now, the practice is to actually test patients for COVID before they are getting intensive portions of therapy.
If there is any reason to believe that they have active disease, we are delaying a little bit to make sure that the COVID itself doesn't become very active right as we're starting chemo, but basically the plan is cure the curable, give the patients the therapy that they need. And certainly in the height of the pandemic, we were actually keeping patients in the hospital rather than having them go back and forth because the travel back and forth might have been dangerous. Currently in New York, we are pretty much back to normal and telling people that they need to stay very rigidly on their ALL protocols, because for many of the patients, delays, especially in younger patients, could actually worsen outcomes. So, right now we want to keep people on track and stay on their path even if it means a STEM cell transplant, we are up and running for STEM cell transplants and bringing people in on schedule.
Do patients appear to be at a greater risk for contracting the virus?
So, I am asked this question about 45,000 times a day, that am I at a higher chance of getting the disease because I have an underlying hematological malignancy, A and B, is it going to be worse? And the answer is, we don't know yet. We are trying. The world is working hard on this and scrambling. Hematologic malignancies in adults are rare, myeloproliferative diseases, CML, ALL, these are not common diseases and we are trying very hard in the epicenter sites to put together data that allows us to have some statistics. But, I can certainly tell you, it is absolutely not the case that a person with an underlying hematologic malignancy will die of COVID if they get it. We thought that in the beginning that if you have that type of an underlying disease there's no way they'll survive the virus, not true.
We have patients with acute leukemias, we have patients with chronic myeloid leukemia, chronic myeloproliferative diseases, lymphomas, who can survive COVID. So, that shouldn't be a blanket statement that if you get it you're necessarily going to do poorly, not true. Also, we thought that patients would have to stop all of their therapies, not sure of that at all. There may actually be therapies, for example, you have an MPN, patients on ruxolitinib (Jakafi), weren't sure whether to start or not, meanwhile ruxolitinib might be a potential treatment for COVID. So, we don't really know what to do. But I would say getting COVID it is not so much fun, try to take precautions.
Patients with compromised immune systems and with hematologic malignancies should be careful. But at the same time, it cannot be said that those patients are more likely to get it. And at the moment, it's not a hundred percent sure that for patients in remission or for patients with stable disease that even if they do get it, are they more likely to have worse outcomes than the standard population. We actually don't know that yet. We do know there have been certain reports that patients with advanced stage cancer who are hospitalized do have a difficult time when they get severe cases of COVID. That said, those were looking at very sick patients with advanced disease who were already in the hospital.
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