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What Should Acute Leukemia Patients Know About the Coronavirus?

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Published on April 13, 2020

Key Takeaways

Experts Dr. Naval Daver and Dr. Tapan Kadia, both from The University of Texas MD Anderson Cancer Center, discuss how care is being modified for patients with acute lymphoblastic leukemia and acute myeloid leukemia in the era of COVID-19. 

Watch to hear their perspectives on treatment, immune function, testing for coronavirus and more. The doctors also share safety tips for care partners, who may still have to go out, to minimize risks for their loved one. 

[Due to extreme load on our website and Zoom platform, viewers may experience a time delay between the audio and video of the interview - please note the transcript can be read below.]

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Transcript | What Should Acute Leukemia Patients Know About the Coronavirus?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on April 9, 2020

Andrew Schorr:
Welcome, I'm Andrew Schorr from Patient Power. Thank you for joining us for this live webinar. As we discuss, in this time of the coronavirus, acute leukemias for families affected; patients and care partners. Joining us are two noted experts in acute leukemias at The University of Texas MD Anderson Cancer Center in Houston, Texas. And we'll have them pop themselves on. They're just going to start their video, and we'll get them on. We're going to have with us, there's Dr. Naval Daver , and he is joining us, and then also we have Dr. Tapan Kadia, who's joining us as well, and he's going to pop himself on, and here he comes.
 
Hello and unmute yourself there, Tapan. There we go. All right, great. We're going to be taking your questions, folks, as we do this because acute leukemia is, as I've described in other programs, a five alarm fire. I think you, our viewers, know that better than anybody and the doctors know, how has that affected treatment concerns, risks of getting the virus, risks of complications if you get it, family issues, we're going to deal with all that. So first of all, Dr. Daver, let's begin with you. First of all, could you give us your title from MD Anderson and your area of specialty?

Dr. Daver:
Sure. Yeah. My name is Naval Daver, I'm Associate Professor in the Department of Leukemia here at MD Anderson, Houston, Texas. And I focus on clinical trials in AML, MDS and we also treat different leukemias, all kinds of leukemias.

Andrew Schorr:
Okay. And, Dr. Kadia, how about you?

Dr. Kadia:
Hi, everyone. My name is Tapan Kadia. I'm currently Associate Professor in the Department of Leukemia also at MD Anderson. I work with Dr. Daver. I specialize in clinical trials, developmental therapeutics in acute leukemias, AML primarily, but also bone marrow failure syndrome. Happy to be here.

Andrew Schorr:
Okay. And maybe you could tilt your camera down a little or sit up a little bit. We just want to get a good look. There you go.

Dr. Kadia:
There you go.

Andrew Schorr:
All right. We're doing this live, folks, and the doctors have been pulled in a lot of directions. Dr. Daver, let me start with you and also for our audience, before I forget, you can hit the Q&A button and send a question to us, and our producers will send it on to me if you haven't already sent one. But the big question, Dr. Daver, is, “Are people with acute leukemias, whether they are currently in treatment or even if they've been treated previously, at higher risk for the virus? And maybe complications that could follow?”

Dr. Daver:
Yeah, I think without any solid data yet out there for leukemia specifically, my concern is, and we all are concerned about this at MD Anderson, is that there will be higher risk because of the immunosuppression to contract the virus, but even more so that there will be a higher risk of having poor outcomes. And there is a study that was published from the group in China where they published in a very high impact journal, 18 patients who had a history of malignancy. Majority of these were solid tumors, and the majority actually had completed their surgery, radiation, chemo three months before they contracted the COVID. And actually 45 percent of those patients required a ventilator or had mortality. So this is almost 10 times the 3 to 5 percent that was seen in healthy non-cancer patients. So we're very worried for our leukemia stem cell patients, even those who are in remission 6 to 12 months out that they could be quite high-risk population.

Andrew Schorr:
So, Dr. Kadia, let me just make sure we understand that. Maybe you could echo that. Even we had a gentleman write in, he’s 77, treated for AML. Everything's normal now, his counts are good. He feels strong, was successfully treated, but it sounds like he still has to be very cautious as an AML survivor, right?

Dr. Kadia:
Absolutely. I think it’s just echoing what Dr. Daver said, I think patients in cancer in general, and in particular those with hematologic malignancies like AML and other leukemias having inherent immune defect not only related to their disease, but also subsequent to the therapy that they get. So even though they're in remission, they have had a history of receiving several therapies. And their immune system in terms of the T cell and the other types of cells that are important in the immune system may be depleted but also may not be as functional. So there is definitely a concern not only that they'll contract the virus, which I think is contagious even to healthy people, but more importantly, what will happen after they get the virus, whether they'll encounter secondary infections, worsening pneumonias and poor recovery from their initial bout.

Andrew Schorr:

Dr. Daver, some people were treated as a child even, for ALL and there are younger AML patients too. And now maybe they were told they were cured, but now we're years down the road. So what about them? I'm thinking of millennials and people like that who at 3 or 4 or 5 years old were an ALL patient.

Dr. Daver:
Yeah, I mean, we don't know the degree of immunosuppression if there is any persistent immunosuppression at that time. But I think given that even healthy populations we're seeing can have very severe outcomes with this, I would just be very, very cautious. Even if you were cured 10, 20 years ago, I would advocate those patients should maintain the highest level of precautionshandwashing, wearing masks, minimize contact, minimize going outside. You just don't want to take a chance.

Andrew Schorr:
We had a question exactly about that, about wearing masks both for them or their care partner who may go out. So, Dr. Daver, what about that? First of all, it sounds like you want people to go out if they can avoid it, but they may have a family member who does, right?

Dr. Daver:
Yeah.

Andrew Schorr:
What about that interplay, if you will, with care partners?

Dr. Daver:
It's impossible for everybody to remain completely isolated, people have to get groceries, they have to go out for essential needs. I think we have to maximize whatever we can do, so I would say if possible, the partner, if able, should go out, so at least there's less risk to the direct individual. And then as soon as entering the house, one of the things that we're doing when we come from the hospital is we change our clothes right away before I touch my kids, before I touch my wife, and then I wash my hands thoroughly for really counting 20 seconds. I think this is the key. Almost never in our lives do we wash your hands for 20 seconds. It's quite amazing. You have to really count it and even take a shower potentially if you're coming from a grocery store. I think these are the things you can do. Mask, I recommend yes, everybody should wear a mask and the partner should wear a mask. The data seems to suggest it reduces it. We don't know the exact numbers, but yeah, I would do all of the above.

Andrew Schorr:
Okay. Dr. Kadia, acute means it's urgent, and so you have people sometimes with these conditions, and they go to the emergency room. They're feeling tired or whatever, and boom, they're in the hospital, because they've been diagnosed with acute leukemia.

Dr. Kadia:
Correct.

Andrew Schorr:
But yet we know the hospital is not really where you want to be now, because you may have COVID patients, et cetera. So, what about the treatment of the acute part of acute leukemia and the need for hospitalization, how are you handling that?

Dr. Kadia:
Yeah, very good point. I think this is one of the big challenges that we face. Like Dr. Daver pointed out, we like most of our patients to stay home isolated when they can. But when you have a disease like acute leukemia, it's not only the initial treatment of acute leukemia where you need to come to the emergency room, get hospitalized and remain in the hospital for a period of time, but to think about all the patients with AML or ALL who are receiving treatment, but then need to return frequently to the hospital for blood checks, for transfusions. They're constantly being exposed to medical environment where there are many, many other sick people. There are potentially many who are carrying COVID, either asymptomatic or even symptomatic. I think it's profoundly important for not only the patients but also their caregivers who are bringing them to the hospital to make sure that they use the gowns, the gloves, the masks that we are recommending to all people.
 
So, we recommend that they wear masks. We recommend that they watch which surfaces they touch and constantly wash their hands, have some hand sanitizer with them to make sure that they are constantly sanitizing their hands. Try to avoid being in places or areas where there are many people and if you are around people, to maintain a distance of 5 to 6 feet, because most of the transmission happens from air droplets that are most concentrated when someone coughs or sneezes within that 6 feet rule. At MD Anderson, for example, in terms of patients who get hospitalized, it is a tough time for cancer patients, because we are limiting the number of visitors that patients can get in the hospital. So our patients with acute leukemia, but also other types of cancers who do you get hospitalized, number one, they are typically not allowed to have a visitor with them.
 
So, you can imagine a person who's coming in potentially at the worst time of their life with a new disease have to come in alone and sit in the hospital room alone. Now granted, nurses are there, doctors are there, but their family, their support can't be there. So I encourage people to get to know Skype and FaceTime and all these other modalities to be able to communicate and have the support with them, because many hospitals do have these restrictions of how many visitors that are allowed in the hospital. In intense situations or in acute situations where there are life-threatening things, we do allow some of these visitors to come.
 
People who have traveled outside of the country or particularly even outside the state of Texas in terms of MD Anderson, many of them are required to be quarantined or cleared or tested for COVID before they come to the hospital. So the name of the game is here, keep your distance, make sure you're wearing protective gear, whether it be gloves, mask and constantly washing your hands, and then find ways to communicate and have that support—and maybe not with personal contact but with some of these video chats similar to what we're doing now.

Andrew Schorr:
But, Dr. Daver, the point is with acute leukemia, when hospitalization is required either initially or other visits to the hospital or even hospitalizations that have got to go forward, there's just no way around that, right, but with protection?

Dr. Daver:
Yeah. I think what Dr. Kadia is saying is spot-on, and we have to admit that, I would put in this terms, the risk of dying from acute leukemia untreated is probably higher than picking up COVID, and so we have to treat what is existing in front of us. If somebody has AML, has low counts, has infection or infection risk or high white count, we have to treat that. But when we're doing that, all the precautions that we can build in, whether it's within MD Anderson, where most of these people will be during their induction therapy, also maybe during the relapse or at home. So unlike many other solid tumors where they actually are trying to delay or defer elective new adjuvants or adjuvant therapy or even surgeries, in acute leukemia, we do not have that ability. We have to proceed with the treatment. And most of our patients, we are admitting them and keeping them in the hospital during that first cycle, which is what we used to do anyway for induction for AML and ALL.

Andrew Schorr:
Dr. Kadia, you and Dr. Daver and your colleagues they're very much involved in trials, but even more than that and anybody, whether in a trial or not, there are blood tests you want in certain amounting, maybe a bone marrow biopsy, whatever. So are you finding ways to do that for people closer to home, and are you communicating with local oncologists or other resources that are close to home so that that can happen in new ways?

Dr. Kadia:
Yeah. Great question. And indeed where we're actually dealing with this right now. As you pointed out, many of our studies and many of our therapies are on clinical trials, which require many patients to come to Houston to get special bone marrows and blood tests. But in this time of COVID where we are suggesting the patients stay home and not travel as much, we are working very closely with the sponsor to these clinical trials as well as the local physicians who are in the hometowns of our patients to help us manage these patients remotely.
 
So we're not only doing physical exams but getting the blood tests, sending the samples or the data back to MD Anderson, getting their bone marrows locally, sending the material or even the results back to MD Anderson, so we can still provide long distance care. It may not be optimal, but I think it's very good, and I'm really happy that we're able to collaborate with so many doctors and health professionals around the country to do this. So yeah, we are recommending in many of our patients who are not able to come to Houston to go to their local doctors and have a management experience that we do together.

Andrew Schorr:
So, Dr. Daver, that means a blood test or a bone marrow, some other kind of monitoring might happen close to home. The data would still come back to you as often investigator in a trial or the architect of the AML plan and there's this collaboration going on. Beyond that, you're doing telemedicine directly with patients too, right?

Dr. Daver:
Yeah, I mean, I think it's quite amazing, as Dr. Kadia was saying, how much we have learned through force, but maybe this will be in good stead for the future, can be done over telemedicine with patients. We are definitely doing that. We've been doing it on the telephone. We are also now doing it through video. And the patients are, in general, of course very, very happy they don't have to travel, but also how much local physicians are able to do under guidance from us. So we're shipping the oral component of many regimens, and then we're talking to local doctors to do the IV components, doing blood work and even bone marrow, which of course we always had to have the patients here. Now they're doing bone marrow locally and shipping it, and we're doing the molecular and flow cytometry. So in reality, what the FDA and the IRB at MD Anderson have given this permission and the data we're getting is actually going to be, I think, quite good. May not be complete gold standard, but quite usable for the clinical trials, yeah.

Andrew Schorr:
Okay. Dr. Kadia, let's talk about testing for COVID.

Dr. Kadia:
Sure.

Andrew Schorr:
First of all, what testing are you doing now of patients who come in related to—are you dealing with more than AML or more than ALL, but COVID as well, which we would worry about. And for all I know, maybe you've had some patients like that. So let's talk about that as people become inpatients and also let's talk about what testing you would want your patients to get as testing becomes more available in the community.

Dr. Kadia:
Great question.

Andrew Schorr:
COVID testing.

Dr. Kadia:
Yeah, thanks for this question. I think just to start off, I'd like to describe the types of tests there are, right? There are two general types of tests that we're able to do. I think the first test is testing for the virus, which is called a PCR or a preliminary chain reaction of the actual virus. The virus is an RNA, which is a type of a nucleic acid, and you can actually detect that with very good sensitivity in patients. And so the test usually involves a nasal swab that goes pretty far back into your nose, almost into your brain, people joke about, but pretty far back. They get a swab of that, and they send it to the lab to get rapid turnaround. Now, our turnaround used to be in the range of four to five to six days, but over just the past few weeks, that timeline has reduced significantly.
 
So now we're getting tests back within 24 to 36 hours of testing where we get a result whether the patient is either positive for the virus or not positive for the virus. So that tells you whether the patient is infected with the virus, which is the COVID-19 or the SARS-CoV-2.
 
The second type of test is actually fairly new and may not be available everywhere, but it's often called a serology test or a test of the antibodies that the patient has against the coronavirus. And what that tells us is that A, is the patient developing antibodies against the coronavirus? And B, has this patient already been exposed to coronavirus unbeknownst to anyone and has developed an immunity of that? Okay, so we know that those patients may be immune and may not develop the symptoms and signs of the coronavirus infection. So those are the two sets of tests.
 
Now, who do we test? Ideally, like you said, we'd like to test everyone that walks in the door, but the availability of testing, the supplies, the reagents just aren't there. And so what we're doing now is anyone who comes into the ER with symptoms, whether it be fever, cough, shortness of breath, some chest pressure, anything that we think could be a cold or that type of a symptom, we test those patients. Anyone who is receiving chemotherapy, whether it be on or off protocol, if they're receiving intensive chemotherapy regimen, we do what's called a pre-chemo COVID-19 test. And the reason for that is we want to make sure that these patients aren't actively infected with coronavirus prior to giving them a very immunosuppressive regimen, which could potentially be catastrophic. And so those are sort of the big scenarios in general terms of how we're doing COVID testing and what COVID testing is.

Andrew Schorr:

Just a follow-up question, what about outpatient? So as testing comes available, let's say somebody lives in suburban Houston, you're in Houston, and there's more testing. Should patients who've had ALL or AML or been treated, should they line up first to get tested to know, are they walking around with the virus?

Dr. Kadia:

Not necessarily, I think at this time I wouldn't encourage people asymptomatic to go get tested if they're feeling fine or otherwise doing well. I think it's more important to stay quarantined in place, isolated from other folks. Because as you're going through these testing places, there are going to be other people there. Ideally, someone who's going to have COVID and transmit it to the rest of them. So, I think in an asymptomatic patient, even if they've had previous AML or ALL or CML and CLL, I would not encourage them to go get testing in an asymptomatic manner.
 
Now, in the outpatient setting, we do see people in clinic who come in with cough and things like that. And we may test them and if they're positive and otherwise doing well, we often actually send them home and ask them to recuperate—and if their symptoms worsen, to come back into the hospital.

Andrew Schorr:
Okay. Let me just mention again to our audience that if you have a question, hit that Q&A button at the bottom of the screen, and you can send us a question. Dr. Daver, let's talk about treatments that people may have and how it affects their immune system. We've referred to inpatient treatment, but also many people now are on outpatient treatment. Now, could be an infusion close to home, not at MD Anderson, but it also could be a pill or a series of pills. So what's the story with that, does it reduce your immunity, or does it even improve your immunity? What do we know?

Dr. Daver:
Yeah, I mean this is a very nice time for AML therapy in that way that we have in the last two years only, a lot of oral therapies that are quite effective. So we have three inhibitors, two of them IDH inhibitors, a very effective drug called venetoclax (Venclexta). And we are using all of these drugs that we have in our arsenal and using them, I think even more now, because either we're able to ship them, or they're available locally. And we can usually give these in combination with low intensity therapy at home and at least buy time if not actually get the patient in remission with that.
 
Now, most of these drugs are immunosuppressive at different levels. They're not as immunosuppressive in high intensity chemo or stem cell, but we do know that most of these reduce the neutrophil count, some more than others. And we also know that they also impact the immune system and make people more likely to have infections. So I think one should not have the false comfort or confidence that because it's a pill, it doesn't impact my immune system. We have pills that can be very, very potent immunosuppressive agents.
 
So, they're good, because they minimize travel. They're probably less immunosuppressive than high-dose chemo, but they're still going to be risky in the COVID era. So one has to still take all the same precautions that you would be taking with traditional chemotherapy or stem cell transplant.

Andrew Schorr:
But not necessarily dose reduction. You stay on your therapy.

Dr. Daver:
Yeah, that's a good question. We've had a lot of discussion and I think if you speak to people in New York that we have been talking to a lot, that answer will be different from what we're giving. They have actually started making changes in the selection of their therapy for patients, even younger patients based on what is going to be most tolerable, because the risk of getting COVID is extremely high there. And if somebody is on a high-dose chemo or transplant, we expect mortality rates of 70 to 80 percent or more.
 
So they have actually started using lower intensity therapies, reducing doses. We have not done that yet in Houston. We don't have—and we hope we will not have—the same numbers, so we're continuing the standard doses. We're selecting treatment based on what is best for AML. If they deserve to be high intensity induction, we're doing that in the appropriate setting. If they should be on a targeted low intensity, we're doing that without production, but that's because we don't have that many cases. So for now, no changes. But this may be different in a month or so.

Andrew Schorr:

Dr. Kadia, we got a question actually that relates a lot to that and says, “Have the experts seen AML post-transplant patients with COVID and if so, how have they done?” What about in Houston, or what are you hearing, Dr. Kadia?

Dr. Kadia:
Very interesting. We see a lot of AML patients. We see a lot of ALL patients, we see all kinds of leukemia patients. We have not yet seen the patients with acute leukemia and COVID-19 here at MD Anderson. And that's unusual. Why is that? I mean, we've seen patients with CLL and some patients with myeloma, with lymphoma, and I think it actually has to do with just what we tell our leukemia patients when they get treated. I think that if you think of an AML or ALL patient getting therapy, it is usually myelosuppressive. We usually tell them to wear a mask, wash your hands, stay away from sick people, don't go to crowded areas. And I think they've been following what they've been following for their acute leukemia treatment and as a result, they haven't been exposed as much to the COVID-19 virus as many of our other ambulatory patients are, such as those with CLL or myeloma who may not be using some of these. So we have not yet seen an acute leukemia patient with COVID in our center. I don't know if Dr. Daver has seen one, but I don't think I’ve see any.

Andrew Schorr:
Dr. Daver?

Dr. Daver:
No, acute leukemia, we have not. It's been CLL, myeloproliferative diseases, myeloma, I think, yeah. Like Dr. Kadia said.

Andrew Schorr:
And in these other conditions, just to understand where somebody said hematologic condition, the combination of the hematologic condition, often older patients, sometimes co-morbidities—that is not good, right?

Dr. Kadia:
Not good. No. I think as you point out and as we've seen in the news and the literature, it's the older patients with co-morbidities and potentially a declined immune system are the patients who are getting the sickest and that are having mortality and death related to the COVID-19. But then again, if you think about just the average age of the diagnosis of AML, it's about 68 years of age. And so most of our patients are older. And so from that perspective, I think we really have to be wary of what can come.

Andrew Schorr:
Dr. Daver, in some areas of acute leukemia, immunotherapy is moving ahead. Some people I know where they are even now wearing a little a fanny pack and having infusion and stuff like that. So all that's moving forward, some of these newer therapies?

Dr. Daver:
Yeah, that's a great question. As you know, I do a lot of the immunotherapies for AML specifically. And this is an area of big concern for us. The COVID initially when the reports came, people thought the death was directly from the viral cytopathic effect or the virus causing organ damage. Now there's a huge amount of data that really shows that it's hyperactivation of the immune system, hyper-inflammation, activation of components like macrophages, T cells, which are normally good cells protecting from infection, but they're hyperactivated.
 
And when we use immunotherapies, whether it's drugs like checkpoint inhibitors or other immune component activators or CAR-T cells, we're actually doing the same thing. So we're very worried that when we activate the immune system and if that patient were to get COVID, they may have a much more exaggerated or ramped up response to the COVID hyperinflammation. So we are trying to avoid enrolling too many people and maybe controlling the enrollment to the immunotherapy. There's not much hard data. There are a few case reports from China, Korea showing maybe some people have bad outcomes on some of the immunotherapies, but I'm a little concerned, and we're not studying new patients on immunotherapies at this time if we have some other options.

Andrew Schorr:
Dr. Daver, you and I have talked about another area of medicine where you treat patients in myeloproliferative neoplasms, not acute, and I have one myelofibrosis. I've heard some wisp that some of the drugs that inhibit cytokines, if you will, the JAK inhibitors might have some place at least to be tested, whether they could tamp down the immune response that caused and could even lead to death with COVID. Any thought about that?

Dr. Daver:

Great question. We have a lot of thoughts, and we've discussed this many hours, both me and Dr. Kadia as well as our larger group as you know Dr. Srdan Verstovsek and a lot of other experts. There are about 40 trials in the U.S. already with all kinds of different agents from immune-enhancing, to immune-suppressive. It just shows people really don't know exactly what pathway will work. I think based on the biology, what we've seen, some people have done some very nice work looking at T-cell profiling, cytokine production, et cetera. It makes sense that a drug like ruxolitnib (Jakafi) could help. It does work in other disease that we treat called HLH or macrophage activation.
 
There's very little prospective data. So people are using that. As you know, there are other therapies people have been talking about such as anti-interleukin-6, this is another immune dampener but again, some have shown success, some have shown not. And we as in clinical trials like to look at the overall denominator and the success rate and really that is not published or available. So we try, if we heard a patient was really sick, probably yes. Do I feel confident as a clinical trial basis that this is highly effective? I would say not yet.

Andrew Schorr:

Dr. Kadia, both you and Dr. Daver are heavily involved in research, and MD Anderson is one of the top cancer research centers in the world. Some of your patients are on trials. So can that go forward, and can research go forward because everybody wants cure? Everybody wants a cure for AML, a cure for ALL. So can you all continue?

Dr. Kadia:

Yeah, absolutely. It's an important point. It's a tough time. When you're doing clinical research at the scale that many of us are doing it, you need infrastructure, you need research nurses, you need a data coordinator, you need the clinical trial staff to help engage patients and get them through the different tests, the different therapies, the data, et cetera. And so we have had a large operation with people. But in a time of COVID, I think one of the goals of the institution, not only us but other large institutions, has been to keep people safe. Not only our patients but also our employees that work with us, and so many of them are working from home. And as a result, we have had to cut down research, clinical research at MD Anderson by a certain percentage to make sure that we're keeping people safe and avoiding excessive crowds at the hospital.
 
That being said, there are still several, a large chunk of priority clinical trials that are trying to advance the field and moving things forward, like you said, that we have to keep up with for our patients, because there are no options in some cases. And so the guiding principle we've used and if there is a good standard of care option available, we don't have clinical trials in that particular area open at that time. But if there is an area of unmet need where there is a signal of good activity or great activity, then we will continue those clinical trials and keep those open. And we know that there are patients out there who need therapy for relapsed AML, relapsed ALL, myelofibrosis that the current therapies are not great. And so in those areas we are keeping things going with our skeleton staff. And I applaud all the people that are working from home and are always available. So we're pushing on, but slower.

Andrew Schorr:
Folks, if you have just one last question, hit that Q&A button and send it to our producers, including my wife, Esther. I just want to ask each of you as we get near the end of our time here, Dr. Daver, are you hopeful that science can help get us past this? I mean, we're doing what we have, but what do you think?

Dr. Daver:
Yes, I think the simple answer is yes. I don't necessarily think there's going to be therapy of COVID. I think that's a short-term goal for helping people who may get it. I think the long-term goal is either vaccines, which already many, many of them are going into trials. They're going to take six months to nine months at the earliest. The FDA is supporting them. Everybody's pushing them as hard as they can, but it's still going to take time. And then maybe in the short-term using serum serology. There are patients who've had COVID, majority actually do recover and when they recover they develop antibodies towards COVID. And there are some human tests now showing, again in small case-based reports, that you could use the serum or antibodies from somebody who's recovered from COVID, give it to an acutely ill patient and potentially save that person.
 
So I think these two approaches hopefully in the six to 12 month range will allow us to overcome it. I think the big question, a lot of experts have been talking about at the CDC and in the news is whether this is going to be a time-limited disease like the Spanish flu or whether this is going to be an annual or chronic occurrence. And I think this will potentially shape a lot of how we approach our trials when we resume doing things in the next four to six weeks.

Andrew Schorr:
Dr. Kadia, what about you, what's your thought? Because I have a chronic leukemia, but people with acute leukemia, any of us, they'll say, Oh, my God, what's the future going to be like for us, and can you guys solve it?

Dr. Kadia:
I think so. I'm actually very optimistic that science and collaboration are really going to help move things forward. I mean, if you look at the amount of collaboration that's happening now, not only in the country but around the world, just to try to tackle this COVID epidemic, we have people on conference calls around in countries; in China and from Japan talking to people here in the UK, the U.S., trying to understand number one, how COVID infects people. Number two, how can we attack the virus? How can we stimulate the immune system? How can we develop vaccines, serology testing, using monoclonal antibodies against IL-6, things like that to help things move forward?
 
So I think that definitely there's been a huge mobilized force of collaboration in science or around the world pushing forward to discover how we can slow this epidemic, stop the epidemic and keep humanity protected from here on. And behind that is the continued effort of all of us to focus on our own diseases and make sure that we keep research going and keep looking for cures and being ready, when the quarantine shuts down, being ready to start opening the trials in the research for all of us.

Andrew Schorr:
Right. Let me just recap some things before we go make sure I've got it right. So people who are in treatment or have been treated for an acute leukemia have to consider themselves vulnerable to the virus and vulnerable to complications, right, Dr. Kadia?

Dr. Kadia:

Yep. Correct.

Andrew Schorr:
Okay. And Dr. Daver, they should seek out and discuss with their specialists perhaps maybe through telemedicine, how some resources, testing, et cetera, could be provided to them close to home and how that can be coordinated, correct?

Dr. Daver:
Absolutely. Yep.

Andrew Schorr:

Okay. And let's hope people understand that all the precautions will be taken if you or a loved one needs to be hospitalized. You heard about the restrictions about visiting and sitting with the person you love if you're the care partner. It's tough, for sure, but I think you have healthcare providers like these specialists and their teams who are very committed. I want to thank both of you at MD Anderson and your colleagues around the world, working on acute leukemias for your devotion to the patient community and to advancing research. And we definitely thank you for your time being with us today.

Dr. Daver:
Thank you, Andrew.

Dr. Kadia:
Thank you, Andrew.

Andrew Schorr:
Thank you, gentlemen. We'll let you go. And I just want to mention to our audience that we will have a replay of this program with a transcript that will be available probably Monday, maybe Tuesday or so. So please tell others about it. Share. And I wish you well with your family. Be safe. Listen, there's some great information here, and really we will get through this. I'm Andrew Schorr, reminding you that knowledge can be the best medicine of all. Thank you for watching.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.
 
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