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Are Waldenstrom Macroglobulinemia Patients at Higher Risk from COVID-19?

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Published on September 23, 2020

Will Waldenstrom Macroglobulinemia Patients be Candidates for the COVID-19 Vaccine?

What is the risk to Waldenstrom patients from COVID-19? Dr. Jorge Castillo, Clinical Director of the Bing Center for Waldenstrom Macroglobulinemia, Dana-Farber Cancer Institute, Boston, joins Patient Power Co-Founder Andrew Schorr to discuss how a Waldenstrom macroglobulinemia patient's current treatments affect their risk from COVID-19. Dr. Castillo discusses the possibility of a vaccine and under what conditions a Waldenstrom patient would be able to be vaccinated. Click to hear the full discussion.

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Transcript | Are Waldenstrom Macroglobulinemia Patients at Higher Risk from COVID-19?

Andrew Schorr:
Hello and welcome to Patient Power. I'm Andrew Schorr. We're visiting, on behalf of the IWMF, a speaker who was at their annual conference speaking virtually and that's Dr. Jorge Castillo, who is the Clinical Director for Waldenstrom's at the Dana Farber Cancer Institute in Boston.

Are Waldenstrom Patients at Higher Risk From Covid-19?

Dr. Castillo, I have to ask you, we're doing this program during the coronavirus, COVID-19 pandemic. You've been through it in Boston, where you are, and someone with Waldenstrom's is likely to say, "Well, what about me living with this condition? I'm at higher risk of getting it. Am I at higher risk of having severe complications because I'm living with Waldenstrom's?" What do you say?

Dr. Castillo: So as we approach the treatment of Waldenstrom's in a personalized manner, I think we should also approach the risk towards developing COVID-19 or catching COVID-19 and actually developing a bad outcome from COVID-19 in a personalized manner, too.

Different Stages of Waldenstrom

Patients have... They're at different stages in their disease and it goes all the way from the patient who is recently diagnosed, never treated, to the patients have received multiple treatments, for the patients who are in active treatments, for the patients who have received many, many treatments, right? So I think the immune system of the patients with Waldenstrom's basically deteriorates over time. I think because of the disease and the time spent with the disease, living with the disease. Number two, the number of treatments that patients do receive. And obviously at the time in which you're receiving an active treatment, then your immune system is also affected.

So there are different levels in ways in which these conditions and situations can affect the patients and the risk of catching and developing bad outcomes from COVID-19. The patients who are recently diagnosed are probably going to be on the best side of things. I think their immune systems are probably less affected by the disease. Their bone marrows and there are other parts of the immune system are less affected by the treatments received. So, I think those patients are probably almost at a level that pretty much anybody else will be in terms of the risk of catching this infection.

I think that patients who might be at a little higher risk are the patients who are actively on treatments. I think those patients, for example, the patients who are on BTK inhibitors, Bruton Tyrosine Kinase inhibitors, I think the risk is probably minimally increased. I think these conditions affect the immune system but when we compare it to, for example, how rituximab (Rituxan) affects the immune system, I think BTK inhibitors affect the immune system just a little bit less degree, at a lesser degree than what rituximab does. And that really jumps up a lot when we talk about chemotherapy.

Chemotherapy and Waldenstrom Risk

I think patients who are on active chemotherapy treatment are at a much, much, much higher risk. So my sense is, if somebody is receiving chemotherapy, with or without rituximab, I think those are the patients who need to be extra careful in terms of the contact with other people, in terms of staying at home, avoiding exposures, because the risk of catching and developing a bad outcome is much higher.

Waldenstrom Patients and the COVID-19 Vaccine

I think a vaccine is on the way, which I think is very hopeful, probably for the first quarter of 2021. And obviously depending on the features of the vaccine, then we will either recommend or not recommend the vaccination for patients with Waldenstrom's. My sense is that as long as the vaccine is not made of a live virus, our patients should be able to get it. The efficacy might not be a hundred percent because of the immune system and all that. But I don't think there would be a safety issue with this vaccine. So in my mind, I think our patients could potentially benefit from these interventions.

Andrew Schorr:
Well, thank you for explaining that. And admittedly, and I think you said it, we just don't have the data. Do we have worldwide data on Waldenstrom patients and coronavirus or the complications of COVID-19? We don't. So it's a discussion with your doctor and hopefully, people are remaining safe, so they don't even go there.

Dr. Jorge Castillo, thank you so much for discussing this very current issue with you and we wish you the best and the best for all your patients. Thank you for being with us.

Dr. Castillo:
Thanks, Andrew. Thank you very much.

Andrew Schorr:
Okay. I'm Andrew Schorr. Remember stay safe and knowledge can be the best medicine of all. 


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