Published on June 3, 2020
Doctors and researchers are learning that treatments for chronic lymphocytic leukemia (CLL) have shown promise in mitigating the effects of COVID-19, the disease caused by the novel coronavirus.
Bruton's tyrosine kinase, or protein, (BTK) inhibitors theoretically could have the effect of minimizing the respiratory problems associated with the illness, according to Dr. Kerry Rogers, a hematologist-oncologist at The Ohio State University Comprehensive Cancer Center in Columbus, Ohio.
“Part of what we are learning that makes this so much worse clinically for some people that get this infection is something called cytokine storm,” said Dr. Rogers in an April 15 webinar with Patient Power Co-Founder Andrew Schorr. “It's an immune activation that causes problems in the body, and it's in response to this virus.
“So, some of the treatments, not just the potential for use of BTK inhibitors, but things you might have heard of in the news like tocilizumab (Actemra) are geared toward blocking this immune inflammatory response, hoping that people won't get as sick if their immune system's not as activated.”
Unfortunately, the idea hasn’t been clinically proven, said Dr. William Wierda, deputy chairman of the Department of Leukemia at The University of Texas MD Anderson Cancer Center in Houston, Texas, who also participated in the webinar. He is in charge of the hospital’s CLL program.
“We don't know how well it works for the severe respiratory distress that some of these patients are in requiring sometimes ventilator support, et cetera,” he said. “We don't know how well it is in terms of modulating that process.”
During the webinar, Drs. Rogers and Wierda discussed other COVID-19-related issues in connection with CLL, including the idea that patients receiving intravenous immunoglobulin, or IVIG, may eventually get transfusions containing antibodies for the SARS-CoV-2 virus. That could protect them from infection.
The immunization would be a passive effect, since immunoglobulin is pooled from people donating blood and passing on antibodies.
“There is work right now, and we've heard from the FDA director, Steve Hahn, about trials with hyper-immune plasma from individuals who've recovered from COVID being used as a therapy for COVID infections,” Dr. Wierda said. “You may have what's called passive immunity by getting antibodies against COVID if the preparation of IVIG that you get includes plasma from a donor who's had a cleared infection from COVID.”
Drs. Rogers and Wierda both reiterated the warnings of other doctors and specialists that cancer patients are at greater risk of infection of the novel coronavirus and developing complications from it, regardless of their treatment.
Both suggested scaling back treatment in the form of in-person doctor visits or infusion appointments.
“All of the treatments that people can get … all of them impact the immune system in various ways,” Dr. Rogers said. “I do think that the duration you've been on it does affect how your immune system is impacted, by the treatment, but I would never say that there's a time where that doesn't have an impact on the immune system, or everything is perfectly fine.”
However, they both noted that work already has begun on helping CLL patients around the world via the exchange of information of those with COVID-19 and preparing for a potential “second wave” of the outbreak.
“There are several of us who are communicating and collecting data, and those data will be summarized and reported,” said Dr. Wierda, who helps run the CLL Global Research Foundation.
“It's not been through the global foundation. It's really more been the community itself coordinating and saying, ‘Oh, can we share information about patients that we have with CLL, and how they're doing, and what are our practices and approaches that we're using for our patients, what's working, what's not working?’” he added. “It's much easier to do that these days than it was 10, 20 years ago, because we have the Internet, and we have emails. It is ongoing.”
Drs. Rogers and Wierda acknowledged that this is a difficult time, especially for people with CLL who are potentially at higher risk for severe COVID-19 infection.
But they said we will get through this.
“I think it's important to listen to the doctors, listen to the science,” Dr. Wierda said. “It's important to do the clinical trials that we need to do that shows that treatments are actually effective. I think it's going to be a while before we get back to a new normal, but there will be a new normal, and we’re here for our patients. That’s for sure.”
Visit Coronavirus: Separating Fact From Fiction for CLL Patients to watch the full webinar and read the transcript.
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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