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COVID-19 and Understanding Impact for Elderly CLL Patients

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Published on April 2, 2020

Key Takeaways

  • It may be possible to have blood drawn at home.
  • Because coronavirus is new, and there won’t be antibodies present, intravenous immunoglobulins (IVIG) are not going to provide protection from COVID-19.

Leading expert Dr. Alessandra Ferrajoli, from The University of Texas MD Anderson Cancer Center, reminds chronic lymphocytic leukemia patients that while practicing social distancing during the coronavirus pandemic can feel difficult, this is “a temporary isolation."

Watch as Dr. Ferrajoli shares some recommended precautions and guidelines for managing CLL treatment, routine testing and IVIG during COVID-19. 

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Transcript | COVID-19 and Understanding Impact for Elderly CLL Patients

Recorded on March 26, 2020

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.

Andrew Schorr:
Hello and welcome to Patient Power. I'm Andrew Schorr and with us once again is a leading expert in chronic lymphocytic leukemia from The University of Texas MD Anderson Cancer Center in Houston, and that's Dr. Alessandra Ferrajoli. Doctor, thank you so much for being with us once again.

Dr. Ferrajoli:
Thank you for inviting me, Andrew. It's always a pleasure.

Andrew Schorr:
So, doctor, for many older people, elderly people with chronic lymphocytic leukemia, that's worrisome enough, and they have anxiety. And although there's been progress with many therapies that you and I have talked about before, oral therapies that you can take at any age, now we layer the COVID-19 coronavirus on top of that. So could we talk about some of the issues that relate to that? For instance, people, may be some are living alone, the idea of staying at home and that when you have CLL, you may be particularly at high risk for getting the virus and complications, correct? 

Dr. Ferrajoli:
Correct. So we are recommending for our patients with CLL, and particularly for our older patients with CLL that have two risk factors, the disease that gives some immunosuppression, some compromised immune system plus the fact that the data from China show that older patients, older people in general are more susceptible to complications from this infection. We are recommending for them to be particularly careful. What we are recommending to all our patients is try to avoid as many contacts as possible. We would like for them to stay home. We would like for them to be exposed to a very small number of family members or friends, because the way to look at it and what the CDC is really recommending is that every time you add one contact, you're actually not adding one contact. You are adding one person that then has been exposed to a number of other people.

So, you are doing a much broader risk than the one person. So we are recommending for them to be home as much as they can—if it's possible to have grocery food delivered to them to limit their activity to what is needed. And we are absolutely recommending for them not to travel. Traveling, it's another risk. Nowadays, it's very difficult because of all the restrictions, but in order of risk, the major risk is when you travel by plane or if you board a cruise ship—less risky if you travel with your own vehicle.

Andrew Schorr:
Now we talked about CLL creating high risk to begin with, age creating even higher risk, and then many older people have what you would call co-morbidities. Maybe they have diabetes, they have cardiovascular issues. That makes it even more, right?

Dr. Ferrajoli:
Well, that I think is what is contributing the most to the problem with a higher mortality rate and higher severity of infection is in older people, because older people have a decline in the activity of the immune system, that is an effect of age. But they are also more likely to have those cardiovascular co-morbidities, the diabetes, possible COPD or other type of chronic lung condition that would then add to the disadvantage of them contracting infection.

Andrew Schorr:
So, doctor, you talk about an older person staying at home. Maybe they live alone, maybe with another family member and having their groceries dropped off, et cetera. And I know some wonderful people have been doing that for older patients, but yet maybe they have children they want to see, their grandchildren they want to see. It hurts your heart when you can't have that personal contact. I know we've been trying to help people use their phone, use their internet if they happen to know how to use that. But basically, you don't want people to have—they're not hugging, you don't want them to be together in that physical way.

Dr. Ferrajoli:
Correct. And what I tell all my patients and also my family and friends is to remember two things. One thing is we now have technology. So, there is a lot of help and a big ability to be in contact, even see your relatives by using the computer technology, the cell phone technology. But the other thing that I remind everyone is this is temporary. So just think about, it's just a temporary isolation, it's a choice that you make to be safe. And the price is going to be that we will all enjoy our lives even more when this is over. So it's not a mandate forever, it's just a temporary precaution.

Andrew Schorr:
Well, as my mother used to say, “From your mouth to God's ear.” And absolutely. So, okay, now people with CLL, not everybody, but many people are having some treatment, and you and I have spoken about oral therapies that many of your patients may be on at home. Should they make any adjustment? Is there any reason why they should take less? Stop taking it? Any change?

Dr. Ferrajoli:
No. They shouldn't make any change without checking with their CLL doctor. There is no indication that taking a therapy could put you at a bigger risk. And actually, that is the opposite. If you're taking a therapy, especially an oral therapy, in the initial phase of the oral therapy, you absolutely don't want to stop it, because you could have a rebounding of your CLL. So we recommend that no one stops therapy without first consulting with their doctor. However, we are all making a lot of adjustments in a way that allows us to monitor the patient without having them to travel or without having them to be exposed to an increased risk. So especially for a center like ours, we are instructing our patient to have the laboratory evaluation done as close as they can to where they live. Sometimes there is even the possibility of having the laboratory evaluation done at your home.

There can be blood drawn down at home. And then we will call them after we have the results of the blood work that can be shared just by a simple picture on your cell phone. And once we review the blood work, and we call our patients, and we ask how they are doing, then we're going to say, "Okay, no changes needed. Let's postpone your appointment for a safer time." So we're doing a kind of telemedicine, if you want to call it like that. Sometimes it's just even more simple is a review of blood count and blood work, and a review of how the patient is feeling. And then that allows us to safely postpone the visit.

Andrew Schorr:
We've turned away a lot from infused therapies, but there's one kind that I get, that still I see other people at the clinic get, and that is immunoglobulin, IVIGAnd in my case, my CLL doctor has wanted me to get it for, gee, about two years now, monthly. So I have a call-in to see, can that be deferred? So what about immunoglobulin? Are you deferring that for some people if they're not traveling? What's your thought about that?

Dr. Ferrajoli:
It really depends what kind of levels they have been able to maintain over time, and also what region of the country do they live. Because the major effect of the immunoglobulin is to protect us from respiratory type of infections. So if you are in the North to where it's still very cold, I think it's a risk benefit that you need to discuss with your doctor. If you are in the South, like where we are in Houston, normally we will discontinue immunoglobulins around April. And I think this year may be a safe choice to discontinue them in March.

However, I would like to add one more since you mentioned immunoglobulin. It's very important for everyone to know that the immunoglobulins are not going to give us protection to COVID-19. The reason is that us, everyone is COVID-19 naive. This is a new virus. We have not seen it. So there are not going to be antibodies present in the immunoglobulin to defend us toward this specific virus. However, there are antibodies that defend us from the other infections that have been circulating in the world for a long time. And so the population has acquired an immunocompetence to these infections. But no, intravenous immunoglobulin unfortunately will not protect us from COVID-19.

Andrew Schorr:
Okay. Well, I think what it all comes down to is all of us having a discussion over the phone with the doctor, with the nurse who knows our personal situation as to, "Do you want to do telemedicine with us? Do we stay on the medicines exactly as we have? Do we need to come in for some kind of blood tests or immunoglobulin? Whatever, but what's right for us at the time and the risk/benefit." Okay. So the last thing I would ask you, Dr. Ferrajoli, is, you've seen viruses before and infections, and you've seen how it particularly affected older CLL patients. Given the precautions you've talked about, do you think, are you hopeful, that we can get through this?

Dr. Ferrajoli:
Yes. Because if we look at what has happened in other countries, in China, they're already on the other side of the curve. Their infectious rate—sorry. That's my pager. Their infectious rate is getting lower. Their number of new cases is declining, and the number of people that have acquired infection and overcome it is increasing. So that will farther diffuse the risk for infection, because if the virus encounters a person that has already been exposed, it's unlikely that that person will be re-infected at least for six months. So based on what we are seeing in China and what we may be seeing and that really, I hope we are seeing it in Italy, that is the peak is starting to go down. I am optimistic that we will go back to a normal state. However, the key is that for once, it's up to each of us to make it happen in the shortest time possible, and that is by following precautions.

Andrew Schorr:
Okay. Well, Dr. Ferrajoli, first of all, thank you for the devotion of you and your colleagues at MD Anderson and your peers around the world. You are angels to us. Thank you for explaining this, particularly for older CLL patients and knowing that you probably have a lot of family and friends back in Italy, of course, all the best to them, too.

Thank you for being with us, doctor. I'm Andrew Schorr with Dr. Ferrajoli from MD Anderson. And remember, we will get through this, and knowledge in these precautions can be the best medicine of all.

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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