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Published on July 14, 2020
Why Is CLL More Severe in Some People and What Does COVID-19 Recovery Look Like?
In this podcast from our "Dinner with the Docs" series, Carol Preston spoke with Dr. Roger Strair, chief of blood disorders at the Rutgers Cancer Institute and hematologist Dr. Seth Cohen of RWJ-Barnabas about how they define CLL. They also discuss how COVID-19 affects CLL treatments and clinical trials.
This program is sponsored by Janssen Oncology and Pharmacyclics LLC. These organizations have no editorial control. It is produced by Patient Power. Patient Power is solely responsible for program content.
Transcript | Defining CLL and COVID-19's Effects on Patients
Hi everyone, I'm Carol Preston with Patient Power. I've been living with CLL for 14 years. Recently, I spoke with Dr. Roger Strair, Chief of Blood Disorders at the Rutgers Cancer Institute, and Hematologist, Dr. Seth Cohen of RWJ Barnabas. We had hoped to meet in person for our Dinner with the Docs series in New Jersey. Well, the COVID pandemic slammed the door on that. However, technology allowed us to meet up close and personal online, along with some 40 CLL patients.
We discussed CLL as an umbrella term for dozens of variations of this leukemia, as well as CLL and COVID. Are we patients more susceptible? Will we become sicker? Are some CLL treatments protecting us? Here's what Doctors Strair and Cohen had to say.
So, could both of you talk a little bit about how you define CLL, and how that impacts your approach? And Dr. Strair, why don't we start with you.
So, CLL is an incredibly heterogeneous disease. Some people will present with very low white blood cell counts, no lymphadenopathy, no swollen lymph nodes. The liver and spleen will be normal size. People will have had a slightly elevated white blood cell count noted strictly on a blood test. And, they will have no abnormalities of the immune system. Their disease may be stable for years, and as you heard from Dr. Garrett, decades.
Other people may present with just the opposite. It's a very heterogeneous disease. They may require treatment urgently because there are very big, swollen lymph nodes that are symptomatic. The liver and spleen may become congested with CLL cells causing problems. Blood counts may be low because the CLL cells are inhibiting the production of normal blood cells, or even causing an immune reaction against normal blood cells.
The heterogeneity and diversity is great. And one of the beautiful things about CLL as an area to study as a substrate for analysis is that we're beginning to understand why these differences exist. And with the development of the new treatments, including some that Dr. Cohen spoke of, we're beginning to understand that just about every patient with CLL who needs to start therapy because of symptoms or other criteria, can expect a good outcome. That's an extraordinary change over the last five years, as a consequence of understanding the biology, the development of new medications to target the abnormalities; and the most exciting thing about it is that it's just the start.
People are now beginning to think about the steps necessary to be taken to move from CLL as a controllable disease, to CLL as a curable disease. Just about every CLL expert, every lymphoma expert, and every oncologist projecting forward and looking at the trajectory, thinks that that is a very plausible goal.
Is there anything that you can comment on about the connection between COVID and CLL? And, Dr. Cohen, what have you been seeing in your practice?
Dr. Seth Cohen:
Normally, CLL patients are more at risk for bacterial and viral infections just based on their lymphoid system not functioning properly, and conceivably, they have a higher risk. There are studies that are studying the immune effect of the inflammatory effect on the lungs for CLL. For instance, some of the Bruton’s kinase drugs are now being studied in clinical trials to reduce the risk of inflammatory effects on the lungs, in specific. So perhaps, maybe those drugs are protective if some of our patients who are listening should be on those medications, from the inflammatory effects of COVID-19.
But all in all, COVID is obviously putting a wrench in everyone's lives. From what we do, makes it much more difficult to provide care for our patients; everyone is trying their best. It is difficult, but thank God, I would say at least in my patient population, while some patients clearly have COVID-19, it hasn't really affected them in the sense of severe hospitalizations, or needing a respirator. I'm just a small subset of the population. I'm sure Dr. Strair can comment on his patient population.
There are certainly B-cell and T-cell abnormalities that are present in patients who have CLL. And those B and T-cell abnormalities may compromise the ability to fight off the SARS-CoV-2 virus that causes COVID-19 infection. But we have to think of the infection as occurring in two steps: the virus getting into the body, replicating, and causing problems; and then the body's immune response. And what has been found, is that it's the body's immune response, the exorbitant immune response, that causes a great deal of the problems, blood clotting damage to tissues, mediated by the immune system. So the weakened immune system may make somebody more susceptible in the early phases of the disease, yet may be a little protective in the later stages of disease.
And in the end, it's unknown how the balance will work out for each individual patient. As Dr. Cohen implied, even some of the medicines used to treat CLL, especially some of the medicines that target an enzyme in the immune cells, may be protective in the later stages of the disease. So overall, it may make people a little more susceptible; on the other hand, some of the patients may have less intense disease.
Our thanks to Doctors Strair and Cohen for their insights, and to the patients from South Jersey who participated with us in Dinner with the Docs. I'm Carol Preston. Remember, your questions can help lead you to more informed treatment decisions.