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How Does CLL Affect Sinuses and the Skin?

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Published on September 25, 2018

At a recent town meeting an audience member asked, “do people with CLL have more sinus issues?” How critical is skin care for those living with chronic lymphocytic leukemia (CLL)? CLL experts Dr. Nicole Lamanna, from Columbia University Medical Center, and Dr. Alessandra Ferrajoli, from The University of Texas MD Anderson Cancer Center, discuss ways to monitor a patient’s immunity, common infections, how patients are affected by allergies, and give recommendations for optimal skin protection.

Provided by CLL Global Research Foundation, which received support from AbbVie Inc., Gilead Sciences, Inc., Pharmacyclics LLC and TG Therapeutics. It is produced by Patient Power in collaboration with The University of Texas MD Anderson Cancer Center.

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CLL Global Research Foundation The University of Texas MD Anderson Cancer Center

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The University of Texas MD Anderson Cancer Center

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Transcript | How Does CLL Affect Sinuses and the Skin?

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.

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.

Male Speaker:

I know that in Houston, there’s a lot of allergies. I was just curious if there is evidence that people with CLL have more sinus issues? Is that true? And also, how important is it for skin doctors, and other doctors to communicate with the physicians that are treating your CLL?

Dr. Lamanna:              

Absolutely, that’s a great question. They’re making it easy, it’s like the segue—all the things you forget to talk about. So, absolutely. I think that there’s  no doubt. We talked—somebody had asked a question about the immunoglobulin levels, and that’s a poor—I think it’s a poor measure of our immunity. But, it’s what we have, that’s available, right now.

And so, most people, about a quarter of folks, when they’re initially diagnosed with CLL, their levels are low. But, the longer you have CLL over time, most patients, their immunoglobulin levels can become low. But, that doesn’t mean that everybody gets sick, and so that’s where I said, it’s a poor measure. The most common infections we see in our CLL folks are the sinuses, and the lungs. Skin being the other one. But, there’s no doubt that oftentimes, we’ll all take histories that our folks will have chronic sinus issues, Plagued for years over time. And so, you know, and this is a tricky issue, because we’re trying to differentiate, when does somebody actually really need antibiotics to treat their sinus infections, and not…

…we’re talking about other ways to support them through their chronic sinus issues, that they’re dealing with on a day-to-day basis. And, each of my patients will do—what might work for one may not work for another, and it’s a little bit of a process that we go through, with each individual, try, try and see if we can deal with your sinus infection. So, it’s absolutely, we see this very, very commonly, I  do think there’s an increased incidence in our CLL patients. 

And, we each may handle it a little differently, but certainly, it’s a thing that needs to be brought up, because it talks about your daily life situations, and what you’re dealing with on an infection basis, and whether or not you need antibiotics, so absolutely we do see that. In addition, when we talk about screening for other cancers, for sure, one of the things, the educational pieces we always give to our patients is about looking for other cancers, as Dr. Keating brought up. There’s an increased incidence of other cancers in our CLL population, and right, those are potentially curative. You have a skin cancer, it’s a basal cell, they remove it, all right, so those are potentially curative.

So, we’re always advocating that you all get your minimum annual skin check. If your dermatologist says, oh, I wanna see you sooner, because something’s suspicious, you do what that dermatologist says, and go more frequently. We’re always telling people to make sure that they do their other cancer, appropriate age cancer screening. Because again, we pick up another cancer, those are potentially curative. The dermatologic issues are very interesting in CLL, and they go beyond the skin cancers.

Our CLL folks can have a lot of other skin manifestations that are related to their underlying immune system. Again, chicken or the egg, is it something that’s awry? We always like to think of your CLL as a disorder of your immune system, is something awry that’s linking? Is CLL directly impinging upon these other immunologic issues, or the fact that there’s something inherently wrong, and that predisposes you to more than one of these issues? So, certainly,  I always recommend that the folks, that the dermatologists are in touch with me about my patients, because there could be other issues that are relating, and it also talks to me about what their CLL may or may not be doing. 

And, for sure, I’m reviewing everybody’s skin biopsies, to see whether or not they need to go back for a second look, if there’s a question about the biopsy, or the extent of the margins, and people forgot to follow up on it. So, I do think that those reports are key, I always have any of those outside reports, if they’re not done internally at my center, then those outside reports are absolutely given to me.

Dr. Ferrajoli:               

And, also, very important is to avoid sunburns, and practice good skin protection, with either clothing or sunscreen. 

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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