Published on August 25, 2020
What are the Risks if I Delay CLL Treatment Because of the Coronavirus?
Dr. Anthony Mato from Sloan Kettering Cancer Center, NYC, joins Patient Power Co-founder, Andrew Schorr to discuss how to assess the risks of delaying CLL treatment during the COVID-19 pandemic. Dr. Mato emphasizes that it's important to assess each patient's unique situation, location and treatment status when making decisions. Andrew and Dr. Mato discuss Andrew's specific IVIG schedule and when increased spacing of in hospital IVIG treatment is appropriate. Watch to hear the full discussion.
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Transcript | Should I Postpone CLL Treatment Due to COVID-19?
Should CLL Patients Delay Treatments & Annual Exams?
Let's go on about cancer care. People with CLL get blood tests, sometimes you've probably ordered a bone marrow biopsy, whether part of a study or not. Some people may have infused therapies as you said, the rituximab (Rituxan) and the obinutuzumab (Gazyva) and other CD20 antibodies, or need to be monitored more closely, they're starting venetoclax (Venclexta) or whatever it is. So what about that? How do we proceed with the CLL journey and feel safe?
That's a really important question, and the guidance has been evolving over the last several months. My general approach is to think about first whether the patient needs therapy or not, that's key. Second part is to decide what's the best therapy for the patient regardless of pandemic or no pandemic, because we expect this to pass, but at the same time, we're making decisions regarding CLL therapy that have potentially long-term consequences to that decision. And then third is to keep in mind what region of the country we're in, New York is certainly different maybe than where you are in California at the moment.
And then think about if there are therapies of equal value for patients or equal similar data to try to pick whatever minimizes the contact with the healthcare system, particularly if you're an area where there are a lot of cases. In New York right now, I'm really focusing on making decisions that are based on the CLL biology symptoms and what therapies I think are the best choice.
I think minimal deferments are okay, certainly not putting things off for a year is not a good idea. Again, it depends where you are in the country, where you're going for this particular testing, but we've been giving individual guidance. If your last 10 mammograms were completely normal, then waiting three months is probably not a big deal. If six months ago you had a suspicious lesion that needed follow up, then I would encourage to follow it. So it's nothing cookie cutter here, everything has to be made based on your knowledge of your actual patient.
Okay. Let's talk about IVIG, immunoglobulin. I get the infusion every 28 days or so, and I've been on that schedule for a long time and knock on wood, I haven't gotten pneumonia, I haven't gotten a sinus infection. I understand at this point it does not give me antibodies for COVID, but it's an intervention, I have to go to the clinic. And I'm there, and I noticed they've taken a lot of precautions, but our friends who were like me with IVIG wonder, can that be spaced out? And is it important on some schedule that they continue?
I think spacing it out is something reasonable to consider, particularly if the infections are well controlled and they're not very frequent anymore, like your situation where you've been on it for a long period of time. There's no magic level with IVIG that I say you have to have it every month. Certainly, if your levels are normal or above normal, after several infusions, it's reasonable to go every other month or every third month. There are subcutaneous formulations of IVIG, which can be done at home. It's hard to switch back and forth, but you also have to let somebody into the house, a home health aide or a nurse. I think it's a nurse particularly to administer the IVIG, so you're taking a risk one way or the other. But I have spaced them out a bit more for patients.
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