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Hodgkin Lymphoma and COVID-19

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Published on July 29, 2020

COVID-19 and Hodgkin Lymphoma Information

Are long term Hodgkin lymphoma survivors at greater risk for complications from COVID-19? Does having a stem cell transplant and the need to be re-immunized mean a Hodgkin lymphoma survivor is high-risk?

Host Ruth Fein and lymphoma expert Dr. Ian Flinn, director of Lymphoma Research at the Sarah Cannon Research Institute discuss coronavirus risks for long term Hodgkin lymphoma survivors. They also share advice for newly diagnosed patients and the important role of social workers and therapists.

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Transcript | Hodgkin Lymphoma and COVID-19

Ruth Fein:
Hi, I'm Ruth Fein, a patient advocate for Patient Power and also a freelance health writer living in Upstate New York. And I'm here with Dr. Ian Flinn, who's the Director of Lymphoma Research at the Sarah Cannon Research Institute in Nashville. So again, thanks for joining us, Dr. Flinn.

We're here to dig a little deeper into living with Hodgkin lymphoma in this crazy year of pandemic life. What about for long term survivors of Hodgkin's disease? There's so many people who are treated as children, now, it's years later. Are they at greater risk either for contracting COVID or if they get it, are they at greater risk for complications?

Dr. Flinn:
I don't think they're a greater risk for getting COVID. Right? I mean, I think we all have this equal risk based on our exposures. It's possible they're an increased risk for complications if they have long term complications from the chemotherapy or radiation. Right? We know that patients who've been treated with Hodgkin's disease, especially if they had radiation to the chest or if they've had bleomycin, you worry that they might have increased risk of cardiovascular complications, cardiovascular disease, coronary artery disease.

And so, people like that, that have other what we call co-morbidities have developed other medical problems, then they are at increased risk of having a worse outcome, having more severe case with COVID-19. But I think it would really depend on the individual. It would depend on the therapy, would depend on how long they've been from treatment to really quantify that in any substantial way.

Ruth Fein:
So what about this scenario? I had a stem cell transplant, I've not been re-immunized. Am I more at risk for COVID?

Dr. Flinn:
So I don't think that that patient who's had a stem cell transplant, they've been re-immunized. You're usually talking a couple year process to do all the re-immunizations. So they're probably a couple of years out after the stem cell transplant. I wouldn't think that that person would really have substantial increased risk compared to their next-door neighbor. Think about it, I mean, this is a new virus, right? I mean, it's not been seen before, so none of us have any kind of immunity to this. And so there's nothing lost by them not having... It's been thus far from the transplant. They can't have been immunized. None of us have been immunized. So I think that they thankfully do not have higher or increased risk based on just having had the transplant. Again, if they've had developed other medical problems because of the transplant or just because of life, then they might be at increased risk of having a worse outcome or harder time with the virus than others.

Ruth Fein:
I would assume that blood counts come into it somewhere though, in terms of white counts and the ability to fight it off, whether it's COVID or something else.

Dr. Flinn:
That's exactly right. But someone who's two years after stem cell transplant should have normal counts, they should have a normal marrow function at that time. Most patients after stem cell transplant will have pretty good, pretty near normal counts, 90 days after a stem cell transplant. And so, during that two year period after the transplant, their immune system really should have been able to repair itself to pretty close to normal. And nothing's ever perfect. Right? I mean, my guess is there, again, if you got very sophisticated, we could find some subtle defects that were different from somebody else.

But frankly, there's such heterogeneity. There's such variation in how people who don't have cancer respond to the virus that I think that, that far in the distance of having had been there therapy for Hodgkin's disease, they're probably not different than the average person.

Ruth Fein:
I'm sure that will be reassuring to an awful lot of people who tuned in to hear you say that. So what advice... Let's switch to the other end and talk about a newly diagnosed patient. What would you say to a newly diagnosed person about how to talk to their friends and family, even their acquaintances about how careful they really have to be? So how do we give them confidence? How do you give them confidence and some balance between I want you to live your life, I don't want you to live in a bubble as we say, but you need to be able to explain to the people around you, how important it is to be careful and safe?

Dr. Flinn:
I'm always inspired, frankly, about how community, the patients' families, their friends, their workplaces come in a time of crisis. Like, the diagnosis of Hodgkin's disease or other cancers, how people do everything they can to help. Right? So my guess is that if they just outline what they need to do and what they need them to do if they're going to come in contact, right? Because it's your circle that's around you. We need them to be careful as well. It's actually very uplifting to see how often people rise to the occasion and do the right thing. Employers often do the right thing. Most of the time do the right thing. And I'm always amazed and reassured that this happens.

So I think they should have confidence in talking to them. They're family, they're loved ones, they're going to want to protect them. I find oftentimes, not in this COVID period, but oftentimes friends and family, people you never heard of come out of the woodwork of trying to help you, help the patient. And sometimes they're giving erroneous advice, "Eat this, drink that, do that," which is, you say, "Thank you. Appreciate it." And then hopefully follow your doctor's instructions, not what they're saying elsewhere. But that's just an example about how the community tries to help patients that are facing these things.

And I think the other thing is to say, for patients going through this, again, it's a finite period of time and it's not forever. Right? Most people, most families can rise to the occasion to deal with this for a six month period, which is the average time for patients with Hodgkin's disease receiving treatment.

Ruth Fein:
What about the role of a social worker or a therapist of some sort? It's easy for us to sit back and say, "Oh, you're having an honest conversation with the people around you." But I think there's a lot to that. And I know for myself who's also been dealing with a rare blood cancer for 25 years. For years, I didn't tell anyone and it was really, the number of people who knew were less than my hand. And so everyone isn't comfortable having that conversation with people around them, especially if it's acquaintances, not just close friends and family. So what tools do you think help? Is it speaking to someone? Or what other advice would you give them?

Dr. Flinn:
Yeah, I think there's many different avenues here, right? One is if you can get yourself into a disease-specific support group, right? So someone who has Hodgkin's disease being in a general cancer support group is not helpful. I mean, my point. I think most of the things that these other people are facing are not what... Thankfully the outcome is usually pretty good for patients with Hodgkin's disease. And so getting into a patient-specific support group. Our practice has psychologists. They're a good resource to talk to and can help. You can bounce ideas off. And in COVID it's even worse than normal, right? Because our spirits are all a little bit low. And so, if you have that available to you, either in person or through a telemedicine type of visit, I would certainly recommend that as well.

Ruth Fein:
Great advice. Thanks so much for your time, Dr. Flinn. Thanks to Patient Power, and I'll leave you with the reminder that knowledge can be the best medicine of all. And stay safe and well and take care.

 


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