Published on July 29, 2020
MCL and Coronavirus Risk
Transcript | Mantle Cell Lymphoma and COVID-19 Risk
We’re visiting with Dr. Peter Martin who's head of the lymphoma area at Weill Cornell in New York City, Dr. Martin, just by being in New York City, where there was really a huge early hotspot of coronavirus and COVID-19, obviously you have experience with that related to patients with lymphoma and maybe with mantle cell. So people around the country with mantle cell are saying, "Dr. Martin, what about me with mantle cell? Should I be concerned of being at higher risk?"
It's a great question. You're right that New York definitely was a hotspot and may again be a hotspot in the future, time will tell. I personally in April spent a month rounding on our lymphoma service when the majority of people admitted had COVID-19 and so I understand I think the anxiety, not only of people with lymphoma, but also of healthcare professionals around the country right now who are looking at this and wondering about day-to-day and the future. I can tell you that from what I've learned and from my reading and my interpretation of the available information out there, interestingly, I think that lymphoma patients or people with lymphoma and their caregivers on the whole have been doing an excellent job of protecting themselves I think to some degree. Somebody who's faced something like cancer knows how to take care of themselves and they probably are already to some degree accustomed to the idea of social distancing and hand-washing and they know what it means to wear a mask.
And so it's been nice to see that. In fact, I think we had fewer people with cancer and COVID-19 than you might have otherwise expected. I can also tell you that the vast majority of people that I've met in New York who have had lymphoma and COVID-19 recovered, most of them never required hospital admission, the vast majority did not require hospital admission. Of those who were admitted, almost all of them went home. And interestingly, that data is to some degree backed up by emerging literature. I think early on in the pandemic, we saw some data from China where doctors there were eager to share their experience. And so very early on, they were telling the world, "It looks like this could be a problem if you've got cancer and COVID-19." They were doing their best to warn the world of what they had seen But it was very early on.
After that, more data from Europe and from North America, really specifically from multiple centers in New York; NYU, Mount Sinai, Cornell, Memorial Sloan Kettering, all confirmed the idea that based on existing data, there's no real clear evidence that cancer is a standalone risk factor for bad outcomes with COVID-19. There are a number of other risk factors that do remain true; age, male sex, other uncontrolled medical conditions. Interestingly, cancer and treatment of cancer don't appear to jump out as major risk factors. Now some of this data is not necessarily the highest quality data. We don't for example have 2000 people with mantle cell lymphoma two weeks after a stem cell transplant who are receiving rituximab (Rituxan) maintenance. So I can't really comment on that, but what I can say is, I think to some degree it's a little bit intuitive that if our immune system is really significantly suppressed, that maybe outcomes might be worse and so we would want to be a little bit extra careful.
On the other hand, interestingly, what we're seeing is that many anti-cancer drugs are in clinical trials, specifically as treatment for COVID-19 infection. BTK inhibitors, XPO1 inhibitors for example. And similarly, emerging data suggests that occasionally it's an overactive immune response, not an underactive immune response that is causing many of the problems we see in COVID-19. And so it may be to some degree that some degree of immunosuppression might even be protective against some of the more significant problems that we see with the COVID-19 infections.
Wow. As we know, there are many people with mantle cell who are treated with rituximab. And so are you changing a maintenance rituximab schedule though with any concern about their immune system being depressed during this time of COVID-19?
I think that it's an important question that probably is best answered in each individual situation based on a variety of factors. So for example, in March-April, New York hospitals were overwhelmed with people with COVID-19 infections. And so there was a real commitment to administering treatment to people who really absolutely needed treatment at that particular time and people who might defer treatment for a month or two, we felt that that was safe to do that. I think in some circumstances it might be appropriate to delay maintenance therapy. I don't think that's likely to have an impact on the immune system of the person who's receiving maintenance therapy. Rituximab really does hang around in the body for 6 to 12 months and so skipping one dose, isn't going to change that, but it can sometimes be helpful in terms of improving social distancing with respect to travel to and from the hospital and the number of people who are in the clinics.
Overwhelmingly though, I do support the idea that if somebody does need treatment, that they should go to the hospital and get treatment for their cancer. Again, because the data supports that more than it supports the idea that treatment could be a problem.
Well Dr. Martin, thank you for real, I think the very positive news that despite the early fears of people with cancer, lymphoma, mantle cell being at higher risk of complications of COVID, you haven't been seeing that with your experience in New York, and we'll look forward to deeper data about that to give us all reassurance. Thank you.
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