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Should I Change My Treatment Plan Due to COVID?

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Published on October 5, 2021

Why You Shouldn’t Delay Treatment During COVID

Watch this video to hear Nicole Lamanna, MD, of the Columbia University Herbert Irving Comprehensive Cancer Center, explain why it is important to continue with your CLL treatment plan, even during COVID. Dr. Lamanna also urges listeners to speak directly with their physicians about any COVID concerns.

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Transcript | Should I Change My Treatment Plan Due to COVID?

Dr. Lamanna:
Hi, Nicole Lamanna, Columbia University. I'm going to talk a little bit about communication with your physician team and concerns about the COVID-19 infection with regards to CLL patients who either are getting treatment or might be getting treatment. This has been obviously a hot topic. I know given the past year and a half with the pandemic, when we talk about patients who are getting treatment for their CLL and there's always a benefit. So you need to keep that dialogue with your physician and physician team, given people's concerns about COVID-19 and infection. And of course, I think it's difficult because each one of you may be on your journey in a different place. And so it's really, really important to have that dialogue with your team. You know, cause what I say is mere general, and I want you to talk to your physicians about this information because COVID-19 is evolving and obviously our treatments are evolving.

And so that's important, but let's get back to if you are on treatment for your CLL or if you're about to need treatment over the next couple of months for your CLL. And I understand the concerns about the COVID-19 infection and what to do about therapies regarding this and exposure. It's important that obviously if somebody really needs treatment for their disease, that likely that treatment cannot be delayed. I mean, there has been some, obviously there are patients who can wait longer for therapies and meaning that you might be getting closer to needing therapies, but are otherwise doing well and can be deferred. And certainly again, have that conversation with your physician. But if you're in need of therapy, it's really important that you get your therapy because we don't want patients getting sicker from their disease due to the fear of the virus.

What Factors Go into Making Treatment Decisions During COVID?

Dr. Lamanna:
Okay. But it's important to have that dialogue with your physician. Clearly in the last year when we were dealing with a pandemic, many of us tended to avoid some of the intravenous infusions or intravenous monoclonal antibody treatments or chemo immunotherapy at the height of the pandemic. Given the need to come back of course, back and forth to the hospital or the practice or more exposure potentially to COVID patients and other people. So that many of us might've pulled back from doing a lot of the intravenous treatments. Also, we, there is obviously a concern with the monoclonal antibodies and some of them were myelosuppressive chemotherapy regimens that perhaps we would be rendering you all more susceptible to having a poor immune system.

And of course then having the exposure of COVID-19 and making more at risk to getting an infection. So we balance, we tend to balance a lot of this with your treatment options, with regards to the targeted novel targeted agents such as the BTK inhibitors and venetoclax (Venclexta). Clearly the data is a little bit more mixed in that sense. Clearly, they're easier to administer, doing a BTK inhibitor is much more easy to administer while we've been going through the pandemic.

So many of us did the oral treatments for our patients, for those who needed therapy. I think a big concern as we learn more about the infection and also about our CLL patients and your immune systems. No, clearly we, any of these therapies might make somebody's immune system worse. And certainly that is a concern for patients while we go through the pandemic that being on any therapy whatsoever might potentially put them at more at risk. And certainly that might be true. We don't have that data across the board. We know when we looked at CLL patients and COVID infections in our experience over the past year and a half, we know that even patients who were on treatments, whether they were all therapies or even some patients who on active observation were sick and in the hospital from COVID-19.

So I think this is data that's evolving, but I think it's important that if you need treatment, that you shouldn't necessarily avoid treatment because of COVID-19. We know that COVID is not going to go away, but we're trying to mitigate the circumstances with the infection of what's going on, maybe in your region and whatnot. And also, we might say, you know what, we might not do this therapy where we might hold the IV therapy or the monoclonal antibody because are high rates of COVID right where you're living, and we'll just do the oral therapy. So again, the dialogue with your physician and team is really, really important, depending upon what's going on. We're going to be dealing, I think with COVID for a while until we get on top of the virus in the country. And I think it's going to take us a little bit of time to do that, because only half of the U.S. has been vaccinated.

And so I say, we're still going to see infections. Hopefully we won't see the severity of the hospitalizations that we did last year, but I think it's going to take us time to actually get on top of this as a country and obviously globally. So it's not that it's going to go away. We're just hoping that people will be less ill, but for you all, we're obviously going to be tailoring therapies. As we learn more, we're going to be tailoring therapies or your doctor might say, we're going to hold this because there's this going on right now in our areas. And because we don't want to have… You have to come back so frequently. So again, understand we understand your concerns about treatment and the COVID-19 infection. [It’s] important to have that dialogue with your physician. The physician might cater your therapy differently, depending upon what's going on with COVID in your area at that time.

So I think that this is constantly evolving. So, there is not a right answer, one size fits all, because things are changing on a dynamic day-to-day basis. So just keep that in mind and clearly have that dialogue with your physician and team, very important. We obviously, each of us have our own notions about what we think is appropriate or not appropriate. You know, with that, we might administer it as, I guess, as I said, many of them surrounding the intravenous therapies and the monoclonal antibodies. But still, if you need therapy, important to proceed with therapy and your doctor just might cater that therapy a little differently depending upon what's going on with COVID-19 in your area.


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