In a recent publication in Acta Haematologica, researchers conducted a review with multiple goals, including 1) defining the mechanisms of immune dysfunction in patients with chronic lymphocytic leukemia (CLL) who also had COVID-19 infection; 2) providing an overview of the clinical outcomes associated with COVID-19 infection; and 3) identifying risk factors correlated with severe morbidity and mortality in this specific patient population.
The authors also investigated potential measures to enhance immune responses in patients with CLL and gain more insight into the relationship between novel therapies for CLL and COVID-19 outcomes, prevention, and treatment. Overall, the purpose of this review was also to explore the impact of COVID-19 on the utilization of these novel agents in the hopes of providing guidance for clinicians treating patients with CLL.
The authors wrote, “The impact of the pandemic on CLL-directed therapy has been a matter of significant concern. Considerations such as timing of therapy, route of administration, the need for close monitoring, and the risk of infections have all become crucial factors in the selection of appropriate treatment.”
One study revealed that a heightened risk of mortality was observed among patients with COVID-19 who also received chemoimmunotherapy regimens and CLL-directed therapy. Additionally, compared with healthy controls, patients with CLL generally demonstrated a reduced response to vaccines, with various factors related to CLL and treatments contributing to the efficacy of vaccines in patients with CLL. The authors also noted that several large studies and a meta-analysis established the safety of mRNA and vector-based SARS-CoV-2 vaccines in healthy controls and patients with CLL, primarily reporting mild adverse events with a safety profile comparable to that observed in healthy adults.
Based on data obtained during this review, the authors indicated that patients with CLL are at augmented risk for severe COVID-19 infections; however, vaccinations and COVID-19-directed therapy have improved clinical outcomes, but clinical challenges persist in this patient population.
The authors noted, “The treatment approach for CLL should follow consensus guidelines. Watch and wait strategy is recommended for asymptomatic patients with low tumor burden. When treatment is indicated, it is the premise of most guidelines that patients should receive the best treatment option considering disease and patient-specific factors.”
The authors concluded, “Patients with CLL constitute a unique population with significant immunodeficiency and a high risk for severe COVID-19 disease, leading to substantial rates of complications and mortality. These patients exhibit diminished humoral and cellular responses to anti-SARS-CoV-2 vaccines, particularly with ongoing or recent therapy.”
Lastly, the authors indicated that while CLL-directed therapy should be guided by disease- and patient-specific factors, management of CLL patients warrants continuous observation, awareness, and prompt clinical response to treat COVID-19 infections effectively.
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