patient care perspectives

COVID-19 and Impacts in Patients With Chronic Myeloid Leukemia

by Gabriela S. Hobbs, MD

Overview

The COVID-19 pandemic has challenged clinical care, particularly for patients with chronic myeloid leukemia (CML). The increased uptake of telemedicine, however, has been helpful for guiding the care of patients with CML while minimizing patient exposure to infection.

Expert Commentary

Gabriela S. Hobbs, MD

Assistant Professor, Medicine
Harvard Medical School
Clinical Director, Leukemia
Massachusetts General Hospital
Boston, MA

“It is important for clinicians to explain that attaining and maintaining a remission in CML is critical to maintaining normal immunity in the event of any infection and COVID-19, in particular.”

Gabriela S. Hobbs, MD

The COVID-19 pandemic has introduced several challenges in routine clinical care and has created unanswered questions in the treatment of patients with hematologic malignancies, particularly CML. During the pandemic, the use of telemedicine has facilitated some aspects of care; however, it has also led to gaps in the assessment of certain routine measures of disease status. Prior to the onset of COVID-19, the majority of diagnosed CML cases would comprise of patients who were noted incidentally to have a high white blood cell count by their primary care doctor during an annual physical.

Throughout the past year, with the increased utilization of telemedicine, there has been a decline in routine blood work and many patients have foregone routine care visits. For example, some CML symptoms such as weight loss and splenomegaly might be attributed to muscle loss from decreased exercise during the pandemic, and chronic fatigue from CML might be attributed to post–COVID-19 fatigue or fatigue from a multitude of stressors brought on from other chronic illnesses or pandemic-related issues. Ultimately, for a variety of reasons, many patients have presented with more advanced CML, further complicating care and outcomes.

To some degree, the pandemic has resulted in delayed diagnoses. However, once a patient does receive a CML diagnosis, they have the option of telemedicine, allowing them to stay home and limit their exposure to COVID-19. Telemedicine can be helpful in assessing drug tolerance, treatment compliance, and emotional well-being. It has also proved useful for patients with long-standing CML who may live in rural areas or settings located far away from their doctors. The main challenge in these situations is determining where to get labs checked.

A common concern during the pandemic has been how to understand the risk of infection and complications from COVID-19 in patients with CML on tyrosine kinase inhibitors. While patients with leukemia are undoubtedly immunosuppressed, those with CML in remission likely have a normal or near normal immune system. Although data may be sparse in this regard, patients with CML rarely suffer from unusual or opportunistic infections. Tyrosine kinase inhibitors themselves may have immunosuppressive and off-target effects; however, as mentioned, individuals with CML in remission do not have higher rates of infections. Thus, it is important for clinicians to explain that attaining and maintaining a remission in CML is critical to maintaining normal immunity in the event of any infection and COVID-19, in particular.

References

American Society of Hematology. COVID-19 and CML: frequently asked questions. Accessed May 12, 2021. https://www.hematology.org/covid-19/covid-19-and-cml

Başcı S, Ata N, Altuntaş F, et al; Turkish Ministry of Health, Hematology Scientific Working Group. Outcome of COVID-19 in patients with chronic myeloid leukemia receiving tyrosine kinase inhibitors. J Oncol Pharm Pract. 2020;26(7):1676-1682. doi:10.1177/1078155220953198

Eşkazan AE. Chronic myeloid leukaemia and the use of tyrosine kinase inhibitors in the days of COVID-19 pandemic. Br J Clin Pharmacol. 2020;86(9):1790-1792. doi:10.1111/bcp.14353

Wang L-Q, Tan Su Yin E, Wei G-Q, Hu Y-X, Nagler A, Huang H. Weathering the storm: COVID-19 infection in patients with hematological malignancies. J Zhejiang Univ Sci B. 2020;21(12):921-939. doi:10.1631/jzus.B2000423

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