How Patients With Blood Cancers Can Boost Immune Systems to Fight Infections Like COVID-19

Members of a family of targeted drugs used to treat blood cancer, known as BTK inhibitors, may be helpful in treating COVID-19, and some of these medications are being tested in clinical trials, experts explained in CURE®’s first-ever live webinar.

Sponsored by Janssen and Pharmacyclics, the webinar, titled “Hear from the Experts: COVID-19 & Cancer Care for Patients,” was designed to provide those affected by chronic lymphocytic leukemia (CLL) and multiple myeloma with information and updates on cancer care during the uncertainty of the COVID-19 pandemic. Topics included whether patients taking BTK inhibitors to treat their cancer should remain on such drugs if they develop COVID-19.

CURE® invited patients, survivors, caregivers, advocates and health care professionals to attend the panel discussion. Dr. Saad Usmani, chief of the plasma disorders program and director of clinical research in hematologic malignancies at the Levine Cancer Institute in North Carolina, served as the webinar’s moderator. Panelists included:

• Dr. Zainab Shahid, medical director of bone marrow transplant infectious diseases at the Levine Cancer Institute
• Dr. Farrukh Awan, director of the lymphoid malignancies program at the Harold C. Simmons Comprehensive Cancer Center at UT-Southwest in Dallas, Texas
• Dr. Ian Flinn, director of the lymphoma research program at Sarah Cannon Research Institute in Nashville, Tennessee
• Lee Greenberger, Ph.D., chief scientific officer at the Leukemia & Lymphoma Society in Philadelphia

In the talk, Drs. Flinn and Awan discussed what patients with blood cancers could do to help boost their immune systems to help prevent infections, such as COVID-19, and the risk for patients who are several years removed from receiving a stem cell transplant.

Flinn: The experts in this field would want to make sure you are getting plenty of sleep, you're eating right and you're taking care of yourself, not just specifically for COVID-19. Exercising and other general health measures are probably the best a patient could do. There's no simple pill you can take. There is no simple medicine you can take that's going to improve your immune system and help you fight off COVID-19. But general health measures will.

Now, there are some exceptions to this rule in the case of patients who have low white counts (who) occasionally use growth factors to bring up their neutrophils to help them fight off infectious complications. By and large, giving patients IV immunoglobulins (IVIG) probably won't help in the setting of COVID-19. We know from the CLL literature that we can prevent some of these recurrent infections by giving patients who have low antibody levels and low immunoglobulins IVIG on a monthly basis.

But, if we look at that data carefully that’s bacterial infections that are being prevented, like in cases such as a viral infection like COVID-19, I wouldn't expect it to be prevented by giving people IVIG.

Usmani: A patient who has acute myeloid leukemia and is a ten-year post allogeneic stem cell transplant survivor, asks if they are at the same risk for COVID-19 as an immunocompromised blood cancer patient or is their risk any different and comparable to the general public?

Awan: That's a difficult question to answer. If you're ten years out of a stem cell transplantation, there are two assumptions I would have to make. One is that you are probably off immune suppression and your immune system is fairly healthy. Ten years out, you would be probably considered cured and I would expect your immune system to be robust and hopefully, unless you were having recurrent infections or regular infections, I would imagine that your risk would be fairly similar to a similar patient population.

I would be cautious a little more than our normal patients and I would also echo another point that Dr. Flinn just made. I think the IVIG role is being discussed a lot in our patients, specifically can they provide passive immunity, and can we use them more to protect our patients?

As Dr. Flinn said, I think the role is limited. It is to prevent secondary bacterial infections and sometimes people start off with a virus and then they get a bacterial infection on top of that. A percentage of our patients with COVID-19 do have co-infections, meaning they have bacterial and viral infections.

They might have some role, but I would also argue that getting IVIG, for a lot of patients, means getting to a health care facility, a clinic, or a hospital, and staying there for a few hours and being exposed to more personnel. So, you have to weigh the risks and benefits with IVIG. But in some patients, yes, I think they might be beneficial but for the vast majority may not be very helpful.