One Cancer Organization's Observations on the Impact of COVID-19 on the Blood Cancer Community

CURE® recently invited patients, survivors, caregivers, advocates and health care professionals to attend its first-ever live webinar, “Hear from the Experts: COVID-19 & Cancer Care for Patients.”

Sponsored by Janssen and Pharmacyclics, the webinar was designed to provide those affected by chronic lymphocytic leukemia (CLL) and myeloma with information and updates as they pertain to the current landscape of cancer care during the uncertain times of the new coronavirus (COVID-19).

Dr. Saad Usmani, chief of the Plasma Disorders Program and director of clinical research in hematologic malignancies at the Levine Cancer Institute served as the moderator for the webinar. Panelists included:

• Dr. Zainab Shahid, medical director of bone marrow transplant infectious diseases at the Levine Cancer Institute
• Dr. Farukh Awan, director of the Lymphoid Malignancies Program at the Harold C. Simmons Comprehensive Cancer Center at UT-Southwest
• Dr. Ian Flinn, director of the Lymphoma Research Program at Sarah Cannon Research Institute
• Dr. Lee Greenberger, chief scientific officer at the Leukemia and Lymphoma Society

In the first part of this series, Dr. Lee Greenberger addressed steps that the Leukemia and Lymphoma Society have taken to help patients with blood cancer during the COVID-19 pandemic.

Greenberger: On the policy side, we've been very active in Washington, D.C., to make sure that the blood cancer patients do not get shortchanged in this whole process and that the hospitals, of course, are adequately equipped, not only to handle COVID patients but, certainly, to handle blood cancer patients. We have 250 active grants placed around the world and they range from supporting clinical trials all the way to basic research. We surveyed and got responses from about 100 of those 250 grantees, and I could tell you a couple of things we learned.

One is that laboratories worldwide are closed. They are probably going to be opening fairly soon. The Australians are opening almost within a week or two. I think the folks out in California are going to be opening kind of in the July frame. In New York I think the conditions look like probably three to six months before they open.

Enrollment on clinical trials, as Dr. Flinn said, are variable across the country. I was speaking to a professor at Stanford who told me, basically, that most of the beds in the ICU unit are (filled by) very few COVID patients and so they are thinking about restarting in a few months and bringing patients in. On the other hand, sweeping to the other side of the continent, 90% of enrollment is down in Boston so it really varies quite a bit.

I want to make the point that as it turns out, of course, inflammation plays a big role in COVID-19 patients, particularly those who wind up in the hospital and have an acute respiratory distress. So, there is sort of a hyper-immune reaction. Many of the blood cancer agents, for example the oral therapies for CLL, ibrutinib (Imbruvica) and acalabrutinib (Calquence), are now being tried to tone down the immune system. Tocilizumab (Actemra), which has one indication outside blood cancer, but is also used to control the immune response in CAR T, is also being tried and ruxolitinib (Jakafi), which is a drug for certain leukemias, again, to control the immune reaction. Beyond that, some of our investigators have switched their lab over entirely to move from blood cancer and taking the technology that they use to, for example, develop new therapeutics for follicular lymphoma and develop new antibodies to COVID-19.

And, thinking more long-term, there are laboratories, particularly the Broad Institute and UCSF in San Francisco, that are looking for agents that might block the ability of viral proteins to engage human proteins on the surface of these respiratory cells to block that interaction. There are a whole bunch of candidates. I think that those agents have a long way to go. I think that the agents that have been approved for certain blood cancers where we know that there is a safety, and we understand the safety of the molecule well, can be applied to control the immune reaction, all the way to new experimental therapies that are going to take quite a while to see whether they can be developed for COVID.

I do think that the COVID-19 situation, at least certainly in New York, which is where I'm located, is not going away very fast, and beyond that, the possibility of reinfections or an additional wave of infection means that we're going to have to deal with this probably on a long-term basis or at very minimum be prepared for a spike, if and when it happens, whether that be in the hospital setting or in the laboratory setting.