SOHO 2026 | Supportive care in CLL: infection prevention, cancer screening and vaccination

As you know, people with CLL, many of them, in fact, most have a normal lifespan, and now with some of these combinations of targeted agents, treatment can be episodic, meaning people begin treatment, end it, have time between treatments, experience more treatments in their lifespan, and observation still is standard, so people have years, sometimes, before they even need treatment. So supportive care is actually embedded across that whole kind of time period. And during treatment, there might be extra supportive care like prophylactic anti-infectives, depending on the regimen. But there’s some things that really are important that we focus on right before treatment just to make sure it’s accomplished, but are true during this whole period. So people with CLL, even those who have never had a treatment, live with a higher risk of infections, including hospitalization and death from infections, mostly respiratory is the most frequent, and also second cancers because of decreased immune surveillance. It’s probably more complicated than that, but that’s the easiest way to think about it. And so even before treatment, we always have a discussion in my clinic about cancer screenings, particularly skin cancer screening, because that has a very big increase over the population expectation in terms of like incidence of skin cancers for people with CLL and people forget about it a lot. And then vaccines or making sure that they’re up to date on what they need, including tetanus, but also importantly, we have a RSV vaccine, pneumococcal pneumonia vaccine, Shingrix, if that’s appropriate for them, and seasonal vaccinations too. So that’s kind of continuous. Before treatment, it’s especially important to cover those things because our treatments, particularly those with anti-CD20 monoclonal antibodies, really decrease antibody responses to vaccines. So if I’m talking with someone about starting treatment, I make double sure that they got all their vaccines or if they’re due for like a pneumococcal vaccine in two months, it’s best to get it a few weeks before treatment just to make sure they can get the maximal benefit from that. And then cancer screenings can be tricky. If it’s something like a screening colonoscopy, someone might have time to do that before treatment or might have low platelets or something that increases the risk. So then we have a discussion about that being on the list for maybe after completion of a one-year treatment when they’re in a better place to do it. So I think just reviewing those things before starting a treatment regimen. And I don’t know that that impacts the choice of treatment so much as other comorbidities, but I do tailor that discussion to what kind of treatment they’re getting, particularly with anti-CD20 monoclonal antibodies.

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