ASH 2025 | Preventing infectious complications in patients with CLL: vaccination and social behaviors

So when I meet a patient newly diagnosed with CLL and have to inform them about the disease, I have a major focus on the risk of infections due to immune dysfunction. That means that I always spend some time interviewing the patient about their history, medical history, in particular focusing on infections. Because I know that’s one of the major causes of morbidity and actually also mortality for our patients with CLL. My focus during that conversation would be on vaccination history, as it’s important for patients with CLL, newly diagnosed with CLL, to receive the full vaccination program before they might at some time point need treatment for CLL. This means that obviously they should receive the annual vaccinations for COVID and influenza. It’s in particular important for patients with CLL to receive repeated vaccinations because it’s been shown several times that patients with CLL would have a higher chance of achieving both a serological but also a T-cell response after vaccination if they receive repeated vaccinations. For pneumococci it’s important that they receive a conjugated vaccine because it’s been demonstrated that provides them with a better immune response than the other options. Also for pneumococci, it’s important to have a revaccination every five years, despite some of the new pneumococci vaccines could provide longer protection for patients not having immune dysfunction as in CLL. 

The other question is, how do you make sure that your patient feels safe in terms of keeping up with a social life? We have actually a number of patients with CLL getting so worried about the risk of infections that they tend to have a social isolation, and that would obviously impact their quality of life significantly. So it’s important to emphasize to patients with CLL that they have no risk of infections outdoors. They can meet with people outdoors as long as they don’t touch each other or anything, then they are not put at an increased risk of infection if they keep meeting people outside. Indoors, still 90% of all infections are actually transmitted through hands. So keep your sanitizer with you if you have a CLL patient, and I spend a lot of time emphasizing to them I’m probably sanitizing my hands five to ten times per hour when I’m at work. So it’s important for the patients to make sure they understand they can actually do these very small hand hygiene issues. If they need to meet up with people where they are worried about transmission of an infection, they can safely meet up outside. A lot of my patients are asking, but what about my grandchildren, can I still take care of them, and I emphasize, if they have kind grandchildren, yes they definitely can. So it’s important to keep that social life and then obviously keep the hand sanitizers, and if they have grandchildren or other relatives with clear respiratory tract infections, then they might need to keep a safe distance during these periods, but it’s important to keep your social life and it’s also important that you keep your physical activity, so that’s also where we need to emphasize to the patients, it’s actually more dangerous just to sit isolated without physical activity to protect yourself from the risk of infections. It’s important to actually get out and still keep with the vaccination program and the hand sanitizing.

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