ESH CLL 2022 | Managing CLL as a chronic disease in the long term to improve overall outcome
Arnon Kater, MD, PhD, University of Amsterdam, Amsterdam, Netherlands, shares some insights into the long-term management of chronic lymphocytic leukemia (CLL) to improve overall outcome. Dr Kater first highlights the long treatment horizon associated with CLL, and the opportunity for time-limited therapy to be used in the future. Dr Kater then emphasizes the importance of considering the psychological well-being and quality of life of patients during treatment. To conclude, Dr Kater explains how clinicians can take a more holistic approach when treating CLL, and should pay special attention to other underlying immune disorders, as well as increased risk for infection and other malignancies. This interview took place during the 2nd ESH Translational Research Conference on Chronic Lymphocytic Leukemia (ESH CLL), 2022.
Transcript (edited for clarity)
For CLL, since it’s a disease with such a long horizon, which is of course a good thing, it’s more and more important to guide your patients through this whole period of time. And as I discussed earlier, if we all wish to go to time limited treatments, whatever means you use for that, you will have hopefully very long periods that are treatment-free (drug holidays) that will be sometimes interrupted by treatments...
For CLL, since it’s a disease with such a long horizon, which is of course a good thing, it’s more and more important to guide your patients through this whole period of time. And as I discussed earlier, if we all wish to go to time limited treatments, whatever means you use for that, you will have hopefully very long periods that are treatment-free (drug holidays) that will be sometimes interrupted by treatments.
What’s very important, is first of all, the psychological, the mental part of patients. That if the patient is in between treatments, he should not feel like he’s indeed in between two bad situations and his life is disrupted, interrupted and he can’t really enjoy his life. So, it’s really important that you pay attention to the quality of life of the patients, not only during treatment, but specifically in these middle parts where the disease is under control and he should have a completely normal quality of life, hopefully.
Second, and we’ve seen this very much with the COVID pandemic, is that those patients are at increased risk for infections. And there are many patients that their responses to the vaccination seems to be poor, specifically the serological responses. And that’s another feature that we should not only discuss treatment, but also these underlying immune disorders, which are cumbersome for patients.
And you should really guide patients, help patients, give them vaccination advice, not only for COVID, but also for pneumococcal vaccinations, flu vaccinations, giving antibiotics. And if you have patients with low immunoglobulin levels, which is typical for patients and they have increased risk of infection, you should also deal with that by giving them chronic antibiotics or by supplementation of immunoglobulins.
Another aspect is that we know that patients with CLL have an increased risk for other malignancies, mostly skin, but also more severe solid malignancies. After chemotherapy, there is an increased risk for MDS and AML.
So, all those kinds of things are very important and give the need for a holistic view on your patients. It’s not only looking at the lymphocyte counts and the red blood cells and platelets and lymph nodes, but it’s actually the whole package that you have to control, if you want to treat CLL patients.
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Disclosures
Research funding Abbvie, Gennetech, Janssen, AZ, BMS
