Considerations for COVID-19 in MCL and CLL


Focusing the discussion on the current state of the COVID-19 pandemic, Catherine C. Coombs, MD, shares key insights into the use of COVID-19 pre-exposure prevention for patients with CLL or MCL.

Anthony R. Mato, MD, MSCE: Callie, I want to jump into the COVID-19 pandemic. This is a topic that we are all very much aware of, unfortunately, and rather than get into a historical lesson about what we were doing 3 years ago, I want to talk about today. Based on the state of the pandemic, is there any limitation to the use of any of the targeted therapies or antibodies in your practice, or should we be changing our approach to patients with CLL [chronic lymphocytic leukemia] based on the current pandemic?

Catherine C. Coombs, MD: I do not recommend any change to my own practice, based on the availability of so many drugs to treat COVID-19 that we didn’t have before. I make sure all my patients are vaccinated fully. I do caution them that there may be lower efficacy of the vaccines when they’re on a BTK [Bruton tyrosine kinase] inhibitor, especially in the setting of anti-CD20s. However, I also offer all of them Evusheld [tixagevimab with cilgavimab], and I have been impressed with its tolerability. I’ve had very few breakthrough cases, and the ones I’ve had have been very mild. Is that [due to] the drug, is that [due to] the fact we’re now in the Omicron [variant] era, [with] Omicron itself [being] less severe, or both? Who knows? But I think things are a lot more manageable now. Even in the setting of COVID-19, we also have all these drugs we can offer patients. I don’t end up using a lot of Paxlovid [nirmatrelvir and ritonavir] due to the drug interactions, with the exception being my patients on watchful waiting. We also have a variety of monoclonal antibodies that have come through for treatment of symptomatic COVID-19, so I think we should offer our best therapies to our patients. I think we are doing quite well with the COVID-19 therapeutics, and the era is a lot different now than it was 2 years ago.

Anthony R. Mato, MD, MSCE: Thanks so much. Does anybody have anything to add that would be different than what Callie just said? I agree with her completely.

Transcript has been edited for clarity.

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