CLL and Its Treatment Can Heighten Patients’ Risk of Infections

Patients with chronic lymphocytic leukemia (CLL) face an increased number and severity of infections due to their disease, as Dr. Jennifer Woyach explained during the CURE® Educated Patient® CLL Summit.

Woyach, a hematologist-oncologist specializing in treating patients with blood cancers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and a professor in the division of hematology at The Ohio State University, discussed the issue of impaired immunity and infection risk among patients with CLL during the summit.

CURE® spoke with Woyach following the summit about her presentation, how CLL and its treatment can affect patients’ immune systems and the importance of adhering to a vaccine schedule.

Q: For patients with CLL, what do you hope the big takeaway is from your presentation at the CLL Educated Patient Summit?

A: I think the biggest takeaways are that the future of CLL treatment is very bright. We have very effective treatments for the disease right now, and a lot of active research is trying to improve upon these already effective treatments.

Q: Can you explain the reasons why patients with CLL have impaired immunity and are at particular risk for infections?

A: In patients with CLL, the immune system does not function as well as people without the disease for a number of reasons. The CLL cells themselves suppress parts of the immune system, and the CLL cells replace the normal B lymphocytes, which are responsible for producing antibodies, so antibody production is also not as effective.

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Q: Why do patients on treatment have a higher risk for infection?

A: Many of our treatments initially cause a higher risk of infections, which improves as the disease becomes effectively treated. This is primarily due to suppression of normal bone marrow, at least in the early stages of therapy.

Q: According to your presentation, “risk of death due to infection has not improved much over the past five decades.” Why is that?

A: The immunosuppression associated with CLL can persist even when the disease is effectively treated, and our current treatments, while eradicating the CLL well, do not always restore normal immune function. Current clinical trials are trying to understand ways that we can use treatment to improve the normal immune system.

Q: How important is it that patients adhere to the recommended vaccine schedule, and what may be some barriers to this adherence?

A: I think the biggest barrier is that the vaccine schedule can be complicated and (it) changes frequently, so it can be difficult for patients and physicians to remember new updates. As well, sometimes when we are focused on discussing treatment, preventative care like vaccines and cancer screening can be forgotten.

Q: Given this information, what sorts of conversations about infections and vaccinations should patients with CLL be having with their care teams.

A: Discussion about infections and vaccines can happen at any time, but I think the most important times to discuss this are in the fall when flu vaccines come out and viruses are more prevalent, as well as prior to starting treatment, as some vaccines might be recommended prior to starting therapy.

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