Infection Prevention for CLL Patients with Dr. Meghan Thompson

Dr. Meghan Thompson, a CLL specialist from Memorial Sloan Kettering Cancer Center in New York, joined the HealthTree Community for CLL on January 10th, 2024, to share insights on how CLL patients who have weakened immune systems can reduce their chances of infection. We invite you to watch her presentation or read the summary. 

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the immune system, making it easier for patients to contract infections. To maintain good health, it is important for patients to receive non-live versions of vaccines, receive immunoglobulin infusions if they have a history of recurrent infections, be checked for other types of cancers like skin cancer, keep an eye on their blood pressure and cholesterol, and consider participating in clinical trials. 

The Importance of Vaccines for CLL Patients

Vaccines help prevent infections in CLL patients. Safe vaccine options for patients include non-live versions such as the flu vaccine, the new RSV vaccine (for those over the age of 60), COVID-19 vaccines, pneumococcal vaccines (like Prevnar 20 or Prevnar 15, followed by Pneumovax 20), and the Shingrix vaccine series. 

How well a vaccine works can change from one CLL patient to another. Even if the response to a vaccine might be lower, it is still a good idea to get vaccinated because they are safe. CLL patients should try to get all their vaccines completed before they start any treatments. Dr. Thompson mentioned that patients should wait six months before getting a vaccine after receiving rituximab or obinutuzumab. This is because these treatments lower B-cells which impacts how well a patient’s body can make antibodies after receiving a vaccine.  

Patients should talk to their cancer doctor about what vaccines to get and when. Because vaccine guidelines change and each CLL patient is different, it's best to have a personalized vaccine plan. Your doctor can help make this plan, thinking about your health needs, past treatments, and how your immune system is functioning. 

Immunoglobulin Infusions (IVIG)

CLL patients who have had a lot of infections, such as serious lung infections, might need extra help to prevent additional infections. One way to help is by receiving immunoglobulin infusions (IVIG). This therapy is mainly for patients with low immunoglobulin G levels (IgG). IVIG gives patients extra antibodies from donors and can help reduce future infections. 

Research and Clinical Trials for CLL

There is a lot of research going on to determine how different treatments affect CLL patients' immune systems. This research might also find ways to make the immune system stronger. Patients are encouraged to ask their CLL specialist about clinical trials. These trials might offer new treatment options and help doctors learn more about CLL.

Comprehensive Health Management Beyond CLL

Managing CLL isn't just about treating the cancer. Patients with CLL also have a higher chance of getting other types of cancer, like skin cancer. It's a good idea for all CLL patients to get their skin checked by a skin doctor (dermatologist) every year. If they've had skin cancer before, they might need to get checked more than once a year.

Seeing a primary care doctor is also very important. They can help keep track of your health and make sure you get regular checks for other cancers, like colon, breast, and cervical cancer. They can also help keep an eye on things like blood pressure and cholesterol. 

Questions and Answers 

Dr. Thompson answered questions from the audience. Here is a summary:

• Are there any vitamins or supplements recommended for CLL patients?
  • Dr. Thompson doesn't currently recommend any specific supplement for CLL, as there is not yet convincing evidence that supplements help treat CLL. She advises against starting new supplements without consulting a doctor, due to potential interactions with CLL treatments and the lack of FDA regulation on supplements.

• Should CLL patients use probiotics?
  • Probiotic use is very individualized and depends on the patient's blood counts and choice of treatment. Dr. Thompson generally does not recommend routine probiotic use for CLL patients.

• Is it common for colds to last longer in the "watch and wait" phase?
  • Patients may experience longer or more serious infections, including colds, though responses vary. Factors like aging, other medical conditions, and individual immune responses play a role in how long an infection lasts.

• How do you manage infections in CLL patients?
  • Dr. Thompson takes a multidisciplinary approach, involving nurse practitioners, pharmacists, and sometimes infectious disease specialists or immunologists. She emphasizes vaccination and screening for immunoglobulin levels.

• Do all CLL patients respond the same to vaccines?
  • Some CLL patients may not respond to vaccines the same as others, but Dr. Thompson still recommends vaccinations due to their overall benefits.

• Can IVIG be used for active infections?
  • IVIG is generally used as a preventative measure against infections in CLL patients, not for treating active infections.

• Are there any precautions I need to take during "watch and wait" in flu season? 
  • Dr. Thompson advises maintaining good hygiene, avoiding sick people, and considering masking in crowded indoor spaces. Staying up-to-date with vaccinations is also important.

• How do I handle infection anxiety and social isolation?
  • It's important to balance the risk of infection with the consequences of social isolation. Adapting activities and following CDC guidelines can help manage this balance.

• How do I handle infection risks around grandchildren?
  • Dr. Thompson suggests discussing with a doctor any preventative measures, such as specific antibiotics or antivirals, based on the type of infection and the patient's condition.

• How do I handle severe and prolonged pneumonia? 
  • In cases of prolonged or severe pneumonia, collaboration with infectious disease or lung specialists is recommended. Treatment may include tailored antibiotics or other interventions based on the individual's situation. 

• What is some of the research that is happening for CLL?
  • Dr. Thompson highlighted the importance of ongoing research in CLL, including clinical trials for new treatments, refining existing therapies, and personalizing treatment plans based on minimal residual disease (MRD) testing. She also mentioned the development of new therapies like BTK degraders and the study of genetic resistance to treatments. 

In conclusion, managing CLL involves more than just treating the cancer itself. It's essential for patients to follow a personalized care plan, which includes getting the right vaccines, receiving immunoglobulin infusions if patients have a history of recurrent infections, and possibly participating in clinical trials. Regular health check-ups and consultations with healthcare professionals are important to address not only CLL but also other health concerns, ensuring comprehensive care is tailored to each patient's unique needs. 

Interested in Accelerating Research? Join HealthTree Cure Hub!

Are you interested in accelerating research toward a cure for CLL? We have created a powerful patient data portal named HealthTree Cure Hub for this very purpose. We invite you to join the 12,000-and-counting blood cancer patients who are collaborating with specialists through research surveys and studies in HealthTree Cure Hub. YOU are the key to improving CLL care. We are grateful for your time and support in helping us progress toward a CLL cure. Create your free HealthTree Cure Hub account by visiting the link below! 

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