Therapy for patients with chronic lymphocytic leukemia during the COVID-19 pandemic

Aim. To present our own experience in treating patients with chronic lymphocytic leukemia (CLL) during the COVID-19 pandemic.

Materials and methods. The first group included 20 patients receiving therapy according to the FCR (fludarabine, cyclophosphamide, rituximab) – 15 people and RB (rituximab and bendamustine) – 5 people. The second group consisted of 10 patients receiving ibrutinib at a dose of 420 mg/day continuously.

Results. Both groups of CLL patients showed a high incidence of COVID-19 associated pneumonia (90 and 80% respectively for groups 1 and 2, p=0.06) and a severe course of pneumonia (84% in patients of group 1 and 66.7% in patients of group 2, p=0.0052). At the same time, none of the patients receiving ibrutinib therapy required mechanical ventilation. Among the patients receiving rituximab therapy, mechanical ventilation was required in 10 cases. Among the patients in group 1, the mortality rate was 55.5%. Among the patients receiving ibrutinib therapy, no deaths due to pneumonia or progression of hematoblastosis were registered.

Conclusion. Bruton's tyrosine kinase inhibitors are the safest and most effective in treating patients with CLL during the COVID-19 pandemic. This is due to the immunomodulatory action of ibrutinib; a higher likelihood of achieving a complete response compared to patients receiving FCR and RB protocols; the possibility of outpatient treatment and minimizing the need to visit medical facilities.

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