Hairy cell leukemia and COVID-19 adaptation of treatment guidelines

Abstract

Standard treatment options in classic HCL (cHCL) result in high response rates and near normal life expectancy. However, the disease itself and the recommended standard treatment are associated with profound and prolonged immunosuppression, increasing susceptibility to infections and the risk for a severe course of COVID-19. The Hairy Cell Leukemia Foundation (HCLF) has recently convened experts and discussed different clinical strategies for the management of these patients. The new recommendations adapt the 2017 consensus for the diagnosis and management with cHCL to the current COVID-19 pandemic. They underline the option of active surveillance in patients with low but stable blood counts, consider the use of targeted and non-immunosuppressive agents as first-line treatment for cHCL, and give recommendations on preventive measures against COVID-19.

Conflict of interest statement

LA: previously provided consultation services for Innate Pharma and AstraZeneca. VB: VB serves on the Advisory Boards of Gilead, Lundbeck, Janssen, AstraZeneca, and Abbvie and has had research funding from CIHR, LLSC, CCMF, Roche, Janssen, Abbvie, and Lundbeck. VB also received fees from BIOGEN for patented compounds unrelated to this study. JCB: research funding: AstraZeneca, Oncternal, TG therapeutics, Pharmacyclics/AbbVie; Advisory Board: AstraZeneca, Pharmacyclics/Abbvie, Beigene, Genentech, Gilead, Innate. SB: served on Advisory board for Pharmacyclics and Janssen, Beigene and AstraZeneca; received honorarium from OncLive; received travel grant from Arqule. JSB: consulting and Advisory Board: AbbVie, AstraZeneca, INNATE Pharma, KITE Pharma; research funding: MingSight Pharmaceuticals: patents and intellectual property: a leukemia diagnostic device (patent pending). Research work is funded by the Royal Marden Cancer Charity. CD: has been an advisor for Medimmune/Innate Pharma (moxetumomab); consulting/Advisory Board for Abbie and Jansen. JD: has participated in advisory committees in Hungary for Novartis, Bristol Myers Squibb, Amicus, Angelini, Pfizer, Amgen, Roche. AG: Advisory Board: Amgen, Takeda. Research funding: Jansenn and Cilag SPA. Honoraria: Abbvie, Jansenn Cilag, Celgene, Amgen, Takeda. Michael Grever: consultant: AstraZeneca, Pharmacyclics, Ascerta, Axio, Inc. Research funding: Hairy Cell Leukemia Foundation for Patient Data Registry; travel expenses: Hairy Cell Leukemia Foundation; Scientific Board Chair: Hairy Cell Leukemia Foundation Scientific Board (no reimbursement); Scientific Honorarium: University of Pittsburgh. SI: Advisory and speaker fees: Gilead and Takeda; Advisory: Beigene; Speaker fees: Janssen, Takeda, and Gilead. RJK: employment: National Institutes of Health and Regional Cancer Care Associates; Honoraria: PlatformQ, OncLive, Cure; research funding: Innate, AstraZeneca, Novartis, Genetech, Pfizer, Teva, Hairy Cell Leukemia Foundation; patents: coinventor for NIH patent for Moxetumomab Pasudotox. SAP: research funding has been provided to the institution from Pharmacyclics, Janssen, AstraZeneca, TG Therapeutics, Merck, AbbVie, and Ascentage Pharma for clinical studies in which SAP is a principal investigator. SAP has also participated in Advisory Board meetings of Pharmacyclics, AstraZeneca, Genentech, GlaxoSmithKline, Innate Pharma, Adaptive Biotechnologies, and AbbVie (he was not personally compensated for his participation). JP: research funding from Genentech, Servier, Takeda, Fate Therapeutics, and Amgen. Consulting fees from Servier, Amgen, AstraZeneca, Innate Pharma, Novartis, Kite Pharma, Takeda, Intellia, and Kura Oncology. FR: Consultancy and Honoraria—Celgene, BMS, Amgen, Astellas, Xencor, Agios, AstraZeneca, Orsenix, Innate Pharma, Syros, Taiho, Novartis; research funding—BMS, Amgen, Xencor, Macrogenics, Orsenix, Abbvie, Taiho, Prelude, Astex. TR: research funding: AstraZeneca, Medimmune, Roche, Janssen, Abbvie, Advisory Board; AstraZeneca, Jassen, Abbvie; travel grant: Roche, Janssen; Honoraria: Abbvie, AstraZeneca, Janssen. KAR: received research funding from Genentech, AbbVie, Janssen, and Novartis all paid to her institution, consulted for Acerta Pharma, AstraZeneca, Innate Pharma, Genentech, AbbVie, and Pharmacyclics, received travel funding from AstraZeneca. AS: consultant and Advisory Boards: AstraZeneca and Innate Pharmaceuticals; Speakers Bureau: AbbVie and Pharmacyclics. JFS: AbbVie, Advisory board, speakers’ bureau, research funding; AstraZeneca, Advisory board; Celgene, Advisory board, speakers’ bureau, research funding, expert testimony; Genentech, Advisory board; Gilead, Advisory Board; Janssen, Advisory board, research funding; Mei Pharma, Advisory board; Morphosys, Advisory Board; Roche, Advisory board, speakers’ bureau, research funding, expert testimony; Sunesis, Advisory board; Takeda, Advisory Board. TT: advisor: Roche, AbbVie, Janssen, Takeda, Gilead, AstraZeneca, Novartis. MST: research funding: AbbVie, Amgen, Biosight, Glycomimetics, Orsenix, Rafael; Advisory Boards: Amgen, Daiichi-Sankyo, Delta Fly Pharma, Innate pharmaceuticals, Jazz, Kahr, Kura, Novartis, Orsenix, Roche, Syros; Royalties: UpToDate. CST: Honoraria from Janssen, AbbVie and Beigene, and his hospital receives research funding from Janssen, AbbVie, and Beigene. ET: consultant for Innate Pharma. Research funding: Roche. Travel cost: Shire. Holder of a patent on the use of mutant BRAF as HCL biomarker. Our research work in HCL is funded by the Hairy Cell Leukemia Foundation, the Leukemia and Lymphoma Society, and the Associazione Italiana Ricerca sul Cancro (AIRC). XT: consultant for Innate Pharma, AstraZeneca; advisor: Abbvie. Clive Zent: funding through the University of Rochester for laboratory research, from Acerta/AstraZeneca and TG Therapeutics, and from the Hairy Cell Leukemia Foundation. TZ: advisor: Roche, AbbVie, Janssen, Takeda, Gilead, AstraZeneca. PLZ: Speakers Bureau: Verastem, Celltrion, Gilead, Janssen-Cilag, BMS, Servier, MSD, TG Therap., Takeda, Roche, Eusapharma, Kyowa Kirin; Advisory Board: Verastem, Celltrion, Gilead, Janssen-Cilag, BMS, Servier, Sandoz, MSD, TG Therap., Takeda, Roche, Eusapharma, Kyowa Kirin, ADC Therap.; consultant: Verastem, MSD, Eusapharma, Sanofi. The other authors declare no competing interests.