COVID-19 and Hairy Cell Leukemia (HCL)
COVID-19 continues to present risks and concerns for immunocompromised individuals, including those with hairy cell leukemia (HCL). Over time, we will learn more about COVID and its short and long term effects for patients with HCL. On this page, we will share occasional updates as new recommendations or research emerge. We encourage all individuals with HCL to consult with your doctor and share any questions or concerns with your healthcare team.
Information from the Centers for Disease Control and Prevention (CDC)
COVID-19 Vaccines for Moderately or Severely Immunocompromised Individuals: Studies indicate that immunocompromised individuals may not build the same level of immunity to 2-dose vaccine as non-immunocompromised individuals. These individuals are vulnerable to COVID-19 because they are more at risk of serious, prolonged illness. The CDC is recommending that "moderately to severely immunocompromised people receive an additional dose" of the COVID vaccine.
Who needs an additional COVID-19 vaccine? According to the CDC, this includes people who have been receiving active cancer treatment for tumors or cancers of the blood.
This additional dose is intended to improve immunocompromised people’s response to their initial vaccine series.
CDC recommends that people with moderately to severely compromised immune systems receive an additional dose of mRNA COVID-19 vaccine at least 28 days after a second dose of Pfizer-BioNTech or Moderna vaccine.
The U.S. Food and Drug Administration (FDA) has now authorized a third dose of the vaccine shots for certain immunocompromised individuals. Read the announcement. >>
Although CDC does not recommend additional doses or boosters for any other population at this time, the U.S. Department of Health and Human Services has announced a plan to offer COVID-19 booster shots to most Americans, beginning this fall. Read the announcement. >>
Published Resources
Hairy Cell Leukemia and COVID-19 Adaptation of Treatment Guidelines
In May 2021, doctors from HCL Centers of Excellence published an update to the consensus guidelines for management of classic HCL. The article, published in Leukemia, provides expert opinion to assist doctors in making treatment decisions for their HCL patients in the context of COVID-19.
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.
This article underlines the option of active surveillance in patients with low but stable blood counts, considers the use of targeted and non-immunosuppressive agents as first-line treatment for classic HCL, and gives recommendations on preventive measures against COVID-19.
Recommendations in this article include:
Individuals with HCL are strongly recommended to follow the national and local guidelines for prevention of the further spread of SARS-CoV-2. These include social distancing, hand hygiene and masks covering nose and mouths.
Patients with HCL are encouraged to receive COVID vaccine unless specific contraindications exist. Confirmation of a serologic response following vaccination would be helpful.
Vaccination in HCL patients may be delayed to up to 6 months or longer after the last application of anti-CD20 antibodies.
In addition to vaccines for COVID-19, an effort should also be made to assure that other immunizations are up to date in patients (e.g., annual influenza vaccination and pneumococcal vaccinations).