I am a CLL patient currently on venetoclax since February 6, 2020, and scheduled to begin my 6 cycles of rituximab infusions on April 8. I would like to delay the rituximab infusions due to pandemic because:
1. I don’t want the exposure risk at hospital.
2. Rituximab will make me even more immune-compromised.
3. Rituximab seems to stimulate IL-6 production, and that seems to be a factor in the most severe cases of covid-19: excess levels of IL-6 creating cytokine storm.
Question: Will delaying the rituximab in my 2-year venetoclax+rituximab combo result in inferior treatment outcome?
ASH has put this out which does not directly answer your questions but provides some direction. “ There is general agreement on holding monoclonal antibodies for COVID+ positive patients.” See the rest at: https://www.hematology.org/covid-19/covid-19-and-cll
There have been a trial in the UK where holding the obinutuzumab similar to rituximab) after starting venetoclax actually improved outcomes, so there is reason to believe that the delay would likely not be an issue but check with your doctor. See: https://cllsociety.org/2018/12/ash-2018-professor-peter-hillmen-on-the-combination-of-ibrutinib-and-obinutuzumab-in-cll-timing-matters/