CLL Can Leave You Immunocompromised. Here’s How to Manage

CLL and your immune system

There are several types of white blood cells, but lymphocytes are the ones primarily involved in CLL.

Healthy lymphocytes protect you against viral, bacterial, and fungal infections that can make you sick. When you have CLL, your body produces abnormal lymphocytes called leukemia cells, which don’t fight infection as well as lymphocytes.

With CLL, your bone marrow still produces normal white blood cells, but the leukemia cells multiply faster and live longer than the healthy ones. As they reproduce, these leukemia cells take over space in your bone marrow, leaving less room for healthy white blood cells. Because the leukemia cells don’t fight infection well, as their numbers increase, your immunity decreases.

If you have a condition like CLL that weakens your immune system, you have a higher chance of developing:

• Infections. People with CLL are more vulnerable to respiratory infections like pneumonia, as well as infections in the skin, soft tissue, and urinary tract. This is both due to the condition itself as well as some of its immune-suppressing treatments.
• Richter’s syndrome. Also known as Richter’s transformation, this rare complication of CLL can transform the condition into other types of lymphoma that are hard to treat.
• Other cancers. Cancers of the skin, larynx, lung, and colon are some of the more common secondary cancer diagnoses that may accompany CLL.

Up to 25 percent of people with CLL experience autoimmune complications. An autoimmune reaction is when your immune system mistakenly attacks your body’s healthy cells.

Most of the autoimmune complications in CLL involve the immune system attacking blood cells. This is called autoimmune cytopenia (AIC), and can happen in several ways:

• Autoimmune hemolytic anemia. This occurs when the immune system destroys red blood cells faster than your body can produce them.
• Immune thrombocytopenia. This happens when the immune system attacks the body’s platelets (clotting cells), resulting in a shortage.
• Pure red blood cell aplasia. Though less frequent in CLL, this is when your bone marrow doesn’t make enough red blood cells, likely due to an autoimmune attack.

Tips to manage CLL while being immunocompromised

There are certain changes you can make to avoid possible sources of infection and boost your overall health — and in turn, help you manage CLL.

Reduce your risk of infection with these steps:

• Wash your hands thoroughly and often.
• Avoid or reduce contact with people who have contagious illnesses like colds, the flu, and COVID-19.
• Ask your doctor about vaccines you should get, such as those for flu and pneumonia (people with CLL should avoid live vaccines that are administered via a nasal spray).
• Avoid eating food that may contain harmful bacteria, like uncooked fish and meat.

Habits to boost your overall health include:

• Eat a balanced diet packed with nutrient-dense food like fruits and vegetables. Just make sure they’re properly washed. Avoid overly processed foods as much as possible.
• Get active to boost your energy levels and stay fit.
• If you smoke, talk with your doctor about effective quitting strategies.
• Try stress-reduction activities like meditation or a fun hobby.

CLL and COVID-19

If you have a weakened immune system from CLL, you may have concerns about the current COVID-19 pandemic.

People with CLL may be dealing with factors like age and a suppressed immune system that also increase the chance of a more severe case of COVID-19. Those receiving cancer treatment like chemotherapy also have an increased risk of complications from the virus.

Fortunately, protective measures like mask wearing, handwashing, and physical distancing can help reduce your risk.

Your treatment plan in the face of a pandemic will depend on your individual case of CLL and potential exposure status. If you’re stable and doing well, you may be able to cut back on in-person appointments and use telemedicine to manage your condition.

If you haven’t yet started treatment, your doctor may suggest waiting if there’s a spike in COVID-19 cases in your area. This can help to minimize potential exposure to the virus as well as the immunosuppressive effects of CLL medications.

It’s important to work with your doctor to develop a plan for monitoring your condition while you wait out treatment.

If you don’t qualify for a “watch and wait” approach, your doctor will typically recommend systemic treatments that require fewer in-person visits to administer and have less immunosuppressive effects.

Once COVID-19 cases in your area lessen, your doctor may recommend switching to more intensive treatments.

If you’re receiving CLL treatment and develop mild COVID-19 symptoms, you may be instructed to get tested for the virus and monitor your symptoms. With mild symptoms, you may be able to stick with your CLL treatment as directed. If you test positive for the new coronavirus, your doctor may recommend pausing some medications until you’ve recovered.

Getting vaccinated against COVID-19 may be a good idea for people with CLL. But it’s important to discuss your individual case along with any other health conditions you may have with your doctor before signing up for a vaccine.

CLL complications

Leukemia cells don’t always stay in your bones. They may exit your bone marrow and enter the bloodstream, where they can accumulate in organs and cause complications. Related health complications include:

• weakened immune system
• low blood cell counts
• enlarged lymph nodes
• infections like pneumonia
• pulmonary embolism (blood clot in your lungs)
• pleural effusion (fluid around the lungs)
• damage to alveoli (lung air sacs)
• Richter’s transformation
• AICs
• other types of cancer

The takeaway

CLL is a type of cancer that starts in your bone marrow and damages white blood cells, which decreases your immunity. People with CLL are more at risk for infections, other cancers, autoimmune reactions that destroy blood cells, and severe complications related to COVID-19.

If you have CLL, you can take steps to stay healthy by avoiding people who are sick, washing your hands frequently, and staying up to date on vaccines. Self-care measures like eating a healthy diet, exercising regularly, and getting adequate sleep can also help boost wellness.