Recommendation from the NCRI CML Subgroup- updated 27th March 2020

Expert Opinion from the NCRI CML Subgroup 17th Mar 2020, updated 27th March 2020

The latest UK government updates are listed here:

https://www.nhs.uk/conditions/coronavirus-covid-19/  and  https://www.gov.uk/government/publications/covid-19/guidance

For specific questions regarding your condition and treatment (outside of the NHS general guidance for high risk conditions) please contact your CNS or your CML specialist.

Are CML patients at higher risk for a more severe COVID-19 infection?

• Patients with CML do not appear to be at a higher risk of getting COVID-19, although data are limited.
• Having a diagnosis of CML or being treated with TKI therapy does not convincingly cause clinically significant immune suppression.
• CML patients can be at a higher risk of COVID-19 infection if they are older (age over 70 years), have other medical conditions or are receiving other treatment which will suppress the immune system.
• There are no published data on the course of the COVID-19 infection in CML patients treated with tyrosine kinase inhibitors (TKI) and reports are rare. Reassuringly, very few CML patients on TKI therapy were infected in the Hubei province in China, and the outcome was similar to the general population.
• Self-isolation (self-quarantine) for 12 weeks is recommended for at-risk individuals, but in our medical opinion, the diagnosis of CML or treatment for CML alone does not clearly fall in this category.
• UK Patients with CML will have received letters from their GP practice, stating that they are in the high-risk category. This will allow full access to government support services and patients are entitled to follow these recommendations. If patients have not received this notification by 29th March 2020, they should contact their GP surgery and not their hospital.
• The life expectancy of CML patients is currently approaching that of the general population. The decision to place CML patients on TKI therapy in the high-risk category for COVID-19 infection must not have a negative impact on triage or other in-patient treatment related decisions, due to their excellent outcome.

Patients should not interrupt or reduce their TKI medication without the advice of their CML specialist team

NCRI CML Sub-group:  

Dr Dragana Milojkovic (Chair); Prof Jane Apperley; Dr Jenny Byrne; Prof Richard Clark; Prof Mhairi Copland; Sandy Craine consumer representative; Prof Nick Cross; Dr Joanne Ewing; Prof Letizia Foroni; Dr Paolo Gallipoli; Dr Andrew Goringe; Prof Brian Huntly; Dr Hugues de Lavallade; Dr Andrew McGregor; Prof Adam Mead; Dr Kate Rothwell; Prof Stephen O'Brien; Prof Oliver Ottman; Dr Seonaid Pye; Dr Anuparna Rao paediatric representative; Dr Graeme Smith; Richard Szydlo MSc. PhD; Dr Andres Virchis. Trainee members- Dr Simone Claudiani; Dr Gillian Horne;