CD40LG and COVID-19: There are preliminary data on the anti-inflammatory effects of Ibrutinib in murine lung,12 effect on suppression of inflammatory cytokines such as TNF, IL2RA, and CXCL13,20 and down regulatory effects on T cells and macrophages.21 A recent paper has shown that use of Ibrutinib in a small number of WM patients is associated with a low rate of COVID-19 related pulmonary complications.11 There is the additional risk of developing IgM flare and potentially worsening the clinical situation because of a cytokine storm if BTK inhibitors are withheld.22