Vaccines - AstraZeneca, Moderna and Pfizer - Which one for CLL Patients.

[RobertCLL]

I had a telephone consultation with my CLL consultant today (I would consider her to be a UK expert in CLL). We discussed 3 of the vaccines, AstraZeneca, Moderna and Pfizer. As the latter 2 manufacturers are mRNA, the first (The AstraZeneca/Oxford vaccine is a genetically modified common cold virus of infected chimpanzees). She therefore instructed me NOT to receive the AstraZeneca/Oxford vaccine as this is a weakened (or attenuated) form of the germ.

I suspect that her comment may be controversial, so just providing the feedback I have received.

[Poodle2]

Strange, I had a telephone consultation with my consultant today as well, in the UK, she said I should take any vaccine that will be offered. This is a bit confusing that doctors in the same country say different things. She is also a CLL specialist. Not sure what to think of this ...thanks for sharing.

[AussieNeil Partner Administrator in reply to Poodle2]

The confusion lies in the simplification for us to 'Avoid live vaccines', which could be expressed more exactly but less effectively as 'Avoid live vaccines capable of infecting you', which then causes uncertainty of which live vaccines we can and can't take. The need for clarification also wasn't an issue with traditional vaccines. That's because the AstraZeneca/Oxford vaccine uses a genetically modified chimpanzee adenovirus to deliver the SARS-CoV-2 spike protein into our cells to encourage an immune response. The genetically modified chimpanzee adenovirus is not capable of replicating in humans - even if immune compromised.

This Forbes article explains the process:

forbes.com/sites/alexknapp/...

Neil

[wmay13241 in reply to AussieNeil]

If you IgG has been compromised by cancer treatments, the AstraZeneca vaccine may not be the best choice. This is particularly true if you get IVIG infusions.

[AussieNeil Partner Administrator in reply to wmay13241]

Why is that? Do you have a reference and if so, does it explain why it is particularly true if you have IVIG infusions and does it matter whether your need for them was before or after treatment? Many of us get IgG infusions, so this is important.

Thanks,

Neil

[mrsjsmith in reply to AussieNeil]

Agreed Neil,

And the first I have heard of this problem and I would imagine because that is the one the UK have ordered the most of it will be the one I receive.

Colette

[wmay13241 in reply to AussieNeil]

My understanding is that the AstraZeneca vaccine works by altering your IgG to recognize and destroy covid-19. If your immunoglobulins are compromised, say by CAR-T, and your IgG requires IVIG infusions to replenish your IgG, then a vaccine based on IgG will not last long.

[cajunjeff in reply to wmay13241]

That’s an efficacy issue. The original post was based on the premise that the Oxford vaccine is unsafe for us because it’s a live vaccine.

As Neil explained, it’s not a traditional live vaccine. It’s not a weakened form of the covid virus which could cause us to get covid. It’s a vector vaccine. I have not seen anywhere where vector vaccines are not safe for us.

With any vaccine we with Cll take there will be questions about it’s efficacy.

[RobertCLL in reply to Poodle2]

I guessed that we were all going to receive different advice.

[ornstin]

These opinions by CLL experts seem to me premature. The AstraZeneca vaccine hasn't even been approved. Its also some way off (months?) before CLL patients will be offered vaccination (so I don't understand the need for advice to be given on vaccines right now) by which time I would expect that more vaccines will have been approved, more data will be available, on which basis there would be guidance on which vaccine or vaccine should be given to the extremely vulnerable, both on the grounds of efficacy and safety. It would be surprising if the guidance just turned out to be "take any vaccine that is offered". I would find that advice a bit worrying, but I suppose it cannot be ruled out.

[mrsjsmith in reply to ornstin]

My Consultant when asked said it was too early to say. As I understand the AstraZeneca is continuing testing on an older trial group. To be honest in the UK if we suddenly get a text or call from our surgeries to go in for the vaccine I doubt if the receptionist will know what we are being offered. They never know which flu vaccine I am going to get !

Colette

[ornstin in reply to mrsjsmith]

Thank you. I am actually fairly hopeful we will know which vaccine we will be getting when the time comes. This could become a fairly hot topic.

[LeoPa in reply to mrsjsmith]

Your consultant is smart. Too early to say is another version of "I don't know*. Only smart people say that. The rest knows everything and have been everywhere (twice at least) 😁

[Pageboy]

I overheard my doctor the other day replying to a patient who was just leaving answer their question about which Covid jab he should get, to have any one which is offered (this wasn’t a confidential conversation btw!). The man was about 90. I don’t know on the balance of risk given his age my doctor considers the vaccine a must for him. But he didn’t sound at all concerned recommending any of the vaccines. I haven’t had the conversation myself with him yet, beyond I should get the vaccine in a few months as I’ve just started treatment.

[Berrytog]

Which vaccine may well depend on which medication CLL patients are already taking. I have read of trials taking place to not just determine the suitability but to see the benefits of our drugs as a partial defence against Covid 19 reducing symptoms and the need for hospitalisation even in the older patients which represent a majority of CLL patients.

[RobertCLL]

Not directly related. But just seen this on the CLLforum website:

Anti COVID vaccines should be strongly encouraged for all close contacts of CLL patients who are immunocompetent. CLL patients must not receive live vaccines (follow Department on Health advice on COVID vaccines for immunocompromised).

Section 12 of the following link:

ukcllforum.org/wp-content/u...

[RobertCLL]

I have just been pointed in the direction of CLL Support, with the following guidance:

images.cllsupport.org.uk/wp...

To quote: "In consultation with CLL specialists at the UK CLL Forum, we understand that the newly approved Pfizer/BioNTech coronavirus vaccine and AstraZeneca's vaccine awaiting approval are both nonreplicating, RNA or subunit vaccines. This is good news for the CLL community. Neither vaccine is ‘live’. There should be no safety concerns for immunocompromised patients, whichever vaccine you are offered".

Interesting why members of the UK CLL Forum are offering different advice.

[Big_Dee]

Hello RobertCLL

I would suspect your CLL Specialist is correct.