I found Dr. Rick Furnam’s information (posted on this site previously) to be the most helpful I’ve run across thus far regarding the Covid vaccine.
I am on Venclexta and will complete treatment in August 2021. Given the fact that to take the vaccine while on the Venclexta would likely not grant me the efficacy a non-CLL patient would experience, my two-part question follows:
Would it be advisable to receive the vaccine in the immediate days ahead AND possibly again after my Venclexta treatment concludes? Is that even feasible?
Is there any information out there as to how long after CLL treatment ends before the body is better able to produce the needed antibodies?
I’m wondering if I waited for the vaccine, how long after August would be advisable.
I apologize in advance if this has been previously addressed. I couldn’t locate any advice on the subject.
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Survivor1951
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My understanding is, the mechanism of action of Venclexta does NOT affect the Covid vaccine. It's the main reason I am choosing Venclexta monotherapy right now since I am in need of treatment & can't wait even 4 months. Venclexta supposedly doesn't affect normal B-cells (correction, insert) AS MUCH AS IT DOES CLL CELLS while anti CD-20 treatments, standard chemotherapy, and anti T cell do. Venclexta affects the anti-apoptotic(anti programmed cell death at the end of a normal cell life cycle) protein BCL-2. Normal B cells don't have an excess of this protein....in fact, cardiac tissue is the only tissue type I am aware of that has a great deal of BCL-2. (p.s. i understand BCL-2 is not really active in cardiac tissue except right after a heart attack, so no worries about the drug affecting cardiac function) So normal B cells shouldn't be greatly affected by Venclexta & should produce antibodies. We can't even say dysfunctional B cells won't respond, this is new vaccine tech. The other treatments affect normal cells to a greater extent, which is where the concern that patients on those treatments may not produce antibodies. Some may, but the recommendation is, to expect patients on those treatments may not respond well. Time will tell if the new mRNA technology is potent enough to give enough of an immune response in these patients.
Here's the recommendation as of November 2020 from the American Society of Hematology:
I am planning on getting the vaccine & my oncs agree. I am going to ask the hospital I am getting admitted to Monday by my CLL specialist if they are giving it, I am on a list from my GP, I am on a list from my local hem-onc, as well as my state of residence (getting treatment out of state). I am looking to get the vaccine from the first people who will give it to me 😂
•Do not administer live attenuated vaccines prior to, during, or after treatment with VENCLEXTA until B-cell recovery occurs. Advise patients that vaccinations may be less effective.
You stated "Venclexta supposedly doesn't affect normal B-cells"
I like the term supposedly.
Hematopoiesis is a complex process in which numerous cells and organs communicate through a process of signaling. When signaling is interrupted all cell processes are influenced and pathway manipulation occurs. This is one of the mysteries of measuring treatment outcomes, and most likely the reason that medicine will say remission rather than cure.
There are literally billions of possibilities for clinical observations when a protein/gene is manipulated. For that matter, research has not yet been able to define this concept in the blood of untreated CLL patients. Consider the contrasting clinical explanations for differing disease progression tempo's and sub categories of complications. E.g, platelet loss vs accelerated lymphocyte proliferation, Richter's transformation, macrocytosis, anemias, thrombocytopenia, etc... Answer for why = undetermined
"Mechanism of action" is more a complicated less explained condition with innumerable possibilities than it is the immediate and obvious action currently being observed.
An illustrated of such observation can be presented in a perturbation model.
Although I do not have a Venetoclax study, here is one similar -
(Apologies in advance) Think of it somewhat in the same way that if you removed one second in time. Therefore, every action thereafter would be influenced less one second. Just for fun, ponder the possibilities for even less than 5 minutes.
If anyone reading here can produce the research data for the equation to measure affect(s) and or outcome probability with regard the hematopoietic cycle and blood cancer treatment, please please share it. Especially if it is Venetoclax or Obinutuzumab relative, as I am personally invested in that perturbation.
It appears that your theory is well considered, and individually this choice may prove desirable.
Hoping you the Best with your well thought choice.
I probably should have said "Venclexta is less likely to affect normal B-cells" or something like that.
Thanks to Gardening-girl and Smakwater for the correction! I added an insert correction to my earlier post. And it would be even more correct to note that the BCL-2 gene subset (there's a number of "BCL-2" gene types) that venetoclax affects is not overexpressed in healthy B cells. But obviously at least Some cells that aren't cancerous CLL ones (like hair follicles) are affected by the drug to some degree.
My anxiety re:upcoming treatment start has left me a bit daft. I'll try to stop the suppositions & stick strictly to the facts moving forward.
I am sorry that I somehow implied to correct you, rather, I meant to compliment your decision in an ongoing pursuit by providing continuum.
I too made such a decision based on the best information available, and my limited understanding of it. We can hope to encourage others of doing the same, as logic would imply the probability of a more desirable outcome , than if we simply left it up to a matter of trust with little measure.
Sofia, Here's a data-filled paper demonstrating that although CLL cells over express BCL-2, circulating normal B-cells are just as sensitive to venetoclax.
Both leukaemic and normal peripheral B lymphoid cells are highly sensitive to the selective pharmacological inhibition of prosurvival Bcl-2 with ABT-199
“…we have also demonstrated that in human samples ABT-199 is highly potent in killing both normal and malignant circulating B cells. Indeed, the virtually identical degree of sensitivity in normal and malignant cells was somewhat surprising in view of the prevailing model that Bcl-2 overexpression in malignant cells selectively primes them for killing by BH3 mimetics.“
However, that paper also has a graph that shows that Pre B cells, Immature B cells and Transitional B cells are not as susceptible to ABT199 as are the majority of circulating normal B cells, which are the cells that would be first to respond to a vaccine.
I also plan to get a SARS-CoV-2 vaccination at first opportunity even though I'm on ibrutinib and may not produce a protective response.
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