B cell T cell Screen

[Palmetto]

Has anyone here had a B and T cell Screen to see if you have enough B cells to mount an antibody response to the covid vaccines? Do you think it would be helpful?

[AussieNeil Partner Administrator]

I had this test (Immunophenotype flow cytometry) during treatment prior to having my flu vaccination. I had zero detectable B cells. My specialist still recommended the flu shot to generate T cell immunity and to stimulate memory B cells and plasma cells. I would suggest the same pretty well holds with COVID-19 vaccinations. Obviously, if we can delay our vaccination until our B cell counts improve, (e.g. after Rituximab, Obimutuzumab or Ofatumumab infusions), then that should give us an improved outcome.

Remember that even with adequate B cells, our likely response is unknown, so we should still practice safety measures after our vaccination, with absolutely no let up for two weeks afterwards, to gibe time for immunity to build and ideally until 2 weeks after our second shot. Don't forget that we don't even know how long healthy people maintain antibody protection from COVID-19 vaccinations!

Neil

[Palmetto in reply to AussieNeil]

Exactly Neil. It may be as short as three months in that we really do not know it hasn’t been tested long enough they do say that the Johnson & Johnson they feel is effective for up to a year we need to get it before the strain mutates any further we really need everyone pretty much vaccinated at the same time and it doesn’t appear that that’s going to happen I don’t know why all of the vaccine appointments are not 24 hours they need to be given around the clock we need to train more people in how to administer the shots it would only take a few trained medical personnel like doctors and nurses to oversee if there are any adverse reactions we literally need tens of thousands of people trained to administer the shot. All that would take would be a several hour training session and certificates could be given this is a crisis and has to be approached that way

[SofiaDeo in reply to Palmetto]

To answer your question as to "why aren't vaccine appointments around the clock"....it's likely due to lack of resources. There's a shortage of healthcare personnel in many places. Some people have already gone months & months without a single day off. We can't ask people administering vaccines to work around the clock. We can't pull staff away from already stressed hospitals. My CLL specialist in a different city from my local hem-onc was surprised to hear my local, In Addition to her oncology patients/workload, was also pulling double duty as a hospital intensivist. Asking these already stressed/overworked staff to deal with vaccine administration on top of everything else? I know that places are recruiting certain healthcare students to be trained in administration. But it does take a little time, IM injections can be a bit harder to administer than SC, IMO. And with the rare but potentially serious adverse vaccine reaction, we've got to have support measures for these people in place. Frustrating, but there it is.

[seelel]

If you have had a recent immunoglobulin blood test, then that will provide a bit of a guide to the ability to create antibody. Although there are number of types of Ig, the test usually confines itself to IgG, IgA, and IgM.

If your levels are in the normal range (particularly IgG), then you might anticipate a reasonable antibody response to a vaccination.

[Palmetto in reply to seelel]

Thank you concern is husband had AIHA in July with 4 rounds of rituxan and Gazyva first of September. Would like for him to get the vaccine as soon as possible but I want to make sure it will be effective. Our consultant felt it should be at least six months But I have requested this test to see if possibly there are enough to make a difference

[GMa27]

I hope to have antibody test after the second shot to see how effective it might be for me.

[bennevisplace]

Someone should be studying the immune responses of CLL patients to Covid vaccination.

In the UK I guess there won't be many able to get an antibody titre.

[mrsjsmith in reply to bennevisplace]

I hope that we will,

We just need to keep asking Consultants to add to blood test requests.

My stepdaughter tells me there is a site in Brockwell Park ( south London ) where you can make an appointment and get an antibody test. Otherwise we will be wandering around in the dark with our fingers crossed for some time.

Colette

[bennevisplace in reply to mrsjsmith]

Yes I hope so too. I will ask but I think my next blood test would be too soon after vaccination (or before, depending on the pace of rollout).Is the site you mentioned testing for antibodies post vaccination or post infection?

[mrsjsmith in reply to bennevisplace]

I would imagine post infection at the moment, but I will ask my stepdaughter to get more information next time she runs past. Hopefully it will not be too much of a problem, and assume we will be in a minority wanting this information.

Colette

[bennevisplace in reply to mrsjsmith]

It will be interesting to know which. I expect the site is doing rapid tests for recent infection, the kind you can also buy. According to NHS research Siemens does the best such test.

For people with weakened immune systems, we really need more than that, i.e. a laboratory assay of the different types of antibody, distinguishing neutralising antibodies that should provide longer term protection against Covid. It would be good to include some relevant measure of T cell response too. But here in the UK these assays might not be available outside a clinical trial.

[mrsjsmith in reply to bennevisplace]

There is a trial at UCLH called Provent ! Not sure where in the UK you are.

Colette

[bennevisplace in reply to mrsjsmith]

Thanks but yes, I have applied to participate. It could be a good alternative to vaccination for those of us with a very suppressed immune system.

[Yuck in reply to bennevisplace]

Why would the Provent trial “be a good alternative to vaccination”?

Thank you,

~ Yuck

[bennevisplace in reply to Yuck]

As all the vaccines contain an antigen designed to stimulate antibodies against Covid, vaccination will be effective to varying degrees in CLL patients. Those with a very weakened immune system - e.g. in treatment/ early post treatment with Ritux/ Gazyva, +/-chemo - should not expect to benefit. Targeted drugs tend to be kinder to the immune system and those who've been on Ibrutinib for a while may well get a worthwhile T cell response from vaccination. But no Covid vaccine has been tested on CLL patients, so we are all guessing.

Provent is a phase three trial of a synthesised antibody AZD7442 given as protection against Covid. Readymade antibodies for people who can't make their own. It's a lot more expensive than vaccine, so would be approved only for those groups considered less likely to gain adequate protection by vaccination.

clinicaltrials.gov/ct2/show...

[Yuck in reply to bennevisplace]

Thank you very, very much for your explanation and the link.

Very appreciated!

Best,

Yuck

[Yuck in reply to mrsjsmith]

What is the Provent trial?

[mrsjsmith in reply to Yuck]

Above my pay grade but a new trial at UCLH for people who may not respond well to vaccines. There is plenty online about it.

Colette

[AnnieZ102]

I don't really have anything useful to add, except to thank all of you who helped put my mind at ease somewhat.

I have regular bloods including flow cytometry. My B lymphocytes have not recovered 16 months post chemo, which was a concern re a vaccine. My T cells are pretty much recovered and my IgG is within normal range, which gives me hope for whenever I'm offered the vaccine. My haematologist doesn't expect to happen before our next phone consult in March.

Anne.