Re vaccine and outcome for CLL you might find ... - CLL Support

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Re vaccine and outcome for CLL you might find this interesting

Lookintomyeyes profile image
Lookintomyeyes

Today, the first results of a key study on vaccine responses in leukaemia patients has been published. I this blog, our Patient Advocacy Manager, Charlotte, outlines the first reaction to the news and what the takeaway messages are for patients and their loved ones.

Key points:

Initial results of a study from Birmingham on vaccine responses of CLL patients has been published.

34% of CLL patients show antibody responses, rising to 75% after two doses, showing the importance of having both doses.

However, CLL patients produced a much smaller quantity of antibodies than healthy people.

Certain groups of patients were less likely to respond, including those on BTK inhibitors.

The study has a number of limitations to be aware of and you should be cautious in using this data to change your behaviour. Seek advice from your haematology care team as necessary.

Today, the first results of a key study on vaccine responses in leukaemia patients has been published in the Lancet journal. This work focused solely on chronic lymphocytic leukaemia patients; this is a type of incurable blood cancer that affects B-lymphocytes. There had been concerns about this particular group of patients and how they would respond to the vaccine, as CLL patients are known to not respond as well to other vaccines, such as the flu, as healthy people do.

This work was led by researchers at the University of Birmingham, including Dr Helen Parry, who has spoken at previous webinars for Leukaemia Care about the COVID-19 and blood cancer patients. The study included both those who had received the Pfizer-BioNTech vaccine and some people who had received the Oxford-AstraZeneca vaccine. It is important to note that this work is a pre-print; this means that the work has not been fully peer-reviewed by scientists outside of the team that conducted the trial. Therefore, the results should be interpreted with some caution.

The headline result brings some welcome news to CLL patients. Only 34% of patients showed an antibody response after their first vaccine (94% of healthy people of the same age have antibodies after the first dose). However, this improved markedly after the second dose, where 75% of CLL patients showed an antibody response (compared to 100% of healthy, age matched people).

However, CLL patients were shown to have over 100 times lower amounts of antibodies. This means that they have produced antibodies, but much smaller amounts than in healthy people. We don’t fully understand the impact of how many antibodies you produce, but this is a concern.

Additionally, it’s important to note that not many people had had a second dose in these early results. 75% responding after a second dose shows potentially positive news, but we need as much data as possible about more people after a second dose to be sure of the responses.

The study also looked to see whether subgroups of CLL populations were less likely to respond than other CLL patients. Unfortunately, patients who were being treated with BTK inhibitors (e.g., ibrutinib, acalabrutinib) were less likely to make antibodies after vaccination. Those patients with less IgA antibodies in their blood in general (meaning they struggle to make antibodies to many diseases) were also less likely to form antibodies after vaccination. Therefore, it seems that more work is needed to support these patients; the researchers suggest further vaccination programmes and better COVID treatments will be needed into the future.

Finally, this study used different ways of sampling patient’s blood. Some patients had their blood taken as if they were having a blood test, submitting a vial of blood. Others conducted a finger prick test and submitted the test as a dried spot of blood. Whilst this enabled more people to participate with an easier option, the finger prick test is less reliable than a full blood test, so this may have impacted upon results. For more information about finger prick antibody tests, please see our blog on the topic here.

In summary, this study has shed some light on those most at risk in the CLL population and gives others cause for hope. However, we would advise that you interpret results with caution and remain vigilant against the risk of catching, as the limitations of the study prevented the researchers from being able to give further advice to patients. If you wish to discuss these results and their relevance to you, we recommend you discuss at your next routine appointment.

24 Replies
AussieNeil profile image
AussieNeilAdministrator

Thank you!

Here's the link to the blog by Charlotte, the

Leukaemia Care Patient Advocacy Manager: leukaemiacare.org.uk/suppor...

Neil

Jonquiljo profile image
Jonquiljo in reply to AussieNeil

Thanks. Has anyone got the link to the actual paper published in “Lancet”? Reading interpretations without the actual data is not optimal.

pkguk2 profile image
pkguk2Administrator in reply to Jonquiljo

Hi Jonquiljo. You can find CLL Support comments on this and a link to the paper here:cllsupport.org.uk/birmingha...

Jonquiljo profile image
Jonquiljo in reply to pkguk2

Thanks! It always is best to have the details of how a study was done.

Well small steps to positivity and some faith in starting a normal life albeit with personal safe guards. Happy with 75% for my situation if I’m the same! Complicated as we are all different in stages of disease and treatment.

I sent off my sample post 2nd dose a couple of weeks ago, so they are still studying.

I wonder when the suggestion for the booster in the Autumn is confirmed.

Good to know we are not forgotten.

Sadly not looking good for anyone on Ibrutinib or Acalabrutinub and with low iGA like me 😕 ! Oh well I wasn’t thinking of a trip to Glastonbury this summer.

Colette

Mystic75 profile image
Mystic75 in reply to mrsjsmith

I'm sorry, CoCo xo

So I've got a 3 in 4 chance of some protection and a 1 in 4 chance of not having some protection. Is that what 75% of people having an antibody response means?

Then what level of protection: 100 times less than a healthy person. What does that mean? It sounds like no protection.

If I were on a BTK Inhibitor I would have even less protection. And if I already have less IgA I would have even less protection.

This sounds like very bad news..

PaulaS profile image
PaulaSVolunteer

Good news for those on Watch and Wait. Not so good for those on BTK inhibitors (eg Ibrutinib and Acalabrutinib).

I'm wondering if they'll now suggest that people on BTKs have a short break from those drugs before having any Covid jabs in future...

I'd be very happy to have an Ibrutinib pause if it would help me get more protection from Covid. I did that when having cataract surgery and a colonoscopy with no problems. But I realise some people with more aggressive CLL might not be so keen on that idea.

Paula

mrsjsmith profile image
mrsjsmith in reply to PaulaS

That’s an interesting question Paula but would it change an improved response that quickly ?

Colette x

PaulaS profile image
PaulaSVolunteer in reply to mrsjsmith

Good question, Colette.

Stopping Ibrutinib for a few days before and after surgery is enough to reduce bleeding problems, but the affect on antibodies and immunity is probably a very different matter... As you say, it would probably need longer to make a difference to vaccine responses.

Paula x

mrsjsmith profile image
mrsjsmith in reply to PaulaS

Paula,

Anyone on Ibrutinib should perhaps be asking their Consultant. It will be interesting to see what response we get.

Colette x

Thanks for posting this, the keenly awaited publication (non peer-reviewed pre-print) of results from the Brummi Uni study.

I have to say I'm disappointed in the methodology, even taking into account the real-world limitations imposed on the researchers, i.e. two different vaccines, two different dosing intervals, and two different sample sizes.

With a cohort of 299 why did they test for antibodies in only 67 "fully vaccinated" samples, especially as previous studies had highlighted the poor responses of blood cancer patients after only one dose?

And can one really come to the conclusion (from "multivariate analysis") that patients on BTK inhibitors are at particular risk, with only 8 such patients, of a total 18 patients in treatment, after two doses?

Bearing in mind these results don't go beyond measuring antibody responses, and the data set is a mixed bag, I really don't think this study adds to the Tel Aviv study in CLL patients published in April ashpublications.org/blood/a...

Seems that finding out what score provides what level of protection is still a great mystery. Hopefully, at some point, the researchers can tell us.

The 100 times lower than healthy person statement (regarding CLLers scores) makes sense ... as a score of say “25” x 100 = 2500, which I understand is roughly a score that healthy people get after getting covid vaccines.

Meanwhile, we “W&W” for better antibodies study conclusions..

bennevisplace profile image
bennevisplace in reply to Pin57

Yes, and we w&w for part two of the antibody studies that endeavoured to look at T cell responses too.

Pin57 profile image
Pin57 in reply to bennevisplace

Bennevisplace, well said about the 2nd mystery and awaiting more info about our T-cells ability to fight covid.

I gotta say there is a lot of hand-wringing about CLLers level of protection w/vaccine (and its an important topic in our house due to special circumstances so I too admit a can be a hand-wringer if I let it be.)... but HU has over 17,000 CLL members and one would think this website's group would be the first-line "alarm" if many members were getting covid and were rushing to the hospital w/bad symptoms and worse yet were dying from covid in large numbers. Just havnt heard of that, have you? Your a smart guy with lots of good insights on CLL and this topic (read lots of your posts). Am I off-base to make such a simple general observation/conclusion on this topic that gets alot of HU air-time?

What do you think? Are we in general, as a group, overly concerned for the worse to happen to us when in reality its does not appear to be happening . Maybe its the secrete T-cells, our savior? ...or maybe its because a good many of us "shield" well (as they say in the UK, ... I like that word, shield) or as we say in the US "we hunker down well!"

bennevisplace profile image
bennevisplace in reply to Pin57

Hi Pin57, good question.

I'd say you've put your finger on the main reason why the pandemic hasn't slain more CLLers: our prior awareness of the risk of exposure to bugs and how to mitigate it means that the most vulnerable of us were protecting ourselves long before getting official advice on hygiene and shielding.

T-cells? I think the jury is still out as to how big a part they play in protecting CLLers. After all, the disease is thought to disrupt the entire immune system including T cell function. And the death rate in blood cancer patients hospitalised with Covid has been a lot higher than in the age-matched population.

It's both heartening and chastening to read of members who have caught Covid and got through it, some fairly unscathed and others after a hard battle. I guess we have heard nothing from those who didn't make it?

Right now, with new variants springing up all over, and only a handful of countries anywhere near herd-immunity levels of vaccination, I think we CLLers are right to stay preoccupied with our response to vaccination, and to look to protective monoclonal antibodies as an alternative means of staying safe. We can't stay cloistered in forever.

Pin57 profile image
Pin57 in reply to bennevisplace

Agree. Another great reply. Thanks.

It’s good to know we have another key arrow in our quiver with the monoclonal antibodies. One of this site’s gurus, probably AussieNeil, Len , or the Cajun man Jeff, sent out a weblink where you can get that secret sauce monoclonal in case your on the road or as a home base “plan”. Comforting knowledge and a great reason to be on this site! Helpful folks indeed, aplenty.

Mjmelmhurst profile image
Mjmelmhurst in reply to Pin57

Dr. Mia Taormina (sp?) of DuPage Medical Center near Chicago said on WBEZ radio last week that monoclonal antibodies are not performing well again the new variants of COVID 19. I found that worrisome, because I had been thinking that those monoclonal antibodies that are currently available could be my best hope should I get infected by COVID 19. I don't know enough about this to know if there are different types of such antibodies that might be made available in the future. Meanwhile, I will remain very cautious.

What with "variants" looming, and in my case with CLL at age 87, I will continue to wear a mask, not only to avoid COVID but all other possible infections.

This article has provided the first explanation for my negative antibody result. Five years ago my IgA were only 97 from the lab range of 90-410. Probably even lower these days. It makes more sense to me now. Even though not the best news I really appreciate the information. I am W&W.

Several posts have mentioned low IgA. Mine is shown in a different format as 0.5 Is this very low? Doctor told me that my immunoglobulins are normal but this doesn't appear to be normal. (I had FCR 6 years ago)

AussieNeil profile image
AussieNeilAdministrator in reply to fieldmeadow

USA IgA ranges are typically around 80 to 450mg/dl (milligrams per decilitre)

Elsewhere that would be reported to be 0.8 to 4.50 g/l (grams per litre)

Actual ranges depend on your pathology laboratory, so an IgA of 0.5 may or may not be low. I wouldn't be surprised to hear that many of us have lower IgA counts than yours.

Neil

ninap profile image
ninap in reply to fieldmeadow

i'm in Canada, fieldmeadow. my IGA is less than .05. i used to get infections all the time. my oncologist suggested that i go on SCIG therapy *cuvitru* to raise my IG levels somewhat. i'm on it all the time now - but my IG levels change marginally. i don't go out but at least i don't get sick anymore. maybe the formats are different in other countries? i really don't know :(

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