Israel approves third dose for immunocompromised

[Youngen]

They finally gave the approval! Will speak with my specialist tomorrow to discuss risk/benefit of pausing Ibrutinib to get the best chances of a response. Fingers crossed!

timesofisrael.com/liveblog_...

[Justasheet1]

I wonder if it will be a third of the same or a different brand vaccine?

[Youngen in reply to Justasheet1]

We are 99.9% Pfizer and do have some inventory of moderna but that hasn’t been used on citizens to date. Unfortunately it will be mRNA in any case

[Justasheet1 in reply to Youngen]

Do you feel that the J&J would be more efficacious?

[Youngen in reply to Justasheet1]

I do, but there is none in the country. Israel had an exclusivity deal with Pfizer with a small amount from moderna. Under the circumstances, I won’t take the risk of getting on an international flight right now so my options are limited

[Justasheet1 in reply to Youngen]

I just read Pfizer is recommending a third of theirs and it increases the antibodies 5-10 fold. No mention of mixing vaccines though I know most people think that’s the way to go.

foxnews.com/health/pfizer-m...

[Youngen in reply to Justasheet1]

Yes- they are basing their recommendation in part, based on the fact that we are seeing about 40% of cases being vaccinated. Keep in mind that we were mostly vaccinated in dec-feb and the antibodies appear to be reducing significantly

google.com/amp/s/www.market...

[Justasheet1 in reply to Youngen]

Youngen,

Thanks for the info. I really would love a third shot but am still without guidance from my CLL expert in this.

I would love his insight on which vaccine to get and for how long I need to pause my ibrutinib for. I don’t want to create a problem trying to solve another one.

I guess I’m gonna have to wait for the

cajunjeff clinical trial to end 😎

Jeff

[Youngen in reply to Justasheet1]

Absolutely! I am Following the trial of one closely too. Waiting to discuss the risks of stopping Ibrutinib and also- chances of a better vaccine response. If they are not significant I am not sure I want to rock the boat since my CLL is finally stable now. We know that many patients with CLL in W&W also didn’t develop antibodies so wondering if it’s worth taking the gamble with the treatment pause.

[809123 in reply to Youngen]

I asked my consultant about stopping prior and after the 3rd vaccine. He was uncomfortable because I have only been on Ibrutinib for 8 months.

[LeoPa in reply to Youngen]

Is it reasonable to expect high levels of antibodies in the blood 6 months after an infection? I thought memory cells were supposed to remain and the immune system would be able to ramp up production of them in no time in case needed. Do we have still high levels of antibodies to the vaccines we received during our lives? Probably not. Why would this be different?

[AussieNeil Administrator in reply to LeoPa]

How long antibodies for a specific illness last depends on the illness, how those antibodies were developed and subsequent stimuli. There are specific antibody tests to check the immunoglobulin titre for given infections. Antibodies from COVID-19 vaccinations have been found to last for at least 6 months:webmd.com/coronavirus-in-co...

Newly produced (or infused) IgG has a half life of 21 days. CD20 monoclonal antibodies (rituximab, obinutuzumab and ofatumumab) can be detected in our circulation up to a year after our last infusion.

If we can make adequate amounts of antibodies to our vaccinations, I don't see why we shouldn't expect similar coverage over time, but I would think the bigger concern is how effective those antibodies would be against new variants. Perhaps it is unrealistic to expect stimulus from similar spike proteins in other respiratory viruses if we take steps to avoid our risk of exposure.

Neil

[neurodervish in reply to Youngen]

I'm still trying to wrap my head around all this. Is there a mechanism for why the J&J (adenovirus vaccine) might be more efficacious over the mRNA for CLLers? My brain hurts!

[Youngen in reply to neurodervish]

Right?? So confusing and since it’s all so new- it’s all theoretical at this point and nobody really knows much for sure! There is a theory that mixing mRNA technology with the classic vaccine technology will trigger a stronger response. But- we don’t know how much stronger and how that would affect immunocompromised with CLL, let alone on treatments which further inhibit enzymes needed to develop antibodies 🤦🏻‍♀️

[JigFettler Volunteer in reply to neurodervish]

Ive not seen anything wrt this. It maybe one vacc mode suits CLL better than another - cant believe thats known tho'.

CLL being so heterogeneous unlikely a one size fits all best fit will be found IMO.

Jig

[Youngen in reply to Justasheet1]

Confirmed that they are only providing Pfizer. WHO just came out against mixing providers. At this point- I will take what I can get

[DanBro1 in reply to Youngen]

WHO is voicing an "opinion". There is no basis in fact for their comments. WHO is strictly a bunch of government bureaucrats getting paid for doing nothing. WHO does not contribute anything other than misinformation. Look at their performance in China - they were and are "clueless". The FDA in the US just spread misinformation and warned against the J&J vaccine saying SIX cases of severe reaction have occurred out of THIRTEEN MILLION administered shots and that the sky is falling. Yet J&J has shown that a booster of their vaccine will increase your immunity to Covid-19 by over 500 to 1000 percent!! This is what happens when you have unelected government bureaucrats setting policy.

[Youngen in reply to DanBro1]

Not disagreeing about WHO but I would prefer not to mix providers unless there is specific guidance/data supporting it. Regardless- not relevant for me since Pfizer is all we have available to us

[DanBro1 in reply to Youngen]

There is no data supporting to mix or not to mix vaccines. I had two Moderna shots and plan on requesting a J&J shot when I complete my CLL treatments. Trying to cover all my bases, so to speak.

[Youngen in reply to DanBro1]

The clinical trial of antibodies in CLL patients showed that some (albeit a minority) did develop antibodies while on treatment. What treatment are you on?

[DanBro1 in reply to Youngen]

Six months of monthly IV Obinutuzumab coupled with one year daily Venclexta.... I have six months to go and I will be finished with the meds.

[Youngen in reply to DanBro1]

Good luck!!! 🍀

[Jm954 Administrator in reply to DanBro1]

Not true DanBro1 - recent studies have supported mixing vaccines Youngen

nature.com/articles/d41586-...

nature.com/articles/d41586-...

ox.ac.uk/news/2021-06-28-mi...

Jackie

[Jm954 Administrator in reply to DanBro1]

I agree the WHO have been completely inept at every step but surely unelected and apolitical experts are better than elected representatives who have no idea about the science and a political party line to follow.

Remember that this is a rapidly evolving situation and that information or declarations from even a month ago may no longer hold true.

Jackie

[bennevisplace]

Thanks. Do you know anything about clinical trials behind this decision, and whether they included immunocompromised subjects? Also how does Israel's regulatory system work in this case?

[Youngen in reply to bennevisplace]

The third dose was approved as a broad study. They only approved it for certain categories of immunocompromised patients (blood cancers, transplant patients, HIV and a few other groups) and they will consider adding additional groups in the future. We are getting it at teaching hospital and will take part in an antibody study being conducted by them.

[kathymac5252]

our US cancer specialist /researcher said that there was not enough data yet to warrant a 3rd dose...she said we would know more in the next two months....

[Youngen in reply to kathymac5252]

Here the third dose was only approved for a subset of immunocompromised people and not for a broader population

[kathymac5252 in reply to Youngen]

My husband is immune compromised as well....low neutrophils and low WBC....our doctor is still paying attention to the trials and data that is slowly amassing....we are being so careful still

[Youngen in reply to kathymac5252]

Even after a third dose (assuming I develop antibodies) I will continue being very cautious as we are seeing a lot more vaccinated people getting COVID. Keep your eyes open for studies from israel about a third dose specifically in CLL patients!

[kathymac5252 in reply to Youngen]

I will.....Israel is doing some great research...