"Nearly all patients with cancer respond well to COVID-19 vaccines" Except us.....!! New Study From US and Swiss

[DanBro1]

uthscsa.edu/patient-care/ph...

[AussieNeil Partner Administrator]

Frustratingly, it doesn't specifically mention CLL when stating what cancers the 7 high risk patients (6% of the study group) who didn't develop antibodies have, just noting myeloma and Hodgkin's lymphoma, which like CLL, are B- cell blood cancers. I would have expected some in the study group to have Non Hodgkin's Lymphoma, if not specifically CLL.

No surprises about the lack of response here:-"Among the high-risk groups, patients receiving a therapy called Rituximab within six months of vaccination developed no antibodies. Rituximab is a monoclonal antibody used in the treatment of hematological cancers and autoimmune diseases."

The anti-CD20 monoclonal antibody rituximab, (also known as Rituxin, Ruxience or Mabthera), targets B-cells and a subset of T-cells and can remain circulating in the blood for 6 to 12 months after the last infusion, killing any remaining B-cell cancer cells along with any new, healthy B-cells. We need new healthy B-cells to respond to the vaccinations and then mature into antibody factories - plasma cells and into memory B-cells, which quickly respond to a subsequent COVID-19 infection by multiplying and turning into more plasma cells to boost antibody production.

The same poor response to vaccinations will occur in anyone treated with any other anti-CD20 monoclonal antibody up to 6 to 12 months prior to their vaccinations, such as obinutuzumab/Gazyva, ofatumumab/Arzerra/Kesimpta and ublituximab (TG-1101).

Neil

[Palmetto in reply to AussieNeil]

Neil ironically we got a phone call today from University of Miami which is affiliated with Sylvester Cancer Center. Husband was treated there by Alencar for a while so we must be in data base. They were studying whether CLL patients were able to mount antibodies after the vaccines. Unfortunately husband had the vaccine end of January and early February and they were looking for people who had been vaccinated in the past 3 months. We told them he would definitely want to be in the study if possible and they are going to see if he still qualifies. But it is a good sign that they are paying attention to whether or not CLL patients under treatment can produce the antibodies.

[AussieNeil Partner Administrator in reply to Palmetto]

I'm also in a study and with no detectable B-cells 6 months after ending treatment, I won't be making any antibodies.

[ava1967ir in reply to AussieNeil]

Hi Neil,What is the effect of Covid vaccine on people who are W&W(without treatment)?

[AussieNeil Partner Administrator in reply to ava1967ir]

Your response to vaccination will depend on how much your CLL has impacted your ability to make antibodies/immunoglobulins. We will hopefully know more from the various studies underway, but I would expect that the higher your IgA and IgM in particular, along with your IgG, the better your response. Immunoglobulin testing isn't done that often by specialists. You might need to ask for that special blood test.

Neil

[neurodervish in reply to AussieNeil]

Hi Neil, Did you read Dr. Parry's preprint submission yet? "Antibody responses after both the first and second Covid-19 vaccine are lower in patients with CLL compared to age-matched donors. This is particularly marked in patients who are taking BTK inhibitors or have serum IgA deficiency. Further approaches such as repeat vaccination or administration of prophylactic antibody may be worthy of investigation for some patients." papers.ssrn.com/sol3/papers...

I've backed off thinking a basic antibody test will be predictive of vaccine efficacy, but wonder if an IgA test might help? I recently received an IgG test, but not an IgA or IgM. I've read that they're normally done all together, but my recent IgG test was not. (Are you tired of being bombarded by these antibody questions? 🤐)

[AussieNeil Partner Administrator in reply to neurodervish]

Makes sense to me that checking IgA and perhaps IgM can indicate the likely response to vaccination, as these appear before IgG, indicating that we have operating germinal centres.

[neurodervish in reply to AussieNeil]

Many thanks!

[agbessell in reply to Palmetto]

I see Dr. Alvez at Sylvester and he has never mentioned any CLL studies . Could you please share the name of the doctor. I am watch/wait since 2016 but have not launched a robust response to the Pfizer vaccine. My Spike protein antibodies have gone from 4.09 to 1.58 to 1.03 (Quest - high is >20).

[neurodervish in reply to Palmetto]

U of Miami is affiliated with the U of Washington sponsored study that I signed up for. Here's a link, if you're interested in more details clinicaltrials.gov/ct2/show...

[gardening-girl in reply to AussieNeil]

Hematological malignancies 25 (19%)

Acute lymphoblastic leukemia 1

Chronic myeloid leukemia 1

Chronic lymphocytic leukemia 1

Diffuse large B cell lymphoma 6

Follicular lymphoma 2

MALT lymphoma 2

T cell lymphoma/mycosis fungoides 2

Hodgkin’s lymphoma 4

Polycythemia vera 1

Myeloma 5

cell.com/cancer-cell/pdfExt...

[AussieNeil Partner Administrator in reply to gardening-girl]

Thanks for finding the source. I'd just woken up

[RosettaClapp in reply to AussieNeil]

oh dear ...I had thought obinutumazab might just have been out of this group ! but there you go ...same old same old routine I expect dont you

[Fran57 in reply to AussieNeil]

Neil, since you are one of fonts of all knowledge (😊), could you let me know what you think, please?My husband is due to start Venetoclax and Rituximab in August ( he has to finish radiotherapy for prostate cancer first 🤦‍♀️)

I am concerned that he will need to have the third booster covid vaccine in September, but I understand that having rituximab will mean even less of a response again.

We will obviously check what his consultant thinks, but I’d like to have some facts in my head too.

Maybe he could have rituximab later, during the Venetoclax treatment, Or should it go at the start, to aid his response to Venetoclax?

I just don’t want him to start the rituximab and then not be able to have the covid booster.

In my head, I’m thinking maybe the consultant will delay him starting ( unlikely now), so he can be jabbed first…

Sorry for rambling on! My head is full up!

Stay safe, Fran 😉

[AussieNeil Partner Administrator in reply to Fran57]

In my case, the obinutuzumab (second generation version of rituximab), reduced my tumour burden so I didn't need a hospital stay during the venetoclax ramp up. I think the obinutuzumab also helped clear my bone marrow, helping the recovery of my concerningly low haemoglobin and platelet counts. So, as you can see, there is no general answer. It depends on tumour burden and blood count status, which can have immediate consequences vs hypothetical consequences from potential exposure to the coronavirus. In the UK, I doubt you'll be able to shift when the rituximab is introduced, but. you could ask! If his treatment for CLL can be deferred just a bit longer, that might just be the best option. Your husband would probably very much appreciate a treatment holiday!

Neil

[Fran57 in reply to AussieNeil]

Thank you Neil; much appreciated.We will ask, but his CLL treatment is already being delayed and I think I’m right in saying the effect of Rituximab might mean a wait of 6 months after the Covid-19 jab, so that might be too long a delay.

Thanks again. Stay safe,

Fran 😉

[AussieNeil Partner Administrator in reply to Fran57]

Yes, your husband probably won't make much in the way of antibodies until at least 6 months after his last infusion.

[DanBro1 in reply to AussieNeil]

I have my last infusion next week (July 23rd).... still have 6 months left on the Venclexta pills. I hope I will begin to produce all kinds of antibodies when I have completed my treatment regimen.

[beanlake14 in reply to AussieNeil]

I am in a study with ublituximab (I finished last July) and still on umbralisib and venclexta and umbralisib til Febrauary. My oncologist is considering having me revax in March, a month after completion which would be me about 14 months out from the ubltuximab. I had Pfizer in January and February. I live in Missouri, one of the ignorant states where people don't think they need the vaccine and Delta is raging. It is so frustrating, but I digress. Just wondering if anyone else in active treatment is having doctors considering revaccinating once complete.

[SamanthaJane123 in reply to AussieNeil]

I started rituximab several weeks after receiving the two vaccines of Phizer. Would that impact the effectiveness of the vaccine? Negative consequences?

My hematologist held of me starting my rituximab treatment until I was fully vaccinated because of your explanation. I'm wondering if I had enough time to build the antibodies. Thoughts?

[AussieNeil Partner Administrator in reply to SamanthaJane123]

Per: journals.plos.org/plosone/a... with my emphasis.

"We measured COVID-19 mRNA vaccine induced IgG and IgA in serum serially, up to 145 days post vaccination in 4 subjects. Spike antigen-specific IgG levels rose exponentially and plateaued 21 days after the initial vaccine dose. After the second vaccine dose IgG levels increased further, reaching a maximum approximately 7–10 days later, and remained elevated (average of 58% peak levels) during the additional >100 day follow up period. COVID-19 mRNA vaccination elicited spike antigen-specific IgA with similar kinetics of induction and time to peak levels, but more rapid decline in serum levels following both the 1st and 2nd vaccine doses ."

We won't know how those with CLL respond until we see the trial reports, but I hope the above is reassuring.

Neil

IgG response of 4 subjects to COVID-19 vaccination

[Lilsa]

Hi Neil and DanBro1,

what if you have the two Pfizer doses and produce some antibodies and then have treatment with a monoclonal antibody? Is your antibody factory still going to be churning out the antibodies? And for how long? Lastly are the memory b-cells destroyed by say obinutuzumab?

[AussieNeil Partner Administrator in reply to Lilsa]

Plasma cells do not express CD20, so shouldn't be affected by Anti-CD20 monoclonal antibodies like obinutuzumab. Memory B cells do express CD20, so you are likely to lose some with obinutuzumab treatment.

Neil

[neurodervish in reply to Lilsa]

What a great question Lilsa , and a much appreciated answer from AussieNeil . I wish there was an easy way to compile all these details into an easily accessed fact-sheet/pinned post. So many useful nuggets are buried within these conversation threads.

[Research123]

From what I can make out the problem is not so much the disease as the treatment for the disease ie the issue isn't so much CLL as the medicines taken for it. And 12 months after the treatment, that is not such an issue. So I think you have to look at your individual circumstances and if you get ill, get an antibody infusion, then hopefully that brings those of us being treated up to a normal level. Thank heavens the medicine has moved on since a year ago.

[peghip]

I wish life was simple. BTK inhibitors and probably Venetoclax produce a a poor anti body response to covid vaccines if at all. Our immune systems are complex and what I haven't seen is any comment on the response of the T cells to the vaccine. We may have no antibodies but our T cells and other components of the immune system may provide adequate protection or enough to provide mild symptoms to covid. For us the issue is no one really knows, so we just have to carry on as though everyone else has the ability to kill us and stay out of their way. Frustrating or what?

[Fran57 in reply to peghip]

I love your opening sentence and can empathise with your frustration!It’s all very well saying we have to make our own decisions, but it’s going to be difficult to influence others’ choices re masks/ distancing etc. and therefore the spread, along with the potential introduction of more variants. 🤦‍♀️

Chin up.

Stay safe,

Fran😉

[DanBro1 in reply to peghip]

Peghip.... I hope what you say regarding our secondary disease fighting ability is true! 😏