Testing for immune response

[Lindaan]

It has been said many times Antibody Tests don't really give us much information about out immunity levels.

Is there any test we with CLL can take to give us a measure of how much immunity we have?

What group i.e. Watch and Wait or currently being treated are doing best after being vaccinated after having a 3rd dose of Pfizer?

[cll2013]

It is my understanding that Labcore Labs can give a definitive % of antibodies.

[LeoPa]

No. Nobody knows how to measure the level of protection provided by the vaccines. All they can measure is the level of antibodies. And that's not enough.

[Pin57]

Here are my layman’s responses to your fine questions (You’ll likely get better in-depth responses from our awesome Admins and others on this website).

Per LLS Study in US that I’m in, they use LabCorp’s test to measure (via a “score”) your levels of spike antibodies after taking the covid vaccine. That test also looks to see if you’ve had covid previously.

The antibodies “scores” are important per LLS telling me they are using those scores in their research and reports to find out how CLLers are responding to the initial vaccines intake (not the 3rd shot). They note that the tests do not “determine the level of protection” of the vaccines.

LLS reports indicated that CLLers on treatment had spike antibodies scores that tend to (but not always) be lower than those on W&W with no treatments yet.

Hope that helps answer your questions.

[SeymourB]

Lindaan -

Immunity is exceedingly complex. COVID-19 is revealing even more details, and chapters in textbooks are being rewritten. I'm sorry to say that there will be no simple answer to which antibody level is protective to what degree or to what general level of immunity we have from what.

Antibody counts are generally used, because they're so easy to measure, but it's like measuring nutrition by calories - ignoring proteins, fats, fiber, vitamins, and minerals. Even so, people with low antibodies are like people with low calories - subject to more illness. Having sufficient calories doesn't mean you can't get rickets or scurvy, though. Science and engineering just have not produced low cost tests for the other aspects of the immune system yet.

I'll tell you what people here have been talking about, though. For SARS-CoV-2 virus, we generally get a quantitative or semi-quantitative spike antibody test. In the U.S., many of us have gotten LabCorp's test 164090 SARS-CoV-2 Semi-Quant Total Ab, through the Leukemia Lymphoma Society COVID vaccine study or from our doctor. That test is a spike antibody test. Other's have gotten Quest Diagnostics test 34499 SARS COV 2 AB (IGG) SPIKE, SEMI QN. But the numbers and cutoff for positive vs negative are different from LabCorp. Your doctor can order these tests. If you are in the U.S., it's likely that they are covered by insurance. These tests require a blood draw. The results cause anxiety and depression more often than they are reassuring!

For general immunity, I usually get a immunofixation test for IgG, IgM, and IgA. For Quest Diagnostics, every 6 months, my hemo/onco orders Quest Diagnostics IMMUNOFIXATION IGA,IGG,IGM QT.IMMUNOFIXATION SERUM IMMUNOGLOBULIN. Quest has other immunofixation tests, too, as does LabCorp. There are normal ranges on this test, but being just below normal only generally means slightly more vulnerable - it's not a cliff that we suddenly get multiple infections.

Much also depends on our behavior and those around us. I've been able to avoid major infection over the last year and a half because of handwashing, sanitizing, masking, and avoiding everyone except my family, who are all adults. They also practice good hand hygeine and mask with quality masks. Even so, I am really scared the last few weeks because of the high case counts and start of school here in New Orleans. My wife teaches 8th grade. Everyone masks in the classroom, but not in the cafeteria. She doesn't go to the cafeteria. We all did a BinaxNow Rapid Antigen test last night, because I have nasal congestion, headache, and am more tired than usual - all 3 of us were negative. I'll test again tomorrow.

As far as the SARS-CoV-2 virus that causes COVID-19 disease, what I've seen are papers that attempt to define "correlates of protection" (CoP) by correlating measured antibodies with symptoms, hospitalization, death, plus possibly other variables, such as which vaccine, which variant, age, comorbidities, previous infection coronavirus, time since exposure or vaccine. CoPs are specific to each virus and variant. So, whatever number that is proposed as protective for influenza is not the same as for SARS-CoV-2 Delta variant.

But the papers all focus on presumably normal population. To assess CLL patient, the correlates should have more variables, such as time since dx, FiSH results, IGHv mutation status, flow cytometry results - especially T-cell function, treatment status, and treatment regimen. It's quite possible that an antibody level that correlates to protection from hospitalization in normal people is not protective for some of us. So, beware of generalities. I have not seen any such correlates of protection study for SARS-CoV-2 for CLL patients.

Complicating it further are the variants. Papers written only 6 months ago are now somewhat out of date. We've seen that Delta is more aggressive, causing symptoms in 4 or 5 days after exposure instead of the 7 to 10 days in previous variants. It sheds more viral particles. Yet, it seems to be cleared by the immune system faster in normal people that successfully fight it off. So, again we have to ask, "What's different about the people that fail to fight it off?" Comorbidities again seem to be the key, as well as standardization of treatment, which has greatly helped survival compared to even 6 months ago.

I should add that a second or third infection happens differently due to already existing immune memory and antibodies. Most of the studies focus on first infection.

None of the vaccines provide absolute protection against infection, even in the healthiest adults. To my knowledge, that statement is true for all known vaccines for all known diseases.

I have read of at least one person who scored >2500 on LabCorp's test 164090 SARS-CoV-2 Semi-Quant Total Ab, and still got infected. I don't believe they were hospitalized. Technically, that's a "breakthrough infection."

Your behavior, and the behavior of those around you is part of your immune system. Boost your immunity via mask and distance.

=seymour=

[Justasheet1]

Lindaan,

I myself don’t get hung up on immunity. I have been vaccinated x3 now, I do all the same things as at the start of this pandemic and hope for the best.

Our hope for immunity lies with others immunity. In the mean while, as others continue to let us down, we need to focus our attention on continued prevention and being heard.

We need therapeutics and lab manufactured treatments to blunt an infection because this virus seems to be ready for the long haul and so should we.

Jeff