Building antibodies post remission

[Survivor1951]

Forgive me if this has previously been addressed. Have any findings been published regarding CLL patients’ ability to more adequately develop antibodies when the Covid vaccine or booster is administered after the patient goes into full remission? Having been in remission since August (vaccinated plus booster earlier in 2021), I’m wondering if a fourth shot might now be in order.

[AussieNeil Administrator]

From the research into antibody responses, we know that we are more likely to develop an antibody response with higher IgA and IgM counts. Immunophenotype flow cytometry testing will also report your B-cell lymphocyte count, though my specialist noted that it's possible to have them present in the bone marrow before they appear in your peripheral blood.

Neil

[2016Longevity in reply to AussieNeil]

Don’t you mean ‘with higher IgA and IgG counts’ ? (and not IgM cause those are low with any CLL’er )

[2016Longevity in reply to AussieNeil]

when in remission doesIgM gets back to normal range ?

[AussieNeil Administrator in reply to 2016Longevity]

IgM is the first immunoglobulin to appear when B-cells become specific to new antigens and mature into antibody/immunoglobulin factories. IgA and IgG are produced later through a mechanism termed class switching.

The time it takes for healthy B-cells to recover depends on the treatment type and the individual. It can take a year or more with anti-CD20 drugs like rituximab. I finished taking venetoclax and acalabrutinib a year ago and finally saw what I hope was a promising lift in my IgA and IgM last month.

Neil

[2016Longevity in reply to AussieNeil]

awesome ! good for you!

[2016Longevity in reply to AussieNeil]

do you feel safer now, with the pandemic still going on etc? and being in remission entering hopefully soon post pandemic era?

[AussieNeil Administrator in reply to 2016Longevity]

I won't feel really safe until I can reliably test at home for all variants, established and new, or promptly be able to be diagnosed by a GP, then be able to pick up an antiviral within a day or so from a pharmacist which is likewise effective for all variants, or be infused within a couple of days with a monoclonal antibody with the same or better effectiveness to the antiviral.

[2016Longevity in reply to AussieNeil]

would the remission CLL’er have the comfort going mask free in an endemic era unlike the Watch and Wait Cll’er who (and their loved one / spouse) need(s) to maskup forever or up until remission is achieved?

[AussieNeil Administrator in reply to 2016Longevity]

It depends on the degree of recovery of their B and T cells, along with their immunoglobulin recovery. Many of us never see our immunoglobulins recover. Full recovery of our immune systems is the major outstanding factor in providing a complete CLL cure.

[johnliston in reply to AussieNeil]

Neil, would recovery of IGM also be a sign of returning CLL cells?

john

[AussieNeil Administrator in reply to johnliston]

It's unlikely, as CLL cells don't tend to shed immunoglobulins. If they did then our IgM would trend high, rather than low, as our CLL progressed. Multiple Myeloma is the blood cancer caused by clonal plasma cells.

Neil

[johnliston in reply to AussieNeil]

I guess the question is do B cells and Cll cells recover separately? Can B cells recover without CLL also recovering? Most treatments target all B cells good or bad.

john

[AussieNeil Administrator in reply to johnliston]

All approved CLL treatments target healthy B cells and CLL cells, though where a target is over-expressed in CLL cells, targeted therapies such as venetoclax can be more effective against CLL cells than healthy B cells.

CLL regrows from any CLL cells surviving treatment, which are usually sequestered in the protective microenviroment of a node or in the bone marrow. Healthy B cells come from lymphoid stem and progenitor cells in the bone marrow. So yes, the two lines recover separately. Studies of the CLL cell genome typically show a growing number of sub-clones developing over time. When the CLL tumour regrows, its likely to have sub-clones resistant to the previous treatment, as they've been selected for. For example, there's a higher incidence of 17p del and TP53 mutated CLL cells in CLL tumours after chemoimmunotherapy treatments.

Neil

[2016Longevity]

congratulations with being in remission !!