After 2 Vaccinations and 2 Boosters Still Zero Antibodies!!

[DanBro1]

Received my LabCorp antibodies report yesterday (Feb 21, 2022). After 3 full-dose Moderna vaccinations and 1 half-dose Moderna booster, I show "No detectable antibodies....". Very disappointing news because I have read that many immunocompromised folks have developed a response after a fourth shot. I am still taking Venclexta until the end of this month. I am thinking that I will get a 5th booster in June after I've been off CLL treatment and my blood has a chance to regroup and manufacture some B cells.

[lankisterguy Volunteer]

Hi DanBro1,-

You may want to contact your CLL Expert and ask if you can get the Evusheld injections.

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They are in short supply but most reasonable medical triage should consider you as eligible.

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Here is a list of links to the 69 times we discussed Evusheld here

healthunlocked.com/cllsuppo...

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Len

[DanBro1 in reply to lankisterguy]

Thanks. Fortunately, I only have 1 week to go on Venclexta. Venclexta cancels out B cell production of Covid antibodies. I have an appointment with my oncologist in 3 days and will ask about Evusheld.

[lankisterguy Volunteer in reply to DanBro1]

Evusheld provides the antibodies that were copied from other people and manufactured in a factory. Your immune system doesn't need to do anything with them, so if you can get the Evusheld, you should be ready to go. Len

[E-Lynn in reply to DanBro1]

No. Venclexta goes Not cancel antibody production. Riuxan and other CD 20 monoclonal antibodies do. Did you get Gazyva? I was on Venckexta over four years and quit because of ITP but got great antibody response before quitting. Last LLS value >2500. Just had Stanford test and also high 90-100% score there.

[AussieNeil Administrator in reply to E-Lynn]

All approved CLL treatments also kill maturing B lymphocytes, which you need to make antibodies. (T helper cells assist with the B lymphocyte maturation process to select for antibody producing mature B lymphocytes (plasma cells) and memory B cells active against a disease/vaccine for that disease).

The difference between anti-CD20 drugs and venetoclax (plus acalabrutinib, Ibrutinib, etc), is that anti-CD20 drugs remain in circulation for up to a year, attaching to and killing any new B lymphocytes. The other treatment drugs have a much shorter half life, in the order of hours. Within a week or so they have left our body, so new B lymphocytes can become available to respond to vaccinations. CLL cells also tend to over-express the target of targeted therapies compared to healthy B cells, plus when healthy B cells mature, they stop or significantly reduce the expression treatment targets. That's why it's not usual practice to repeat vaccinations after CLL treatment.

Neil

[E-Lynn in reply to AussieNeil]

I respectfully disagree. My venckexta had me at uMRD but dr Coutre said to continue which I did. My alc was low but functional. Thus I have produced antibodies.

[AussieNeil Administrator in reply to E-Lynn]

It's a matter of degree, so I've modified my reply accordingly. CLL cells over express BCL-2, so are more targeted than healthy B lymphocytes. If you look at the LLS studies, you can see that that the those in treatment are less likely to produce antibodies.

[E-Lynn in reply to AussieNeil]

Neil - I am a part of the LLS study. Sadly, when the questionnaire was first sent out, Venclexta was not even listed as a treatment. The standard of care in the US is Obinutuzumab (Gayzva) plus Venclexta, so many of those responding later probably had that CD20 monoclonal antibody. I was on Venclexta as mono therapy and from my first jab, has an increasing response that culminated in the maximum response both as measured by LLS at LabCorp and by Stanford, who has their own unique test which they use as a gateway (or not) to Evusheld. So I view the LLS study results with a grain of salt or not rose colored glasses or whatever. I think Larry Saltzman is trying to clarify the data that may not be correctly tagged.

Also, Neil, I feel my posts last night (2AM my time) were abrupt and I appoligize to you and CFarrar. I was lying in bed with my iPhone, thumb texting away while my brain was ratteled by the beginnings of this terrible war in Ukraine.

[AussieNeil Administrator in reply to E-Lynn]

Thanks for your update and for raising your valid concern which led me to modifying my response. Thanks also for your involvement in the LLS study, which while it has been more informative than other blood cancer vaccination effectiveness studies, still lacks the detail we so much want to know for CLL.

I think that one of the silver linings of this pandemic, is how much more we've learned about the human immune system, in particular our adaptive response. I hope that extends to a much improved understanding of how CLL and CLL treatments impact the immune system, given immune system restoration is the last outstanding challenge for a full CLL cure.

With respect to how we respond to vaccinations while under treatment, there's so much we still don't understand. CLL suppresses the immune system in many ways, so treatments should reduce that impact. BTKi, BCL-2 and anti-CD20 (and I presume PI3K treatments) have varying efficiencies, partly influenced by how much their targets are over-expressed in CLL cells compared to healthy B-cells. CD20 expression on CLL cells can vary from dim to bright, though it's usually not particularly strongly expressed on B-cells. Yet anti-CD20 treatments have such a long impact on our ability to respond to vaccines (and by extension, illnesses, so we are at risk of experiencing them again in full, rather than muted). If only COVD-19 monoclonal antibody protection lasted for a year or more!!

Neil

[DanBro1 in reply to E-Lynn]

Yes, I received Gazyva infusions - once per month for 6 months, coupled with a 12 month protocol of Venclexta.

[SycamoreN]

I've had 4 vaccines - 2 Astra Zeneca and 2 Pfizer. I've been tested by the Royal Marsden, London after each of them and have mounted no antibodies. I'm on Ibrutinib. Sadly Evusheld is not available to us in the UK.

[stevesmith1964]

HiOur immune systems are strange. I have had 3 vaccine shots and 3 doses of Covid. Still no antibodies. I had monoclonal antibodies on day 10 of my second (delta) infection, just as a precaution. If the pattern continues I am due my next covid infection in next 4 to 6 weeks.

[E-Lynn in reply to stevesmith1964]

And I never had COVID, but because I get IVIG, I now have the kind of antibodies produced by the disease thanks to someone's donation to the blood pool. (I know I've never had COVID as I'm part of a US NIH study of immune compromised response to the jabs that requires I spit into a tube every two weeks so they can check various antibodies.) Also the LLS study looks at two sets of antibodies, those produced by the disease and those from the jab. In my last blood test for them, those post-disease antibodies showed up for the first time.