Vaccines After Treatment

[GerryPL]

When I was first diagnosed with CLL I was given 'top-up' vaccines for the normal childhood illnesses. In addition in the last two years I have had Shingrix for shingles. Now just finished a 12 month course of Obinutuzumab and Venetoclax. Can anyone advise if that treatment is likely to affect my previous vaccinations and is it advisable to have boosters?

[AussieNeil Partner Administrator]

CLL treatments spare newly produced B - cells and the mature plasma B - cells that produce antibodies/immunoglobulins, so your previous vaccinations may not need repeating. It's actually not as straightforward as that, because CLL inhibits plasma cell production, which is why it's common to have low immunoglobulin (IgA, IgG and IgM) counts when we have CLL. CLL also drives T cells, including helper T cells, into exhaustion, which is in part why we struggle to respond to vaccinations. Recommendations for vaccinations/boosters when we have CLL recognise this difficulty, hence the requirement for boosters for some illnesses, such as pneumonia.

There's a further difficulty resulting from your treatment with obinutuzumab/Gazyva. Monoclonal CD20 antibodies like Gazyva, Mabthera (rituximab) and ofatumumab/Arzerra, stay in circulation, continuing to eliminate maturing B - cells until all the drug is gone. That can take up to a year after your last infusion. So for the best vaccination outcomes, you really should wait for at least year after your last infusion before having recommended vaccines/boosters. You may get some T cell protection if you have vaccinations earlier, but with no healthy new B-cells, you won't be able to make new plasma cells, so no immunoglobulins.

The recommended vaccination schedule when we have CLL L, can be found here: healthunlocked.com/cllsuppo...

Neil

[GerryPL in reply to AussieNeil]

Thanks so much for your comprehensive reply, it answers my questions and gives me a clear strategy for the future.

[AussieNeil Partner Administrator in reply to GerryPL]

It's possible to check your antibody levels for illnesses covered by vaccinations. Immunoglobulin results from standard IgA, G and M testing can provide some guidance on your likelihood of responding to boosters, but it also depends on the vaccine technology (for example, much better responses are reported for prevnar vs pneumovax or shingrix vs zostavax - not that you should have a live vaccine) as well as individual variances.

What's important is keeping across your country's latest official guidance for the immune compromised per the previously mentioned pinned post: healthunlocked.com/cllsuppo... and ensuring your clinic provides you with the recommended boosters. As you'll read in that post, sometimes it takes persistence and the written support of your CLL specialist/consultant to get your PCP/GP to proceed.

Neil

[GerryPL in reply to AussieNeil]

Thanks again Neil for your advice. I have a follow up appt with my haematologist in three months and will discuss it with him, particularly the chance to have Immunoglobulin tests. My loose plan is to have prevnar and shingrix booster early next year. As I said I really do appreciate you taking the trouble to reply.

[kitchengardener2]

Well you may react differently. However, it was AFTER having had MMR vaccines that my CLL was diagnosed. I had had the vaccines for travel to the Far East and had a bad reaction to the Rubella portion. This led to a raised lymph nodes on my neck which didn't go away. That was 2018 and I am now having CLL treatment and responding well.

I have every vaccine offered as advised. Have had Shingrix, Pneumonia, Flu and five Covid19 jabs.

[GerryPL in reply to kitchengardener2]

Thanks for replying, hope your treatment continues to go well.