Stopping Venetoclax for COVID-19 vaccine

[Doremefasol]

Could you please tell me what is the recommended time for stopping Venetoclax treatment before and after administration of the Covid -19 vaccine?

[lankisterguy Volunteer]

Hi Doremefasol,

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I can't find or recall any mention or reason that Venetoclax would need to be paused to have a COVID-19 vaccination. I looked here: venclexta.com/covid19

I am not aware that there is any specific data on pausing Venetoclax and my CLL expert doctor did not recommend pausing for vaccinations. I got a moderate response to my 2nd vaccination, and greater than 2500 on my 3rd and 4th vaccinations, all while on daily Venetoclax.

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Perhaps you are thinking about the drug -drug interaction with Paxlovid, where drugs like Venetoclax, Ibrutinib etc. must be paused due to an effect from Paxlovid that acts like grapefruit and other CY3PA inhibitors. But Paxlovid is NOT a vaccine, it is an antiviral capsule taken daily for 5 days, as a treatment for a known infection. (this comment was edited to remove mention of Evusheld and insert Paxlovid- thanks to a suggestion from gardening-girl who is a great resource- I'm sorry for the mistake)

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There are some CLL treatments that make COVID-19 vaccines less likely to cause your body to create the desired antibodies, including Rituxan and Obinutuzumab, and those may block your immune response for up to 6 months.

The comment below from AussieNeil appropriately suggests that you should discuss this with your CLL specialist.

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Len

[AussieNeil Administrator in reply to lankisterguy]

Len and Doremefasol,

All CLL treatments wipe out healthy B cells and CLL cells. So to improve the chances of producing antibodies, theoretically it makes sense to stop treatment long enough to allow enough new B cells to mature from the bone marrow and respond to the vaccine, then another two weeks for them to mature into antibody producing plasma cells. Doremefasol, stopping venetoclax for that long should be discussed with your specialist.

Neil

[Doremefasol in reply to AussieNeil]

Jesus, that long ? I thought I could stop like for 2 days. I am afraid to stop for longer. Not only that, but I relapsed last year on Ibrutinib which was paused for3 weeks on my doctor's advice, and due to neutropenia. My specialist is on vacation. I discussed 4 doses of vaccine with her briefly, but my body was not ready yet to take vaccine. Now, I am kind in a hurry. Going to see my grand baby for his1 birthday. As for the time being, I am recuperating from Long Haul Covid and doing quite well, but still without breath when up the staircase, and sometimes feeling that the 20% OF BRAIN GRAY MATTER IS GONE for sure, AND WILL NEVER RETURN. Have to compensate somehow. . Thank you, Neil, for your input.

[Doremefasol in reply to lankisterguy]

Hi, I asked that question because first, you guys have an enormous amount of knowledge from your own experience and also from the literature that links to, you are posting. Secondly , My Oncologist is on vacation. And lastly, someone from our forum posted that his consultant ask him to stop Venetoclax for 7 days before administration of Covid vaccine. I also can't find anything about stopping the treatment. Go figure. PS. Cant find the post about 7 days pause for vaccination.

Thank you for taking part in this conversation and giving your imput.

[SofiaDeo]

I have a very aggressive variant, and my specialist is not recommending I stop my CLL treatment. I do get the vaccines for any potential T-cell or other immune component benefit. I am not sure this has a "general answer" appropriate for all, but think instead it should be more of a decision based on each specific patient.

[Doremefasol in reply to SofiaDeo]

I didn't have any antibodies against Covid after 3 vaccine, Then, I contracted the dreadful virus, and now struggling with a Long Haul version. Had to wait until Prednisone will be weaned off, to 20 mg /day, since more than that, would further impair my response. My Oncologist mention to me that I need the 4 vaccine, but that was several weeks ago, when I still have had fluid in my lungs. Next Week, it will be 3 months post release from the hospital so practically I could have the vaccine next week. Unfortunately, my doctor is on vacation, so I can't further discuss pausing Venetoclax. Our previous conversation was somewhat casual, since I was not ready yet because Covid. I also got Evusheld 5 weeks ago. No problem with steroids and/or immunosuppressive medication, because they are {2 synthetic monoclonal antibodies), already made, as you know. Somebody from our forum mention a short while ago that his consultant made him stop Venetoclax for 7 days. I would be afraid for that long. I stopped Ibrutinib in the past, because I was going neutropenic and shortly after relapsed,- hence Venetoclax.

[AussieNeil Administrator in reply to Doremefasol]

If you've had Evusheld, then there's a theoretical concern that it will mop up the antigen proteins in a vaccine, so that you may not get much of a response to a COVID-19 vaccination. I don't think there's yet official guidance on how long after Evusheld shots to wait before COVID-19 vaccinations.

Seems the 7 day venetoclax break guidance prior to vaccinations, is based on the fact that new B lymphocytes highly express BCL-2, so are very vulnerable to venetoclax. Presumably the 7 days allows time for new B cells to be produced and released by the bone marrow and to have matured enough to be able to respond to vaccinations, but my searches for papers about this have so far been unsuccessful.

Neil

[lisakc1 in reply to AussieNeil]

If regular vaccines do not create antibodies, and Evusheld does, what is the point of the standard vaccine? I read that Evusheld covers the Omicron variants. Thank you again for your clear and concise way of translating the science. You are a blessing!

[AussieNeil Administrator in reply to lisakc1]

Evusheld IS antibodies - artificial ones. It's for those who can't make their own.

[Doremefasol in reply to AussieNeil]

fda.gov/news-events/press-a...

[Annie1920]

If you had Obinutumazab or any other anti CD20 meds before starting venetoclax the effects last a good 18 months two years which is why I am hustling for Evusheld in the UK as we don't respond with making many/enough antibodies from any vaccines.. We are part of the severely immunocompromised group

[HappyDave]

Hi

I have now had five Covid 19 vaccines. I am on O and V until November 2022 and I was told to carry on taking the medications and have the vaccination at the same time by my Consultant. I had a few side effects but nothing dramatic after the inoculations.

I am unsure how effective the Covid vaccines have been in producing antibodies although I was part of the University of Birmingham study on CLL patients.

Best of luck and take care.

Dave.

[Doremefasol]

Thank you for taking the time to answer.I had a Covid antibody titer done after the third one , and none was detected.My oncologist is on vacation, will wait till she comes back.

[country76]

I have had the 2 Covid vaccines and 2 boosters. None of them have produced antibodies.

So far I have had two rounds of Evusheld.