COVID update: Who remains at higher risk? by LLS.org

[lankisterguy]

COVID update: Who remains at higher risk?

lls.org/covid-19-resources

Almost exactly three years ago on December 12, 2019, we received the first reports of a cluster of patients in China with symptoms of what turned out to be COVID-19. Vaccines and COVID-19 treatments have dramatically lowered COVID risk for most people, including for most blood cancer patients and survivors, but some remain at higher risk for serious outcomes including death from COVID.

The Leukemia & Lymphoma Society (LLS) has been at the forefront of providing scientific evidence about the risk of COVID-19 in people with all types of blood cancer and the protection they can expect from vaccines and monoclonal antibodies.

Our LLS National Patient Registry (a project of the Michael J. Garil Patient Data Collective) click.e.lls.org/?qs=7584cc5...

reported on the safety of COVID vaccines in blood cancer patients in May of 2021,

click.e.lls.org/?qs=7584cc5...

followed in July by the first of several reports on vaccine efficacy in blood cancer patients.

click.e.lls.org/?qs=7584cc5...

The Registry continues to provide important information about the ongoing pandemic.

As we enter our third COVID winter, LLS wants to share what it knows—and recommends—about how blood cancer patients can reduce their risk.

The preventive monoclonal antibody Evusheld should be used on a case-by-case basis.

New COVID subvariants taking hold in many parts of the country are resistant to Evusheld treatment. The decision to administer Evusheld should be made on a case-by-case basis based on locally circulating virus strains and the individual patient’s risk for infection and severe disease.

Blood cancer patients, especially those with weakened immune systems, should talk with their oncology healthcare team about what’s right for them. Whether or not at-risk patients receive Evusheld, they should continue to wear masks, social distance, and layer on other precautions to avoid infection.

Vaccines are safe and effective.

The most important thing every single one of us can do is stay up to date with COVID vaccines. The updated (bivalent) booster is designed to protect against a wider range of COVID variants than earlier vaccines. Everyone needs the primary vaccine series (including an extra dose if your immune system is compromised) plus a bivalent booster two months later.

Unless your oncology team says vaccines are not right for you, or there is a reason to wait because of current treatments, LLS strongly encourages everyone to make a plan today to get up to date on COVID and other vaccines as soon as possible.

How can I tell if my immune system is compromised?

People with the following types of blood cancer are less likely to develop protective antibodies and they are less able to fight off an infection because the cancer affects immune B-cells:

• Chronic lymphocytic leukemia

• Diffuse large B-cell lymphomas

• Follicular lymphoma

• Marginal zone lymphoma

• Mantle cell lymphoma

• Waldenström Macroglobulinemia

• Stem cell transplant patients, especially those continuing on immunosuppressive medications

Patients with myeloid forms of leukemia, Hodgkin’s lymphoma and multiple myeloma are more likely to develop antibodies (75% to 100% of them have detectable antibodies), although as always it is not one size fits all. Some of these patients may not produce enough antibodies to maximally be protected from infections compared to healthy individuals.

Some treatments that are essential to treating cancer can also deplete immune B-cells. These include:

• Bruton tyrosine kinase (BTK) inhibitors, such as Imbruvica® (ibrutinib), Brukinsa® (zanubrutinib) and Calquence® (acalabrutinib)

• Anti-CD20 antibody treatments, such as Rituxan® (rituximab) and Gazyva® (obinutuzumab)

• CD-19 targeting CAR T-therapy (Breyanzi®, Kymriah®, Tecartus™, Yescarta®)

• Anti-CD38 / B-cell maturation antigen directed therapies

Note that some of the treatments listed above blunt immune response during and for months or more after therapy.

There is no test to know exactly how well an individual's immune system is working. Individual patients respond differently to treatment and their immune systems recover at different rates. LLS strongly encourages all blood cancer patients and survivors to talk with their healthcare team about their immune status and what is best for them.

Talk to your healthcare team immediately if you test positive or have a known exposure to COVID.

COVID treatments work best when started as soon as possible after COVID-19 diagnosis. Do not delay talking with your healthcare team if you have symptoms, test positive for COVID or have been exposed to someone with COVID.

Antiviral medications Paxlovid™ (nirmatrelvir/ritonavir), Legevrio™ (molnupiravir), and Veklury® (remdesivir) remain active against currently circulating COVID virus subvariants. All can be used to treat non-hospitalized patients with mild-to-moderate COVID-19 (confirmed by a positive COVID test), who are at high risk of progression to severe infection.

Each drug is authorized for use in people of different ages, but there is at least one antiviral medicine available for everyone 28 days of age and older. Paxlovid and Legevrio are taken orally (capsules or tablets) for 5 days, while Veklury must be given in a medical facility as an injection or infusion. Veklury can also be used for hospitalized patients.

Regarding a monoclonal antibody treatment called bebtelovimab, the FDA has recently withdrawn this option as it has been determined this treatment is not effective against the newer variants causing COVID-19 infections.

LLS has resources available and Information Specialists available to answer questions.

LLS has a COVID-19 Resource Center

click.e.lls.org/?qs=7584cc5...

with links to our regularly updated FAQs, charts with information about COVID preventions, treatments and vaccine dosing, and access to data about vaccine safety and efficacy from our LLS National Patient Registry.

Our Information Specialists click.e.lls.org/?qs=7584cc5...

are also just a phone call or click away. LLS Information Specialists are highly trained oncology social workers and nurses who can assist you through cancer treatment, staying safer during COVID, financial and social challenges and give accurate, up-to-date disease, treatment, and support information.

LLS COVID-19 research continues: How to join us

When COVID-19 struck and was hitting the blood cancer community especially hard, we launched a unique COVID-19 research study as part of the LLS National Patient Registry.

We thank each one of the more than 12,000 patients and survivors who joined the Registry and helped us generate scientific data that has improved patient care and helped educate public health officials and policymakers at every level of federal and state government about the unique challenges blood cancer patients face.

Should you have a question, please send an email to us at [e-mail]

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Len

[AussieNeil Administrator]

CLL Society’s COVID-19 Update for the Week of December 5th, 2022

As expected, after much of the US gathered indoors for the Thanksgiving holiday weekend, COVID-19 numbers are once again headed in the wrong direction after an autumn lull. Hospitalizations have jumped by 25% in recent days, and we are already seeing increases in test positivity, wastewater surveillance virus levels, and even cases-which we have mentioned in prior updates are grossly under-reported due to the wide availability of at home rapid antigen testing.

More at: cllsociety.org/2022/12/cll-...

[lindalou5 in reply to AussieNeil]

I have heard quite a few younger and middle aged people say that since they had it and it wasn't that bad, they now choose to not get the newest booster. My own extended family has had several cases, but no one seems to get very excited about it anymore. A census was taken and a good amount of people in the US would like to see our Medical Expert-Fouchi- be prosecuted, because he didn't have the gift of seeing into the future and he wanted us to be safe. So sad that our nation has become so spoiled that they won't listen to the experts because it might interfere with their important plans.

[AussieNeil Administrator in reply to lindalou5]

Yes, the pandemic has uncovered those who care more about their personal freedom than the freedom of others.

It's a pity that early on in the pandemic, the CDC wasn't prepared to acknowledge the immunity achieved from a COVID-19 infection, or better yet how good hybrid immunity - infection and vaccination, immaterial of order, was. The quantity of antibodies fades over time, irrespective of how our bodies learn about the coronavirus and of course, the more recent variants are extremely good at evading detection from antibodies formed from earlier exposure, from either infection or vaccination.

Neil

[Guffy]

Thanks Lankisterguy. Interesting and timely. I found 'There is no test to know exactly how well an individual's immune system is working' particularly noteworthy. I'm on w & w, and I've been advised to be thoroughly vaccinated against Covid and flu - which I am - and so far I haven't had either. But I guess we can't predict where our blood levels are going to be at any one time and it pays to be prepared, no whatever how well we're feeling. Stay safe, everyone!

[Pearlpink]

thanks for such a useful and interesting post! Such a good summary! Will save it for future use!