COVID: Staying Safe As The Virus Evolves - LLS Podcast / CLL Society’s COVID-19 Update December 5th, 2022 / Dec 15 2022 end Antibody Study

[lankisterguy]

The Bloodline with LLS has a new episode! thebloodline.org/TBL/132e13...

COVID: Staying Safe As The Virus Evolves

Join us as we speak to Dr. Lee Greenberger, the Senior Vice President and Chief Scientific Officer of The Leukemia & Lymphoma Society. In this episode, Dr. Greenberger gives us updates on the COVID-19 pandemic.

As the virus has continued to evolve at a rapid pace, we discuss how the national approach to this pandemic has changed and what measures we can use to stay safe.

Patients and their families will be given updated and accurate information to stay safe as we all move into the winter season, where we gather indoors and celebrate holidays with family and friends.

LISTEN NOW thebloodline.org/TBL/132e13...

New! Access The Bloodline with LLS Subscriber Lounge where you can gain access to exclusive content, discuss episodes, and make suggestions for future topics.

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

cllsociety.org/?s=covid

cllsociety.org/2022/12/cll-...

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Thank you for your participation in the LLS National Patient Registry, a project of the Michael J. Garil Patient Data Collective.

With your assistance we have been able to promote research that has guided blood cancer patients through many questions regarding vaccine safety, COVID risk, and therapies. This research had included LLS sponsorship and funding of COVID antibody testing through LabCorp.

As of December 15, 2022, the LLS National Patient Registry will be ending its Covid antibody study and thereby LabCorp will no longer honor or process any lab slips presented as ordered by this LLS project. Should you desire a COVID-19 antibody test, you will need to work with your provider to request that test and the financial responsibility for that test will be your own or your third-party health coverage.

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,

• Waldenstrom’s 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 individuals’ 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 a COVID-19 Resource Center 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.

LLS Resource Center link: lls.org/covid-19-resources?...

The Latest Information and Resources from LLS on COVID-19:

COVID-19 Vaccines: FAQs for patients and caregivers: updated frequently to provide the latest information on COVID-19, vaccines and other prevention strategies to help blood cancer patients—and everyone—protect themselves.

COVID-19 Vaccination Schedule for Moderately to Severely Immunocompromised Patients

Monoclonal Antibody Therapies (includes information on Evusheld preventive treatment)

Antiviral Treatments for COVID-19 in Non-Hospitalized Patients

Let's respect and protect each other as we move toward business as usual

Larry Saltzman, MD

Lee Greenberger, PhD

Gwen Nichols, MD

Janaela Scott, RN, MS

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Len

[jimvan]

Thank you, lankisterguy, for posting this. I found the presentation useful.

[msbypass4cll]

I Have been dreading the day when Bebtelovimab was considered ineffective ,(and no longer available despite the regional differences in percentage of variants)., with the withdrawal of Eveshuld likely to follow. How protective are well fitted N-5 masks? The Mass school study released a month ago compared infections ingroups where all parties were masked against comparable groups who were unmasked. As I understand its n-95's are tested for permeability largely on specialized equipment , Are there any other forms of evaluating how effective they are in protecting individuals?

[lankisterguy Volunteer in reply to msbypass4cll]

Hi msbypass4cll

Your questions are great and I wish we had better and specific answers.

This link will take you to CLL Society's weekly COVID-19 update:

cllsociety.org/2022/12/cll-...

SNIP: In Summary

Having Evusheld provide those with CLL/SLL an additional layer of protection is no longer something that our community can depend on at this time. In speaking with our industry partners here at ASH, several are working on developing new formularies of COVID-19 antibodies (aka Evusheld 2.0), which is very encouraging. But these are not even in early clinical trials yet, so the earliest we can expect them to be available to the public could be fall/winter 2023.

If you have known exposure to COVID-19 or are experiencing any symptoms at all, please get tested early and call your healthcare provider. Preferably obtain a PCR test which can more reliably detect presence of the virus), so that you can have adequate time to receive treatments that can prevent the development of severe disease. Paxlovid must be started orally within five days of symptom onsetand Remdesivir must be started intravenously within seven days of symptom onset.

Please obtain your bivalent booster if you are eligible and have not already done so. Now is the time! Even if you have not historically had a robust spike protein antibody response, we now know that the vaccine stimulates other important parts of the immune system such as memory T-cells that are also important for fighting off COVID-19 infection.

Wear minimally a well-fitted KN95 mask or most preferably an N95 mask while around others who live outside of your household. Surgical masks and cloth masks will not protect you if someone around you is infectious. You can obtain quality N95 masks free of charge from many local pharmacies across the country.

Practice social distancing and avoid indoor gatherings or crowded situations as much as possible.

Please revisit your COVID-19 Action Plan.

Practice good hand washing often and use hand sanitizer.

Ensure there is good air-flow and ventilation whenever you are around others by opening windows or doors as weather allows, and/or using a HEPA air purifier if you have one available.

The chart attached compares the surgical mask (ear loops & poor fit) dark blue/gray bars to respirators ( N95 equivalent FFP2) - See the full paper at:

jamanetwork.com/journals/ja....

Len

Mask vs N95 Respirator Risk in COVID workers

[lankisterguy Volunteer in reply to lankisterguy]

Here is an old chart (Spring 2021) so based on original COVID-19 - not even the Delta variant, so the times must be taken with a huge grain of salt.

Len

Exposure time vs mask or respirator use

[msbypass4cll in reply to lankisterguy]

THANK YOU. I follow the CLL Society as if my life depended rised on it, yet somehow I missed the JAMA study. I would note that it compares surgical masks to respirators , not to the n-95 masks I rely on for protection. Since life going forward without prophylactics and targeted MABS will necessitate even more weighing of risks, it would be nice to know what the actual risks might be.....

[lankisterguy Volunteer in reply to msbypass4cll]

Both charts refer to N95 Respirators which is the correct nomenclature. You may be referring to a KN95 mask

See: publichealth.hsc.wvu.edu/ne...

SNIP: KN95 masks originated in China as a counterpart to the N95 respirator and are now made in a number of countries around the world. They are intended to provide protection close to that of an N95 respirator, which is regulated by the CDC National Institute for Occupational Safety and Health (NIOSH). An N95 respirator has straps that go around the head to ensure a tight seal and ideally is fit-tested. A KN95 respirator has ear loops and does not form a tight seal; however, the leakage of air around the mask is much lower than with a surgical mask.

KN95 and N95 masks are both rated to filter out at least 95% of particles down to 3 microns. The N95 is more effective due to being able to achieve a better fit. They have similar resistance to inhalation and exhalation (which affects breathing comfort), with the N95 being slightly less resistant.

Currently the US is not experiencing a shortage of N95 masks; they are widely available. They are usually more expensive than KN95 masks.

Len

[msbypass4cll in reply to lankisterguy]

THANK YOU. I am sorry it took mw so long to review this and get back to you. It is very helpful. (I know the ever changing nature of Covid variants makes his an ever moving target, but the charts are still a good comparative guide.)