Acalabrutinib and covid vaccines

[Rrriver]

I have been on acalabrutinib for 2 months and doing very well. It has been about 6 months since I have had my last covid vaccine , and I am due for another. My question is will the covid vaccines work while taking acalabrutinib?

[lankisterguy Volunteer]

Hi Rriver,

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There is another discussion on getting a 2nd bi-valent a few minutes ago:

healthunlocked.com/cllsuppo...

and 9 days ago: healthunlocked.com/cllsuppo...

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Len

[Rrriver in reply to lankisterguy]

Thanks Len , many of these discussions are about getting numerous Covid vaccines . I have had 5 Covid vaccines, I HAD COVID IN 2021, I had sotrivamab monoclonial anti bodies, and my last vaccine was modera bivalent in sept 12/22. In Canada we can have a 2nd bivalent after 6 months and my concerns are 1) will the vaccine work while I am taking acalabrutinib? 2) will the vaccine effect my acalabrutinib results? 3) should you stop taking acalabrutinib for a period to make the results better ?

[lankisterguy Volunteer in reply to Rrriver]

I don't know of a definitive answer. I recall we have some data that Rituxan and/or Obinutuzumab may impede vaccine effectiveness for 6 months, and that people taking Ibrutinib or Acalabrutinib, had lower response to vaccinations in the LLS study 2021-2022.

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You may want to read the past postings in the box on this page labeled:

Related Posts

*CALQUENCE (Acalabrutinib) not working right after Covid vaccination?

*Covid Pfizer vaccine acalabrutinib efficacy one case

*Covid Vaccination ✈️🚢🚇🚠🚘

*Covid Vaccine after obinutuzumab

*Acalabrutinib and covid antibodies

Not all of them are on target, but there may be some "pearls" in the replies.

Len

[Rrriver in reply to lankisterguy]

Thank again Len, my understanding is acalabrutinib weaken the B cells and you need strong B cells to boost your immunity. I think that is why you might have to stop treatment to achieve a stronger efficiency. I am concerned I may not have protection from Covid while taking BTK’s and I may be taking avalabrutinib long term. I feel like I am back to where we had no vaccines and very worried to get Covid . Acalabrutinib is keeping me alive but I have no protection from Covid. We need better covid treatment for the immune compromised

[kitchengardener2]

I have had six Covid jabs, the last one being Moderna bivalent. I had access to antibody random tests through the National Office of Statistics Covid19 Survey programme which my husband and I have been part of since 2020. Mine almost all came back with negative results bar two following Moderna jabs which were inconclusive. I asked my consultant if she could arrange a full antibody test. This was done in January along with my normal three monthly blood tests. It was a spike protein test but the result was negative for antibodies. This was to be expected since I am taking Acalabrutinib (second year now and good results). My consultant says that the Acalabrutinib is probably stopping the antibody development but stopping the Acalabrutinib is not a good option because my CLL is responding so well. My husband has apparently high level antibodies after four jabs, neither of us have had (to our knowledge) Covid19. We wear masks always in shops and anywhere we feel necessary. We generally use normal masks but on recent aircraft flights have worn FFP3 masks the whole time. Visitors to our home are asked to test prior to coming and on the occasions we visit anyone else, we ask them to test. We feel that this is not going to change anytime soon and so it is just a matter of changing our lives to accommodate the virus risk.

[Nucleusman]

should do but keep wearing mask cos immune system low

[LeoPa]

Nobody knows for sure. It's individual. For some it works for some it doesn't. That's the conclusion I came to so far based on what I have read. But I'm no doctor so I can be wrong.

[AntonMB]

I have been on Acalabrutinib since January 2022. In total I have had 6 vaccinations, my last in October 2022. I have been tested for antibodies monthly via the ONS Uk Covid survey and I continue to test positive for antibodies at a higher level. I have not had Covid.

[SERVrider]

That's a very good question. Early research showed that if you were male, and on a BTK inhibitor, you were very unlikely to make any or many antibodies in response to any of the Covid vaccines. I am both but went ahead anyway with all six of my recommended vaccinations. So far I have avoided any of the Covid variants. Is it the vaccinations? Is it being moderately careful? Is it the SCIG? or have I just been lucky?

[spi3]

My hubby is on both acalabrutinib and Venetoclax and got both his annual COVID and flu shot. He happened to get COVID over Christmas and had mild systems. P.s I suggest not taking both shots together he had a tough night with the symptoms though.

[Curling123]

if we are not responding and producing antibodies on Acala, then why are doctors, specifically mine, pushing me to get all vaccines? Is it because there is a slight chance a few of us might produce antibodies without anyone knowing how or why? In Canada we are not tested for antibodies that I know of.

[AussieNeil Partner Administrator in reply to Curling123]

Yes, there is a slight chance of producing antibodies while on acalabrutinib or another BTKi treatment. The very small vaccination risk is outweighed by the potential benefit of producing antibodies, which climbs with repeated boosters. Much more importantly, however, is that most of us gain cellular (T cell) immunity from vaccinations. While this has been most studied for COVID-19 vaccinations, studies for other vaccinations show similar results.

With respect to COVID-19 vaccinations, we know that antibodies can neutralise the SARS-CoV-2 virus, preventing it from entering our cells, thereby preventing or at least reducing the severity of a COVID-19 infection, so that we hopefully don't get sick enough to need hospitalisation. Memory B cells from previous vaccinations or SARS-CoV-2 exposure are not affected by CLL treatments and are stimulated by vaccination to switch to antibody generating plasma cells, which are also not affected by CLL treatments.

T cells recognise which of our body cells have been taken over by the SARS-CoV-2 virus and destroy them before the virus can spread from l infected cells. All CLL treatments thankfully spare our T cells, which function better when our CLL tumour burden is reduced by treatment.

There is a considerable amount of misinformation or worse, disinformation (deliberately false information) on the internet about the supposed dangers of COVID-19 vaccinations. The risks are considerably worse from an infection and most of the population have been infected, so it's pretty well inevitable to become infected if you don't mask, etc. Vaccination (even just one shot) has been shown to reduce the risk of death in country statistics where these are available. healthunlocked.com/cllsuppo... While these statistics are for the general population, from these results, you can appreciate why CLL specialists recommended keeping up to date with vaccinations/boosters.

Neil

[Rrriver in reply to AussieNeil]

Thanks Neil, I always feel better after your explanations. I had Covid once , and had sotrovimab antibodies, so hoping my immune system now knows how to protect me. With all the new cll treatments in the last few years, we can only hope new Covid treatment are on the horizon for blood cancer patients.

[Curling123 in reply to AussieNeil]

Exactly as you mentioned above, Neil.

I do remember my doc saying we have T cell immunity to help us along. I had forgotten about that. You explain our concerns very well in your posts, probably better than our healthcare professionals do when they are rushed. Thank you.

[Rrriver in reply to Curling123]

a small chance you might produce antibodies with vaccine is better than no chance without vaccine. I had Covid a year ago and I hope I still have antibodies from that. My question still is should we stop acalabrutinib for a few weeks and then get the jab?

[AussieNeil Partner Administrator in reply to Rrriver]

You need to be off a BTKi for a minimum of 3 weeks for any worthwhile benefit from doing so. A week off before the vaccination is needed to clear your system of B cell inhibition (and the risky part of lifting CLL cell inhibition). Then you need 2 weeks for any B cells which have responded to the vaccination to mature into plasma and memory B cells. Then the plasma cells produce antibodies for a few months and the memory B cells keep circulating in your blood, waiting to be triggered into switching to plasma cells if they detect a SARS-CoV-2 virus.

We've had some members do this, but I recommend it only be done under supervision of your CLL specialist. There's a risk of tumour flare developing with the longer break from BTKi treatment. Going back on the BTKi reverses the flare, but it can take some time if the flare is serious.

Neil

[Rrriver in reply to AussieNeil]

Great info Neil, Thanks

[Pacificview in reply to AussieNeil]

Neil,The vast amount of information that you have absorbed about CLL is really impressive. What is your background that you have become more knowledgeable than most?

Seriously, I read response after response from you that would be on par with most CLL experts, pretty impressive.

[Curling123 in reply to Rrriver]

I don’ t know the answer except my doctor, a senior scientist, oncologist, said get all the vaccines required during Covid and I was on Acala when I got the vaccines. He never said to stop Acala. As mentioned, we don’t test for antibodies in Canada, so I really have no idea if I produced any, some, or none. I had Covid last year too, mild bout, so maybe the vaccine worked.

[Eucalyptus22]

Here in the UK there has been a trial called the IMPROVE trial to see if coming off a BTKi could help produce antibodies after vaccine. This is due to the recognition that BTKi's prevent us from producing antibodies. This is suggested to discuss with your consultant. My personal experience is that I came off 1 week, got vaccinated, stayed off for a further two weeks. At that point I had bloods tested and again at 12 weeks. No official results yet. However I had a private antibody test done and I produced 303 u/ml. This is compared to all other tests after each of my 5 vaccines where I produced 0.5u/ml.

A result. Not a great one but I have been told that anything over 200u/ml is clinically significant.

The other good thing was that my test results showed no negative impact from being off Acalabrutinib for 3 weeks which is very significant when planning any future vaccine.

These BTKi's are wonderful but in a pandemic they make our lives very challenging.