vaccinations

[Islandjewel23]

Hi good people, I’m 5 mos into Acalabrutinub and finally WBCs are coming down, but still pretty high. It’s time for a flu vaccine and soon the next Covid shot will be available. And there’s the RSV vaccine! I’m wondering about my response to any vaccines at this point in my treatment. My onc says to go ahead, but I’m not completely satisfied with her knowledge level with CLL (she told me not to hold Acala if I needed Paxlovid, which I knew to be wrong.) I just like to do my own searching before going ahead with her recommendations! I can’t seem to find info about vaccines when on Acala but not quite responding yet. Any thoughts? Thank you!

[AussieNeil Partner Administrator]

As I understand it, during treatment, we are less likely to respond to vaccination boosters for anything where we haven't either had an infection or had a previous vaccination. That's because all approved treatments (and pretty well all of those currently in trial), are unable to clearly differentiate between healthy new B cells and CLL cells. (CLL cells can express higher amounts of the BTK and BCL-2 targets, so can be more susceptible to targeted therapies than healthy new B cells, but the healthy B cells still suffer. That's much of why our lymphocyte count can sometimes drop under the lower reference level during treatment. An immunophenotype test, which reports the clonal B and healthy B cell counts, helper, cytotoxic and natural killer T cell counts, should give you an indication of how you'll respond to new vaccinations, but I haven't seen a study confirming that.)

When we've had the flu, COVID-19 or previous vaccinations for these illnesses, we hopefully have some memory B cells (they are mostly spared from the effects of treatment because they don't particularly express CLL treatment targets, plus are in a semi dormant state, waiting for their B cell receptors to be stimulated by the booster or actual illness). Importantly, we are more likely to have memory T cells. So boosters hopefully stimulate memory B cells to change into antibody/immunoglobulin producing plasma cells and should improve our cellular T cell response to an infection.

In short, while studies have shown that you probably won't see much improvement in your protective antibodies from vaccinations/boosters during treatment, it's still worth having them because you are at increased risk of infection and are more likely to gain some T cell protection - probably even from your first RSV vaccination, that should reduce the severity of any subsequent infections.

Neil

[bennevisplace in reply to AussieNeil]

A lot of people have asked basically the same question. I think you just gave the definitive answer Neil.

[Corkyrissa in reply to AussieNeil]

Hi Neal.

You are so helpful know so much info.

I on imbruvica for 6 yrs and am wondering about the RSV vaccine, I thought I read somewhere you shouldn’t have it if you are on a blood thinner ( Eliquis). Concerned about the side effects of this vaccine.

Also, is it necessary to stop the imbruvica when I get any vaccines … flu , RSV, Shingles, pneumonia, covid booster?

Thank you so much

Anna

[AussieNeil Partner Administrator in reply to Corkyrissa]

Hi Anna,

The interaction checker drugs.com/interactions-chec... reports

"Interactions between your drugs

No interactions were found between the drugs in your list. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider."

With respect to your question about temporarily stopping Imbruvica/ibrutinib when having any vaccines, you'd need to stop it for some time prior to your vaccination (say a week minimum to give your bone marrow a chance to produce some new B cells), then wait another two weeks for those B cells to mature into immunoglobulin producing plasma cells before resuming Imbruvica. That's a longish break compared to what's usually done for surgery, but after 6 years on Imbruvica, it's probably safe to do so. You should check with your specialist. There were some trials where people did this for COVID-19 vaccinations, but I don't know if improved vaccine efficiency has been reported. You should still have a good chance of producing some T cell immunity from vaccinations without stopping Imbruvica; unlike other BTKis, a couple of studies have shown that Imbruvica improves T cell function.

Neil

[Corkyrissa in reply to AussieNeil]

Thank you 😊

[CycleWonder in reply to AussieNeil]

Neil - Based on your answer here, and with the approval of my CLL specialist, I will get the new Covid vaccine and flu vaccine.

What about the RSV vaccine? It is my understanding that this is a one time vaccine. If this is correct, should I wait until I can more safely stop the Pirtobrutinib before having the RSV vaccine?

Thank you,

Patti

[AussieNeil Partner Administrator in reply to CycleWonder]

I haven't looked into the RSV vaccination particulars - my Aussie co-admin CLLerinOz is maintaining our pinned post on vaccinations. healthunlocked.com/cllsuppo...

The CDC cdc.gov/vaccines/vpd/rsv/hc... are recommending "using shared clinical decision-making (SCDM). This means that health care providers should talk to these individuals about whether RSV vaccination is appropriate for them." cdc.gov/vaccines/vpd/rsv/do...

I presume that as with the Shingrix vaccination, until studies are available for the immune compromised, CLL specialists won't hold a consistent position on the RSV vaccine.

Meanwhile, yes, it does appear to make sense to hold off until you can maximise its effectiveness with respect to taking pirtobrutinib.

Neil

[CLLerinOz Administrator in reply to AussieNeil]

Thanks, Neil. That's consistent with the advice I've seen, too, although a statement the CDC sent to clinicians yesterday, noted that "Vaccination should be prioritized in adults ages 60 years and older who are most likely to benefit, including those with certain chronic medical conditions associated with increased risk of severe RSV disease, such as . . . immunocompromising conditions". emergency.cdc.gov/han/2023/...

I've just written an updated reply to our pinned post with a summary of the latest advice. healthunlocked.com/cllsuppo...

CLLerinOz

[kitchengardener2]

I am two years into Acalabrutinib. Blood numbers within normal ranges and I have a good partial remission. My consultant and CNS both advised me to have anything available. They said that it's possible the vaccines are triggering defence cell. I has usual annual flu vaccine, pneumonia and Shingrix all about 3months into treatment. I have since had flu jabs and this year's is booked. I have also had six Covid19 jabs. I also had a blood test to check for antibodies which couldn't find any positive sign. We wear masks everywhere and avoid crowds.

Hope this helps. Stay aware, stay safe and stay well x

[Islandjewel23]

Wow, Neil, you have a lot of great knowledge about CLL and how to explain it well! And thanks also to the others who’ve answered. I’d say it’s a pretty clear recommendation to get all of the vaccines! I signed up for the flu today, and am waiting for the FDA/CDC to approve the newest Covid booster within the next couple weeks. I’ll get it as soon as allowed. I’ll wait 2 weeks between each one, and do the RSV at the end. Thanks to you all for your fast answers and for sharing your experiences and knowledge!!