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Are People With Blood Cancer Responding to the Vaccine?

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Published on August 11, 2021

Study Shows Varying Vaccine Response in Blood Cancer Patients

In this segment, Dr. Larry Saltzman, MD, Executive Research Director of the Leukemia & Lymphoma Society, explains that some blood cancer patients may have little to no immunity to COVID-19 even after being fully vaccinated. Dr. Saltzman also shares that immunity levels can vary depending on your blood cancer type and the treatments you are receiving. Keep watching to learn more.

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Transcript | Are People With Blood Cancer Responding to the Vaccine?

Andrew Schorr: Hello and welcome to Patient Power. I'm Andrew Schorr, in San Diego. And joining me is Dr. Larry Saltzman with the Leukemia & Lymphoma Society. Dr. Saltzman, welcome back to Patient Power.

Dr. Saltzman: Thank you, Andrew. Pleasure to be here.

Andrew Schorr: So Larry, since you're my friend, I'll call you that. You were a CLL patient as I am, and I have another blood cancer as well, myelofibrosis. The LLS has just come out with a study that's being published about myself and others who have been vaccinated, trying to understand did we develop COVID-19 immunity? What do we know at this point?

What Do We Know About COVID Vaccine Response in Blood Cancer Patients?

Dr. Saltzman: Yes. So LLS is performing a research study, observational, meaning patient-reported dates of immunizations and reported treatments that they may have had in the last two years. And we have asked them to go to a laboratory and have serology drawn for both the nucleocapsid antibody, which in COVID-19 will tell us if they've actually had a natural infection, and the spike antibody, which will tell us if they had a response either to the infection or to the vaccine. And that's what's important here. We have looked at, analyzed data from patients who joined the study in March of 2021 and had lab results as of May 12th, 2021, that included approximately 1,445 patients. And what we found is that in blood cancer patients in general, okay, in general, 25% of hematologic patients have not responded to the vaccine. Now, when we say they have not responded, the serology levels go down to a very low number.

And let's just say that is 0.4. And below that, the lab cannot detect antibodies because of the sensitivity of the test. We're not telling people that they absolutely don't have any, but we know that they're very, very low and we consider that and the CDC and FDA, based on healthy subjects and the vaccination trials, would consider that to be a non-responder. So, 25%, in general, have not responded. And then in our paper, we look specifically at different types of blood cancers, and we look specifically at reported treatments. And so, there is good news and then there's the not-so-good news. The good news, as an example, is people with smoldering myeloma 100% have responded to the vaccine. People with Hodgkin's lymphoma more than 90% responded to the vaccine. On the other end of the pendulum are people like you and I with CLL who have shown that maybe 35% of us or so have not responded to the vaccine.

And of those 35%, there is maybe a quarter of those who did not respond and did not report taking any therapies in the last two years. So, it may be a function of the disease, as it affects the B cell lymphocytes of the others who did not respond it's pretty clear that they were on some kind of therapy, meaning a BTK inhibitor or Rituxan (rituximab) or obinutuzumab (Gazyva), sorry it's hard for me to say, or even CAR T therapy as I was on. And so most anti B-cell therapies seem to affect the results.

Andrew Schorr: Yeah, it's not a happy result and so first, before we go on, you and the LLS actually came out with sort of direction and almost what they call a slogan. For those of us who are worried where you say, "Get Vaccinated Act Unvaccinated." So, what's behind that? I mean, is that about you and me wearing masks generally?

How Can Immunocompromised Individuals Stay Protected?

Dr. Saltzman: I think it is that. We obviously have only surveyed a certain number of people and there are one and a half million blood cancer patients living in America. We haven't surveyed everybody. We don't know who's had vaccines. We don't know who has not. We know that Delta variant is now more contagious and there is no real up-to-date data yet on who may be having breakthrough infections, who are blood cancer patients, or who is not. So, from our perspective, we want everybody to keep their guard up. And that means get vaccinated. Yes. And keep your guard up. We think wearing masks, washing your hands, social distancing is still a valid suggestion. Yes.

Andrew Schorr: One other part of your ongoing research is studying T cell response, another part of the immune system, I've had the blood draw for that. Where do we stand and what can we expect for updated information from the LLS?

Dr. Saltzman: So there is a study that just came out of the UK, which is encouraging because on the surface it shows that people who have not responded with antibodies are responding with T cells. And so that's just hot off the presses. Actually today, this week, our study has been launched. We invited 1,000 patients to have their blood drawn for T cells, about five to six hundred people now have consented to do that. It means they need to go to the lab. These studies are pure research, so different than the antibody results. We will not be reporting back to an individual what their T cell counts were. We will report back in six to eight to 12 weeks because the serology is going to take six to eight weeks to process what we see in various groups of individuals. We'll report back by blood cancer diagnosis, we'll report back by treatment diagnosis.

And in addition to what we're doing currently with patient-reported information, we have asked everybody who will be part of the T cell study to make sure that they've approved the sharing of their medical records with LLS. And we will be delving into their electronic health records in a de-identified way to marry these results with true treatments based on medical records. So, this will be a more complete study and we'll take a little longer to aggregate the data. So, expect that in a few months, actually.

Andrew Schorr: Larry, there's just one other study, if you will, or aspect of the study you're doing as well, and I've participated in this and that has gone back for a second antibody test.

Dr. Saltzman: Yes.

Andrew Schorr: So where there's been a time interval, and that's a big question for people, is even if they had antibodies that they developed originally, do they wane over time? And so you're studying that as well.

Dr. Saltzman: We are studying that and anecdotally, I will report, although it's not in this paper – but the trends are that for better or worse people who did not show an immediate antibody response after their vaccine, and saying they had their blood test on three to five weeks after their vaccines are essentially not showing any more antibodies, three to four to five months down the road, that we're seeing. And those who did respond with antibodies actually continue to have the antibodies in their system. And we know again from the government trials that there is some waning of antibodies. In other words, there is some lessening over time, but actually, that's pretty normal. In most instances, a vaccination or infections that people don't keep their antibodies around forever, but they keep the memory cells so that if they're exposed, they will respond again. And it looks like that is holding true in this. So anecdotally.

Andrew Schorr: Right. So that brings up the whole question of boosters. And we'll explore that in a separate program, as the government talks about that, the medical community, and decides whether or not boosters feed the people at a low response or a waning response, whether it would make a difference. So just to sum up, Larry, so you have this paper that's come out that shows variation in what type of blood cancer somebody's had, or whether they're on active therapy that may affect their immunity. And so those of us with CLL, we're at one end of the spectrum, myeloma patients may generally be at the other, but that's a discussion I would imagine, as always, for a patient and their doctor, about their specific situation.

Is Getting a COVID Vaccine Booster Recommended?

Dr. Saltzman: Absolutely. And Andrew, I want to say that we are not recommending boosters. We're recommending that there be clinical trials for this. So, we can look at the safety profiles and what may come with the various combinations of treatments and different vaccines that really needs to be studied. And we're also very clear that we are not recommending if someone would ask us that they go off their treatment to then wait to get vaccinated. Again, we are very hesitant to do that. And so that's a discussion, as you say, for a patient and their doctor, and frankly, I've said this privately, I've said this publicly, I would much rather be cancer-free, in remission and wear a mask and be careful than to risk going into relapse, just so I could get another vaccine attempt to boost my immunity. I just really encourage people to treat their cancers and be very careful about what's going on in our environment.

Andrew Schorr: Okay. Very well said, Dr. Larry Saltzman from Leukemia & Lymphoma Society, thanks for your leadership, Larry, along with the team at the LLS. And I know many of us are participating in your studies and we'll follow this data, and we're delighted that you have something hard to share with us right now. Thanks for being with us.

Dr. Saltzman: Thank you, Andrew. More to come. Thank you very much.

Andrew Schorr: Okay. As you say, more to come. I'm Andrew Schorr, remember knowledge and operating sensibly and safely, that can be the best medicine of all.

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