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Will a COVID-19 Vaccine Affect CLL Patients?

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Published on June 10, 2020

How does a Coronavirus Vaccine Affect CLL Patients?

We all want a coronavirus vaccine to be developed sooner rather than later. What's the current status? And what will a vaccine mean for chronic lymphocytic leukemia (CLL) patients?

In this segment from our recent Answers Now program, host Andrew Schorr talks to Dr. John Allan from Weill Cornell about the possibility of a vaccine and whether it will be live or inactivated. Dr. Allan also explains why past cancer treatments could potentially affect the body’s response to a vaccine. Watch to learn more from a CLL expert.

If you missed Parts 1 through 3 of this series, watch them at CLL Patient Concerns in the Middle of Coronavirus, Is CLL Care Finally Returning to Normal? and CLL Clinical Trials and Treatment During COVID-19.

This program is sponsored by AbbVie, Inc. and Genentech, Inc.  These organizations have no editorial control. It is produced by Patient Power.  Patient Power is solely responsible for program content.

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Transcript | Will a COVID-19 Vaccine Affect CLL Patients?

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Recorded on June 4, 2020

Andrew Schorr:

Welcome to the CLL Answers Now program. I'm Andrew Schorr in Southern California. Joining us is a great panel today. Thank you so much for being with us. There's Dr. Phil Thompson at MD Anderson in Houston, Texas; Dr. John Allan, who is at Weill Cornell in New York Presbyterian in New York City; and Jeff Folloder, a CLL patient like me. Jeff joins us from Houston, Texas.                      

Related to a COVID-19 vaccine—when it's developed, and we hope there will be, what do we know about, do we know, it's okay if you don't, how it'll interface with somebody with CLL and this whole idea that we went through with the zoster vaccine (Shingrix) and all that, a killed virus? So can you talk to us a little bit about that? Just what we know or how we're going to find out.

Dr. Allan:

Yeah, I think it's a great question. It brings into question not only live versus an inactivated virus for our CLL patients, but whether or not the treatments that they may have had in their past may affect their immunity to establishing an immunity to the antigen from the vaccine that we're injecting. And so, those are a little bit unknown kind of questions.   

What I can say in my experience with several coronavirus-positive patients that have been on therapies, therapies like alemtuzumab (Campath), very immunosuppressive treatments, and things along those lines that have developed the disease, that many times they remain positive. In fact, we are seeing this new phenomenon where you can continue to swab some of our CLL patients or other lymphoma patients and may remain positive for the virus four, five, six, seven weeks out, but asymptomatic.           

We don't quite know if those patients are actually shedding the virus still and, in fact, infectious? We believe they are. We tell them to quarantine. But my personal experience is, now that we have antibody testing coming around, we are starting to see that many of our CLL patients and many patients—and I just had a patient now that was literally positive for the coronavirus positive swab test for seven plus weeks, a Campath-treated patient, who just cleared the swab and the antibodies were positive. And so, this is somebody I was fearing may never develop antibodies. Fortunately, he had almost zero complications from the disease. And so, there's a lot about the illness that we don't know; if there are other genetic factors, if there are other things. People can get very, very sick, and they might be young and healthy, and you think why would they be sick? And then you have others that are immunosuppressed, that had a low grade temperature, maybe a few days of diarrhea, and that was all they had. Never got hospitalized, and then felt great the remaining time and completely asymptomatic.

So there are a lot of things we don't understand. But I can say that our patients that do seem to be immunosuppressed, and I'm starting to really ramp up my antibody testing of my true positives, and I'm seeing that they're becoming positive for their antibodies. So that's hopeful that our patients might they be on ibrutinib (Imbruvica) or have had anti-CD20 therapy, or whatever it might be, will be able to mount the response to the vaccine whenever we get it available. I think whether it's a live or an inactivated vaccine that comes around, I think most of them are inactivated that I've heard about. Fortunately, that makes our job a lot easier. We'll have to have that risk, because obviously someone who's very immunosuppressed, heavily pretreated, is probably not going to get a live vaccine. That's contraindicated currently in our guidelines.        

I think you can think about exceptions for low-risk watch-and-wait patients that have never had treatment, IgG levels are adequate, and have no infectious complications, because we give them influenza vaccine and Shingrix and all these things, and some of them even get old live shingles vaccine and have never developed it.

So these are all hypothetical. Then I think that's something we'll have to grapple with, but what I'm happy to see is that our patients do seem to be responding to developing antibodies. And, in fact, are starting to clear the disease. It does seem to take a little bit longer, but they do seem to be mounting those responses, which is important and I think a good sign that when a vaccine comes around, our patients will still be able to get access and be protected.

Andrew Schorr:

All right, great. I think very hopeful. That's what we all want because we're sort of shut in, some of us.

So let me just summarize a couple of things. In New York, one of the issues is public transportation right now, but you're also working with outlying centers to help give you information, interaction with patients. And you're at a point, Dr. Allan, where you want people to get the right treatment for them and understand their goals of treatment. And all that comes into play just like before.          

At MD Anderson, you got lots of parking lots, huge freeways that are not usually too clogged nowadays. So you can get there. So now, maybe they'd come to MD Anderson physically, although you have the outlying clinics as well, and again, full range of treatments and trials on the table. Dr. Thompson, right?

Dr. Thompson:

Yes.

Andrew Schorr:

Thank you, Dr. John Allan from Weill Cornell in New York. Thank you, Phil Thompson for being with us once again. I always love to hear your Australian accent. Thanks for being with us from MD Anderson.    

Jeff Folloder, thank you for all you do. We got these physicians who are angels along with the other healthcare providers, but Jeff, you're an angel too, leading the CLL community and juggling all the concerns people have. Thank you all for being with us. We'll let you go. You can pop yourselves off and we'll have you on again, okay?

Jeff Folloder:

Great.

Dr. Allan:

Thanks.

Dr. Thompson:

Thank you.

Andrew Schorr:

All right, ladies and gentlemen, this is what we do on our Answers Now programming, and you can see that it's a moving target. If we interviewed Dr. Allan a few weeks ago it would have been a different story. If we interviewed Dr. Thompson at a different time, it might've been different.        

And, Jeff, his thinking is evolving just like mine is. So thank you so much for being with us. Thank you to AbbVie and Genentech for supporting this program. Get the full range of treatment for you. Have the consultation with your cancer doctor. As Dr. Thompson said so well, "Cancer is a big deal." Right? And so you've got to pay attention to that. There's this other stuff swirling on. They're taking precautions, so you get the right treatment.         

All the best to you guys. I'm Andrew Schorr. Remember, knowledge can be the best medicine of all. 

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