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COVID-19 Booster Shots and Antibody Tests for CLL Patients

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Published on October 1, 2021

What Should CLL Patients Know About COVID-19 Booster Shots?

What can patients with CLL expect after receiving a booster shot for COVID-19? Andrew Schorr, Patient Power co-founder and CLL patient who recently received a booster vaccine, is joined by CLL expert Nitin Jain, MD, of the MD Anderson Cancer Center to discuss why CLL patients should receive a booster shot, whether to ask your doctor for an antibody test, and what the results mean. They also discuss the protections that are recommended for CLL patients as winter and family holidays quickly approach.

Support for this series has been provided by Janssen Oncology and Pharmacyclics LLC. Patient Power maintains complete editorial control and is solely responsible for program content.

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Transcript | COVID-19 Booster Shots and Antibody Tests for CLL Patients

Andrew Schorr:
Hello, and welcome to Patient Power. I'm Andrew Schorr. I've received my booster shot two weeks ago, and I got an antibody result in a test just a couple of days ago, 92.3. We are joined once again by a noted CLL expert at MD Anderson Cancer Center, Dr. Nitin Jain. Thank you so much for being with us.

Dr. Jain:
Absolutely. Great to be here.

Andrew Schorr:
Okay. So, you're getting asked all the time now, "Should I, as a CLL patient, get a booster shot? And then when do we measure it? What interval? And what is does the number mean?" So, what do you say?

Why Is it Important for CLL Patients to Get a Booster Shot for COVID-19?

Dr. Jain:
The data is evolving as we are speaking. So, I think one thing is true that everyone, every CLL patient in my opinion, should get a booster shot. Because we don't know data yet for patients with CLL that how the booster shots will work per se, because now that it's approved, we, and many other people are trying to do trials where we can check the levels before and after the booster shot and see how much the booster shot is working. So that's still happening right now. And hopefully in the next two, three, four months, we'll have some medical data to that effect. But what we know from the medical literature is that there was, for example, a study in kidney transplant patients where kidney transplant patients were given a booster shot, and then they looked at their levels pre and post the booster shot.

And they saw that practically everyone, their levels improved, even if they had good levels to start with, like they had a level of, let's suppose, 2-, 3-, 400, when they got the booster shot, that level became 900. Or if they had level of 10, which may be on the lower side, their level improved to like 2-300. So, everyone's level improved after getting a booster shot. I think based on that, I think getting a booster shot should help CLL patients. Now we know that patients with CLL do not have an immune response very well, so it is likely, it is possible that we may not see the same benefit as you would see in a general population, maybe in a kidney transplant patient population or other immune suppressed population, but still it's, I think better than nothing. And I think only the time will tell in the next few months when we have the medical data for CLL patients, and we can tell you for sure, "Oh, X number of patients had improvement of their levels after the booster shot." But we just don't have that right now.

Andrew Schorr:
Okay. Now what about the interval of testing? So, for me, it happened to be two weeks later. Do you have to wait a certain interval to measure antibodies accurately after the booster?

When Should Antibody Testing Take Place?

Dr. Jain:
In our center, we are recommending one month. I don't know whether that's based on really solid, scientific evidence, but that's what in general, the recommendation has been for our patients. And one of the clinical trials we're involved in checking booster shot levels. That's what the interval is being suggested to do, wait for one month to check the antibodies. So that's what we have been doing, but can you do a shorter interval? I guess it's possible, but again, one month seems a reasonable approach.

Andrew Schorr:
Okay. And what about the number? So those of us in the patient community, somebody says, "Oh, I got 250, I got this." For me, 92.3.

Dr. Jain:

Yeah.

Andrew Schorr:
Do we have any clue at this point as to how much is enough? What protection level?

What Is the Ideal Level of Antibody Response After Vaccination?

Dr. Jain:
Yeah, I think that's a good question. I don't think we truly know. Obviously the higher, the better, but is there an absolute cutoff that you say, "Oh, if you're above 50, you're immune or below 50, you are not immune or 100 or 400." I have seen some study designs where booster vaccinations were being planned, where the investigators have used different cutoff from being zero as a cutoff, like less than zero is nonimmune and any positive value is considered immunity to as high as 400. Like a trial where they could use 400 as a cutoff. Another trial was using 40 as a cutoff. And the paper I was quoting you for the kidney transplant patients, which was published in New England Journal of Medicine, which is the most premium medical journal, they had used an arbitrary cutoff of 100, maybe just as a boiler plate.

They also say they don't know which cutoff, but they just use 100 as a cutoff. So, I think it's suffice to say that we don't know a true absolute cutoff, and it's possible that every cutoff is different for a different patient, meaning that a person maybe has a healthy immune system, maybe immune at a different level than a person with an immunocompromised immune system. But I think general thing will be higher the better. So, I think, but I cannot tell you if there is one specific cutoff, which is well established in the literature.

Andrew Schorr:
Okay. So just to summarize, you recommend that CLL patients get a booster shot.

Dr. Jain:
Yes.

Andrew Schorr:
At MD Anderson, you wait about a month to test for it, but that's maybe arbitrary. We're still figuring that out. And as far as the level of immunity provided by the result is still being studied. And there's not a clear answer yet. Did I get it right?

Dr. Jain:
Yeah, that's correct. That's absolutely correct.

Andrew Schorr:
Okay. Thank you so much for being with us and explaining it because it's a very present discussion for the CLL community. I really appreciate your time.

Dr. Jain:
Sure, absolutely.

Andrew Schorr:
Andrew Schorr with my friend in Dr. Nitin Jain at MD Anderson Cancer Center. Remember, knowledge can be the best medicine of all.

 

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