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Do Patients with CLL Make COVID Antibodies?

Do Patients with CLL Make COVID Antibodies?
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Published on May 26, 2021

CLL Treatment May Affect COVID-19 Vaccine Efficacy

As more patients with conditions like chronic lymphocytic leukemia (CLL) get vaccinated to protect themselves against COVID-19, the question remains; is the vaccine working? For some, the answer is yes.

A recent analysis of people with CLL who received COVID-19 mRNA vaccines showed that some, but not all, make antibodies after vaccination. People who have not yet undergone treatment for CLL were more likely to develop antibodies, whereas people who were actively in treatment or had previously received treatment were less likely to develop antibodies.

Of the 44 patients in the analysis, the “antibody response was more robust in patients who have never been treated,” said Lindsey Roeker, MD, a leukemia specialist at Memorial Sloan Kettering Cancer Center (MSKCC). This bodes well for the people in the “watchful waiting” period when first diagnosed with CLL.

Clinical trials have demonstrated great efficacy for these vaccines in the general population, but patients with immunocompromising conditions were not included in these studies. To understand how patients with CLL responded to vaccination, Dr. Roeker, who was the principal investigator of the MSKCC study and lead author of an April 2021 letter to the editor published in the journal Leukemia, looked at antibody formation in patients with CLL after receiving two doses of a vaccine.

People who were receiving BTK inhibitors or venetoclax (Venclexta) were less likely to make antibodies in response to the vaccine than people who were not treated. These responses mirror how patients with CLL respond to other vaccines, Dr. Roeker explained.

Should Everyone Get the COVID-19 Vaccine?

CLL patients should continue to be vaccinated against COVID-19. Many experts and medical organizations, including the CLL Society, have deemed the vaccine safe.

“There is no reason to believe that there should be any safety concerns with the two mRNA vaccines that have been authorized for emergency use (Moderna and Pfizer),” the CLL Society reported in February 2021 in an official statement. People with CLL who were infected with COVID-19 before the vaccine was available faced hospital stays and lengthy recovery times.

Dr. Roeker echoed that advice. “Any protection is better than no protection,” Dr. Roeker said, emphasizing that the vaccine may not be as effective in people with CLL as in people without CLL, though there is still a lot we don’t know about how the immune system responds when exposed to COVID-19 after vaccination.

The reason this information regarding antibody response in patients with blood cancer is coming out now is because during the early clinical trials of the COVID-19 vaccine, immunocompromised or immunodeficient individuals were not included. Immunocompromised people are now receiving vaccines, and real-world studies are ongoing to learn more about vaccine efficacy in patients with CLL.

Going forward, more data will become available as research scientists conduct larger studies.

Are Individual Antibody Tests Worth It?

Dr. Roeker recommends talking with your oncologist or medical team about whether antibody testing is right for you, particularly because we don’t yet have enough information to know exactly how to interpret the results. As the body’s response to fighting off an infection is more complicated than just antibody formation, we don’t know the full story with just an antibody test, and more evidence is needed to understand the real risk of getting COVID-19 after vaccination, she said.

She also recommends talking with your medical team before taking additional treatments, such as monoclonal antibodies, to bolster the effect of the vaccine. This is because the data isn’t yet available about the efficacy of those treatments in strengthening the effect of the vaccine.

Keep Masks on in Public

It’s spring and people are eager to trade in winter clothes for shorts and T-shirts, but one item should stay in the daily rotation: the mask.

The recent guidance from the Centers for Disease Control and Prevention (CDC) resulted in many forgoing their masks in public spaces, but this is not the time for the immunocompromised or their care partners to take such risks, Dr. Roeker advised.

“Until there is less virus around us, continuing to wear a mask in crowded places is probably the safest way to go,” Dr. Roeker said. 

~Lauren Evoy Davis

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