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The Vaccine Versus CLL

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Published on February 26, 2021

Experts Discuss COVID Vaccine and CLL

What should chronic lymphocytic leukemia (CLL) patients know about getting vaccinated? Is the COVID vaccine less effective in immune compromised patients? What should our behavior be after we receive both doses of the vaccine? 

In this video segment from our “Dinner with the Docs” event on living with CLL, two experts lead an informative discussion on what CLL patients should know about the COVID vaccine. Dr. John Burke, MD, is a Medical Oncologist/Hematologist and Associate Chair of the US Oncology Hematology Research Program at Rocky Mountains Cancer Centers. Dr. Robert M. Rifkin, MD, FACP, is a Medical Oncologist/Hematologist at Rocky Mountain Cancer Centers. They are accompanied by Host and Patient Advocate, Carol Preston. 

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 | The Vaccine Versus CLL

Carol Preston: Hello, Colorado. Welcome to Dinner with the Docs for chronic lymphocytic leukemia, or CLL, and our medical experts from the Rocky Mountain Cancer Centers. Here with us tonight are Dr. John Burke, and Dr. Robert Rifkin from RMCC. So, Dr. Burke, have you had CLL patients come down with COVID? 

Dr. Burke: Yes. I've had a number. Yeah, so, we know that patients with blood cancers and cancer in general, but especially hematological cancers, have a less favorable outcome if they get COVID than patients who do not have such cancers. And so, those data are now starting to be published. So, that was my impression during the year. And that does appear to be the case from articles that are now getting published.

Carol Preston: So, what about the question of whether I'm on watch and wait, I'm relatively young, am I in any more danger of getting COVID than the next person? Or will it be more severe for me because I have CLL, but I haven't been treated?

Are Watch and Wait Patients at a Higher Risk for COVID?

Dr. Rifkin: We tend to try and stick pretty closely to those well-published guidelines for instituting therapy. It's always hard if you're young and you've been watching and waiting, and I told you you had CLL, and you want me to do something about it. But there's a lot of times when you actually don't want to do something about it. And so, I don't know how John feels, but I tend to really follow the guidelines pretty strictly.

Dr. Burke: Yeah. That and, I think, it's a little tough to tease out in the studies where someone is in their CLL course, and how that correlates with COVID outcome. I mean, it takes a lot of patience to sort that thing out. And a lot of these research data that are retrospective, like, do you have CLL or not? And were you on active treatment or not? So, I think the general take home point from these statements coming out is that if you have that diagnosis of CLL, yes versus no, really or any blood cancer, but especially, probably heme malignancies, more than solid tumors, the outcome from COVID is worse than if you don't have malignancies.

And probably it would be that those who are more immune suppressed, as a result of multiple prior lines of treatment, are at higher risk for an unfavorable outcome. Now we know that CLL patients, many who've never been treated and remain on watchful waiting, still have some degree of immune suppression with low antibody levels. And so, just because you've not been treated, my guess is that you're probably not as safe, or nobody's safe really, but your immune system is more suppressed. And my guess is you're probably at higher risk than someone who doesn't have CLL period, you know? 

Dr. Rifkin: Again, we need more clinical trials, more data. And what you'll find is lots of anecdotal reports. But the proof of the pudding is really going to be the phase three, randomized trials, and then tracking outcome to see if we can decrease ventilators, decrease hospital stays, all those good things. So, nothing is perfect. 

Carol Preston: We hear that the vaccine is not as effective, or the antibody strength is not as robust in patients with immune compromised systems. So, where are we on that, the vaccine versus CLL? Or you don't have to preclude one from the other.

What Should CLL Patients Know About the COVID-19 Vaccine?

Dr. Rifkin: We strongly encourage all of our CLL patients to get vaccinated. My approach is if you have a pulse, you should get vaccinated. It's pretty straightforward. I think the only concern, and it is being studied prospectively at NCI and other places, is I really want to know how well they mount a response. So, if you look at flu vaccines, they're between 30 and 40% effective. 

And we're guessing because of all the things that go on the flu vaccine core, what we should grow up in eggs and give to people, this is much more exact science. And there are actually many really cool YouTube videos where you can see how the vaccine was designed and engineered, explained in understandable terms. And these are so much more effective. The side effects, I think the thing that's going out there in the community right now is that the second dose is far worse than the first. And that's led some people to be hesitant about getting the second dose. You just need to do it.

Carol Preston: So, for CLL patients who are getting the vaccine, and hopefully, all of us will at some point, what should our behavior be once we get both doses? And especially, if we live with people who are not immune compromised. Correct me if I'm wrong, I think we know that even if you've had the vaccine, you can still shed some virus. And so, what is your recommendation for behavior? 

What Should Our Behavior Be After Receiving Both Doses of the Vaccine?

Dr. Rifkin: There are two components to immunity. I mean, one is your personal immunity when you get the vaccine, which as I said, markedly reduces your risk of getting COVID, but not to zero. And the other is the herd immunity, that the prevalence of the virus in society has a major impact on how much it's transmitted from one person to the next. So, I can be vaccinated, but if I'm in a room of 10 people and nine of them have not, there still can be a lot of transmission within that room. 

And so, my chances of getting it goes up if nine people in the room with me can get it. Whereas, if no one in the room with me is very likely to get it, the prevalence of the virus in our community goes way down, and then the likelihood of anybody getting it goes down. So, it builds on itself. And that's the importance of the so-called herd immunity. 

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