Today I would like to chat with you about the antibody response to vaccines given to CLL patients. The first part of my post is an anecdote and further studies are ongoing. The second part of this post include the scientific results of two other vaccines given to CLL patients, two studies in which I participated.
PART 1: My friend Anne is in the same clinical trial at National Institutes of Health (NIH) as I am. We have been both been taking Ibrutinib since 2012. She got both shots of the Pfizer vaccine and was curious if her body would respond by creating antibodies.
In a normal healthy person, the Covid-19 immunity process typically takes two weeks after the second dose of the vaccine. One month after Anne’s second dose the total IgG/IgM antibodies to SARSCoV-2 Nucleocapsid protein test results were nonreactive, which means no antibodies were found. However, eight weeks after Anne got the second dose antibodies were finally detected: Positive >0.79. There’s a little hope here. It will be interesting to see if the antibodies continue to increase in number.
As a cancer survivor and Ibrutinib user, I am interested in my own immunity process. NIH will soon be opening a CLL vaccine clinical trial on antibodies. As soon as I am notified that their proposal has been approved, I will post the information to the NIH clinical study on the antibody response to the vaccine in CLL patients.
Another option is the Leukemia and Lymphoma Society (LLS) is setting up a patient registry and is paying for quantitative antibody testing at LabCorp. This study expands to more types of cancers. The link to their registry is: https://www.ciitizen.com/LLS/?utm_source=LLS&utm_medium=Partner%20Landing%20Page&utm_campaign=&utm_content=&utm_channel=LLS&utm_vehicle=
PART 2:
I was one of the participants in the NIH CLL HEPLISAV-B (hepatitis B) and SHINGRIX (shingles) vaccine studies. The recently published initial results from the vaccine studies has been published.
The full article can be found here: https://ashpublications.org/blood/article/137/2/185/474376/Effect-of-Bruton-tyrosine-kinase-inhibitor-on?searchresult=1
Below is a brief summary of the results from NIH:
SHINGRIX: Approximately 60 percent of untreated patients CLL patients and approximately 40 percent of BTK-inhibitor (ibrutinib or acalabrutinib) treated patients developed an antibody response against the shingles virus. This response rate is less than in the general population, however we are encouraged by these responses and recommend the SHINGRIX vaccine to CLL patients that have not yet received it. However, we do not know how long the antibody response lasts. The antibody response to the Shingrix vaccine is based on a research test and, therefore, is not part of your CRIS record.
HEPLISAV-B: Approximately 30 percent of untreated patients CLL patients and approximately 5 percent of BTK-inhibitor (ibrutinib or acalabrutinib) treated patients developed antibodies against the hepatitis-B virus. Patients treated with a BTK-inhibitor do not appear to reliably develop antibodies following vaccination with HEPLISAV-B. CLL patients that are untreated are still able to develop antibodies against the hepatitis-B virus, albeit at lower rates compared to the general population.
Side Effects: The side effects for both SHINGRIX and/or HEPLISAV-B were very similar compared to those observed in the general population – there is therefore no evidence to suggest that CLL patients suffer from more side effects following vaccination.
As cancer survivors we have some hopeful news. As Dr. Brian Koffman says, “We are all in this together.”
Dr. La Verne, I'd be surprised if your friend Ann
ReplyDeleteDr. La Verne, good to hear from you!
ReplyDeleteI'd be surprised if your friend Anne was tested for anti-nucleocapside antibodies to check her response to the Pfizer vaccine. The anti-nucleocapsid antibodies would be testing for past COVID-19 infection. Most likely she received the positive/negative antibody test looking for antibodies to the Spike protein. Unless she receives a semi-quantitative test she won't likely find out what her antibody titer actually is.
In terms of the NIH vaccine studies it is important to point out that the response to the hepatitis B vaccine measured the de novo response to vaccine, and the response to the zoster vaccine measured the recall immune response. For those of us on BTK inhibitors our response to the SARS-CoV-2 vaccination will likely mirror the de novo response to the hepB vaccine, and that is very little antibody production.
Somehow my message disappeared before I could push "Publish". If you did receive the message just ignore this one...I tried to recompose. Also please don't feel obligated to post. Beth
ReplyDeleteDr. La Verne, good to hear from you!
I’d be surprised if your friend Anne was tested for anti-nucleocapsid antibodies as a way to measure response to the Pfizer vaccine. Anti-nucleocapsid antibodies would detect past COVID-19 infection, but not a response to the Pfizer vaccine. She likely got a positive/negative anti-Spike antibody test. In order for her to find out anything more than a positive response she would need a semi-quantitative anti-Spike antibody test.
Something important to point out is that the response to the hepatitis B vaccine measured the de novo response to vaccine, and the response to the zoster vaccine measured the recall immune response. For those of us on BTK inhibitors our response to the SARS-CoV-2 vaccination will likely mirror the de novo response to the hepB vaccine, and that is very little antibody production.