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Chronic Lymphocytic Leukemia (CLL) Patients and Protection Against COVID-19: Passive and Active Immunity, Monoclonal Antibodies, and Vaccines

In science and medicine, information is constantly changing and may become out-of-date as new data emerge. All articles and interviews are informational only, should never be considered medical advice, and should never be acted on without review with your health care team.

All CLL patients are immune-compromised. That is why infections are so dangerous for us, and that has proven especially true with COVID-19 resulting in tragically high rates of severe disease, hospitalization, and even death.

Getting vaccinated against COVID-19 seems especially important for us as a preventive measure, and CLL Society joins all the experts in highly recommending that all CLL patients get vaccinated ASAP. We have even successfully campaigned to move vulnerable cancer patients up the line in terms of when we can do can get our shots.

And while we strongly argue that some immunity is better than none, we must face the cold reality that we are notoriously bad at making antibodies and mounting an immune response to existing vaccines.

The new SARS-CoV-2 vaccines may be excellent at revving up the average person’s immune system, and while we are hopeful this time will be different, there is reason to suspect our response will be less predictable and robust based on our poor response to other vaccines, especially if we are being treated with drugs such as ibrutinib or others as described by Dr. Pleyer from the NIH.

Bear with me while I explain a little about liquid, or humoral, immunity, and cellular immunity. It is a gross understatement to say that immunology is complicated, but we need to understand something about how it works to best defend ourselves against the many invisible armies that are gunning for us.CLL patients, due to their disease or its treatment, can be poor at forming antibodies, especially after drugs such as monoclonal antibodies (mAbs), such as rituximab and Obinutuzumab, that deplete our B cells as described here. Those B cells are necessary for making antibodies, the liquid or “humeral” part of our immunity.

Our “cellular” immunity is led by our T cells, where the cells themselves direct others to kill the viruses or do the killing on their own. T cell function is also often impaired in chronic lymphocytic leukemia.

To use a football analogy, a strong immune response involves a complicated set of hand-offs and passes between different players (cells) in our immune system and we CLL patients fumble the ball a lot. Making antibodies and activating T cells is “active immunity” and requires an effective immune system and strong teamwork.

Switching analogies, while in most cases it is better to teach someone to fish than to hand them cooked fish and chips, in our case, we are slow learners and may never successfully fish on our own and may end up going hungry.

Fortunately, there is a good source of prepared fish. Dropping all the analogies, if we could get enough pre-made “neutralizing” antibodies against the spike (S) protein found on the SARS-CoV-2 virus that should prevent the SARS-CoV-2 from entering our cells and infecting them, then those antibodies would be expected to passively protect us while they hang around without us ever having to learn how to make the antibodies ourselves.

We already have proof that when the cloned (monoclonal) antibody “cocktails” are given early in the illness, they lower the risk of severe COVID-19 in high-risk patients such as us.

But what if they were given pre-exposure to prevent us from ever contracting COVID-19?

As it turns out, there is a trial open now looking at exactly this possibility. Cloning two of the most potent neutralizing antibodies found in the blood of patients who have recovered from COVID-19, and turning them into a long-acting formulation, AZD7442 administered in 2 injections, given at the same time, that is hoped to offer passive immunity for six months or more.

I’m a believer and have enrolled in the PROVENT trial to prevent COVID-19 in vulnerable patients like us.

To quote from the PROVENT trial website:

The PROVENT Study will research a combination of 2 investigational monoclonal antibodies for the prevention of COVID-19, the disease caused by the new coronavirus (SARS-CoV-2). The study is looking at how well the investigational antibodies work and how safe they are”.

I will write more about the details of the trial in my next post and about my decision to enroll and my experience and recommendations.

In the meantime, please check out all the links in this article, do your own research, and let me know what questions you have or comments that you might want to share

Stay strong. We are all in this together.

Brian Koffman MDCM (retired) MS Ed
Co-Founder, Executive VP and Chief Medical Officer
CLL Society, Inc.

CLL Society - COVID-19

When appropriate, the CLL Society will be posting updates and background information on the present Coronavirus pandemic focusing on reliable primary sources of information and avoiding most of the news that is not directly from reliable medical experts or government and world health agencies.