By Brian Koffman, MDCM (retired) MSEd
Immunity Part 1
1. CLL is a cancer of the immune system, so it should come as no surprise that because we are immunocompromised we are at higher risk for:
a. Infections
b. Second cancers
c. Poor response to vaccines, including COVID-19 vaccines
2. Blood cancers (including CLL) are a common cause of impaired immunity, but there are many others including:
a. AIDS, hepatitis C, and other infections that damage the immune system
b. Mild and severe forms of congenital immune dysfunction (such as the boy in the bubble)
c. Medications, including but not limited to:
i. Systemic steroids (the risk from most steroid cremes is negligible)
ii. Many types of chemotherapy
iii. Monoclonal antibodies commonly used in CLL, such as rituximab or obinutuzumab
iv. Anti-TNF (tumor necrosis factor) drugs used to treat lupus, rheumatoid arthritis, and other auto-immune conditions
v. Drugs taken after an organ or bone marrow transplant or to treat auto-immune complications seen in CLL such as immune thrombocytopenic purpura (ITP) and autoimmune hemolytic anemia (AIHA). Some of these commonly used drugs include:
1. Cyclosporine
2. Tacrolimus
3. Sirolimus
d. Radiation
e. Having no spleen from trauma, surgery, and other rare causes
f. Poorly controlled diabetes
g. Malnourishment, especially low protein levels
3. Approximately 10 million people (less than 3% of all Americans) are immunocompromised to some extent
4. The response to COVID-19 vaccines are only now being studied in the immunocompromised population, and the results have been disappointing
Dr. Brian Koffman, a well-known retired doctor, educator, and clinical professor turned patient has dedicated himself to teaching and helping the CLL community since his diagnosis in 2005. He serves as the Executive Vice President and Chief Medical Officer of the CLL Society Inc.
Originally published in The CLL Society Tribune Q2 2021.
