Ask the Doctor Question:
My wife is a CLL survivor for almost 19 years. She has been on Imbruvica and IVIG for 7-1/2 years. She had both Pfizer injections in January/February 2021, and also signed on to be part of the LLS national survey on efficacy of vaccines to those with CLL. She has taken the antibody test with the following results:
SARS-CoV-2semi-quant total AB: positive @1.0
My wife’s oncologist (Dr. Harold Richter of Boca Raton) recommended her to Dr. Amy Schiffman, an immunologist, for a better explanation and possible further help regarding the test results and her immunity. Dr. Schiffman explained that the results showed that she had very little immunity. The doctor recommended that she get a booster of Moderna vaccine and in one-month after, have a series of blood work ups to determine her standing as to ability to fight the COVID infection.
I am writing this note to ask if the recommendations make sense. Are we on the right track in this constantly changing environment? We are, of course, masking, social distancing, and now not going to any indoor venues.
Answer: It sounds like you are exactly on the right track. As you know, the FDA just recommended that third booster shot for the immunocompromised. The studies that have been done specifically on CLL patients so far indicate that those who had ZERO response will still not respond to a booster. Those who had a little bit of a response may get a little boost. And those that had a good, but not great response will get the best boost of any of us.
Since your wife actually had a response of 1.0, even though that is considered low, she did technically have a response so she might get a little boost in her antibody level. And some bump is better than none at all. So CLL Society is in congruence with the FDA/CDC recommendations for everyone to go ahead and get the booster at this time. We just wrote a piece on this subject that can be found here:
It is a great idea for your wife to consult with an immunologist as well. For those of us who do not respond well to the vaccines, it is looking like monoclonal antibody therapy may be our best bet in the future (although nothing has been approved by the FDA yet on that front for preventative use). CLL Society is working on hard on this topic, and hopefully, we will have more to share in the months to come.
In the meantime, we did create a tool that we refer to as the COVID Plan. It is three checklists you can print out and fill out so you have a plan in place should anyone in your household have either known direct exposure to someone with COVID, or a positive test result. You can find those checklists at the bottom of the page in this article:
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