What CLL Patients Should Know About RSV and COVID Vaccines

Our recent CLL Global Research Foundation virtual town hall featured CLL Global President, Dr. William Wierda, and Dr. Patrick Reville, Assistant Professor in the Department of Leukemia at The University of Texas MD Anderson Cancer Center. CLL patient advocate Jeff Folloder moderated the event. Watch the full webinar.

Transcript

Jeff Folloder:

Dr. Reville, apparently COVID is still a thing, and it’s still top of mind.

William would like to know if there are any forthcoming preventative offerings for CLL patients to prevent COVID, sort of like what tixagevimab/cilgavimab (Evusheld) did.

Dr. Patrick Reville:

Yes. This was actually – I saw this question ahead of time, and I don’t know if there’s anything coming that would be sort of new antibodies. I mean, there are certainly continued developments from a vaccination standpoint, and so there is some ongoing research both looking into sort of new antibodies from products such as Evusheld with sort of the newer variance.

In addition, sort of ongoing work with updating vaccination. Today, there’s nothing new that’s approved compared to, I think, this time last year, for instance.

I don’t really know sort of the timeline of kind of where that is in development. I don’t know, Dr. Wierda, if you have any better understanding of the development there?

Dr. William Wierda:

So, AstraZeneca, who produced Evusheld, pulled it from the market because it was no longer active. They have another drug that they have been running clinical trials on that hopefully will be approved. It’s particularly important for patients who don’t respond to the vaccination and/or can’t tolerate the vaccination. So, I do anticipate – I don’t know what the timeline is, but I do anticipate a replacement for Evusheld becoming available in the near future.

Jeff Folloder:

Dr. Reville, I want to follow up and go off on just a little bit of a tangent. We’re talking about COVID. The subject of vaccines and boosters and all that wonderful stuff. Apparently there’s a new kid on the block.

And that new kid on the block has initials RSV. Should CLL patients be getting RSV vaccines, and how should they be dealing with the RSV situation?

Dr. Patrick Reville:

Yes, I mean, I think a lot of these respiratory viruses have been an ongoing problem for CLL. I mean, even obviously pre-COVID. The RSV has been around, other coronaviruses were around. Influenza. So, the respiratory viruses in particular have been an issue for patients with CLL, and that has to do with a number of issues related to the immune system, both intrinsic issues related to them having CLL but also issues with antibody production for patients that are on treatment, either previously with chemotherapy or currently with in particular CD20 antibodies or BTK inhibitors that might affect the way that the body is able to mount an immune response.

So, in terms of vaccines, I mean, that would be a vaccine that we would recommend for patients with CLL. They would sort of fall into the category for which it’s now approved, and would be a group of people that can have more severe complications related to RSV infections that we would hopefully like to prevent by having them vaccinated.

There are some issues from time to time around when to administer those vaccines to get an optimal response, and so for a lot of patients, if possible, timing it when people are maybe not receiving the CD20 antibodies in particular could help to have them mount a better immune response.

At the same time, there are a lot of patients that are on continuous therapy, either with BTK inhibitors or even continuous venetoclax in some settings, in the relapse setting.

And so if therapy can’t be interrupted, then I think giving the vaccines when it’s reasonable to give the vaccines is a good approach.

We don’t have great testing usually to really look specifically at an individual level about the response to the vaccine, so I think a lot of it is just sort of giving the vaccine at sort of the optimal time points to try to maximize your responses.

And then I think the other part of your question is sort of dealing with RSV. We see a decent amount of RSV in our leukemia patients and across hem malignancies in general, so that is something that we manage, either on the inpatient setting or the outpatient setting, if it’s reasonable to do so.

So, I think as patients are not feeling well, getting sort of testing for a variety of viruses, it’s nice we kind of have some targeted antiviral therapies for different things, including RSV, that are potentially reasonable to consider in the right setting.