Can Vaccinations Cause a CLL Flare?

Our recent CLL Global Research Foundation virtual town hall featured CLL Global President, Dr. William Wierda, and Dr. Erin Parry, an Investigator of Hematologic Neoplasia at Dana-Farber Cancer Institute. CLL patient advocate Jeff Folloder moderated the event. Watch the full webinar.

Transcript

Jeff Folloder:

So, since that booster can cause a flare, are there any other vaccines, like the shingles vaccine, tetanus – are there any other vaccines that can cause a CLL flare?

Dr. William Wierda:     

So, let me just clarify a little bit by what I mean with flare and what we’ve seen with COVID and COVID vaccination and flare.

As you say, the vaccination, we have not seen any cases of CLL as a result of getting a COVID vaccination. When I say a flare, it means that the vaccination in some way activates the CLL, which results in enlargement of the lymph nodes or a rise in the white blood cell count, more so than you would expect if nothing was done to the patient, more so than what their standard rise in the white count is.

So, these usually happen relatively quickly. A lot of times, they’ll be in the same arm that is vaccinated. Typically, they are what we refer to as self-limited. They subside over a few weeks. It’s probably the result of the immune system getting activated and the interaction between T cells and normal B cells and the CLL cells and the immune environment that stimulates the CLL cells to divide and become activated.                                        

Like I said, most of the time, this flare subsides over time, over weeks. In the past, I have occasionally needed to give steroids to quiet the immune reaction down because it isn’t subsiding, and that has been successful. There have been rarer numbers of cases where despite giving steroids, the symptoms have not subsided and patients have needed to go onto treatment. That hasn’t been real common, but I have seen that.
So, that kind of describes the flare that we’ve seen. There are other vaccinations that I have seen this happen with, not so much the flu shot. I have seen it with other vaccinations though.

Again, I don’t think it’s necessarily the vaccination doing something that’s terrible and activating and causing the disease to grow. It’s more activating the immune system. We know that there’s an interaction between the immune system, normal immune cells in patients with CLL and their CLL cells, where you can trigger growth of the CLL by stimulating the immune system.

Most of the time in those other cases of a flare with vaccination, it is, again, self-limited and subsides over time. The COVID vaccination is, as you all know, a new vaccine, which is an RNA-based vaccination and is something different than we’ve had to give patients previously. So, we do watch carefully for these things because of the fact that it’s a new vaccination. We don’t have long-term safety data with this vaccination. So, that’s another thing that we think about a lot and monitor for.