The Latest COVID Recommendations for CLL Patients

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:                 

What are the current COVID recommendations for CLL patients? Is one booster preferred over the other? Dr. Wierda, I’m starting with you.

Dr. William Wierda: 

Well, the easy answer is the second question, which – is there one vaccination that’s preferred over another.

My answer to that would be not really. The Moderna versus the Pfizer are similarly active. There’s a new one that’s a new version that’s coming out that captures the current strains that people can consider as a booster. If it’s not available already, it will be available momentarily and can be given with a flu shot. If patients haven’t had a booster within the last year and they haven’t had COVID within the last year, then I tend to recommend a booster now.

Now, there are now hard and fast rules about this. I have seen patients who have had flares in their CLL as a result of getting boosters. I know that the CDC has recommendations that may be a bit different than what I’m doing in the clinic.

I’m a little bit more comfortable with being flexible about it, particularly because we have nirmatrelvir/ritonavir (Paxlovid) and we have remdesivir (Veklury), and the strains that we’re seeing are less aggressive. So, they don’t cause as severe of symptoms in patients. Many patients have had an infection previously and, as a result, have some immunity to it.

So, it’s very different than it was in 2020 in terms of being relatively aggressive about vaccinating and boosting, etcetera, for those reasons. Like I said, my practice generally has been if somebody hasn’t had COVID within the last year or a booster, then I will recommend a booster now, i.e., this fall. If they’ve had a reaction, a flare from a prior booster, then I would say, okay, maybe you could just avoid heavily boosting, particularly if you’ve had a recent COVID infection that has cleared.

I do recommend that people get the flu shot annually. Now is the time to be thinking about that. We have recommended RSV vaccination for patients but less emphatic about that because that typically is not a life-threatening infection with the RSV. It can be complicated, and patients can have to be admitted with RSV infections, particularly those who are heavily immunosuppressed. So, I’m not as strong about that recommendation. I am for some patients. But RSV is another vaccination to think about. That’s just a one-time vaccination.