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Coronavirus vaccine effectiveness in CML patients

Blood Cancer UK has said that the coronavirus vaccines are less effective in people with blood cancer. Does anyone know what that means for CML? Is the effectiveness less for CML patients who are stable (undetectable PCR) on one of the CML drugs?

On the Blood Cancer web site, reference is made to some research recently reported in the British Journal of Haematology at https://onlinelibrary.wiley.com/doi/epdf/10.1111/bjh.17644 However, that is too medically technical for me to get a handle on what it might mean in terms of risk for vaccinated CML patients and whether, for example, continued protective measures should be taken like face masks etc.

Has anyone asked their Consultant about this question?

David

Hi David

The short answer to your question on effectiveness based on this scientific article is: somewhat less. Although, patients with CML had the best serological response (COVID-19 antibody response) i.e. 75 % of immunized patients achieved necessary protection. 75 % was for the full CML subgroup, apparently there are some differences in persons receiving imatinib or 2nd gen TKI-s. What those differences actually were, was not clearly explained. 

BUT! This study assessed the response to Pfizer/Biontech or AstraZeneca vaccine based on single shot only so the picture might be completely different (most likely better) when the person has received two shots as required. This article does not say that CML patients are left defenseless rather that the response may be a bit impaired after one shot.

Another thing to consider. As a CML patient of course we would like to avoid getting infected at all. But, in regards to vaccination, I truly believe that the goal is to avoid hospitalization and serious consequences. The article does not draw any conclusion whether this impaired serological response is in terms of "avoiding infection" or "avoiding hospitalization". Those two things are very different. Having a mildly symptomatic COVID-19 infection as a vaccinated CML patient is something we should be ready for just in case.

I think the reason for an impaired vaccine response lies in the fact that TKI-s somewhat suppress our lymphoid cell linage as well and antibody production (which derives from the lymphoid cells) is not so effective. But if you have general cytopenias due to early phase treatment, e.g. neutropenia (I am a good example of this), I would of course shield myself from COVID-19 just to be sure.

To sum up:

1. the article only analyzed results after one shot for a two-shot vaccine

2. it would be good to have your antibody level tested. It may give you some insight whether additional shots are needed. A third round of shots is currently on the horizon for most vaccines approved in the EU.

 

Timo

I have a call with my consultant tomorrow and will be asking him about that.

Timo

Many thanks.

David

The Blood Cancer UK data was from a survey they conducted amongst patients with all blood disorders/cancer, so did not differentiate between for example CLL (a B cell disorder/cancer) and other related diseases and CML.

Whether the apparent 'reduced' effect of the vaccine - as Timo points out was based on a single vaccine- is because some of the survey respondents may have also been suffering from either disease related or treatment related immune deficiency.

The NCRI CML Sub-group are compiling a response to the BCUK Survey, which they will publish over the next few days. In my opinion BCUK have been rather irresponsible because they have not contextualised or categorised the patient sub-populations used in that survey, for reasons known only to themselves.

This has caused some CML patients to panic and assume that they are not protected. Vaccines are never 100% protective, but the Covid vaccines are pretty effective. It is important, in my opinion, to make sure you continue to use rational methods of personal protection inspite of this Governments apparent dismissal of the evidence of continued risk of infection (currently rising in the UK) presented by members of the scientific community. 

I work in the retail industry and will continue to ask my customers to wear masks and use hand sanitation for the foreseeable future. The UK stats are currently very (very) worrying....I will not be going back to the pub or getting on a plane anytime soon!

Sandy

Thank you, Sandy. I agree that Blood Cancer appears to have been less than clear in what they have said and that is a pity for patients who need precise statements about things like this.

David

Hi all,

Just out of curiosity and for ease of mind, I did an IgG antibody test for the spike protein.
I got tested 6 weeks after my second dose of pfizer.

The result was 23000 AU/ml!

For info, I am PCR-U for the last 8 months and I don't have myelosuppression, my wcb always hovers around 10k (high end of normal range).

Overall a very very good antibody result, I would say!

Regards,
Koralia

Thank you 

I’ve been worrying about the new UK trends. I watch John Campbell channel since January 2020. As it seems we will be going to have a high prevalence over the next few months with numbers soaring in the UK.. towards the end he mentioned leukaemia efficacy of the vaccine which then worried me. I logged on to this support page as I felt I needed some reassurance. These threads have helped. I was just beginning to feel safer, now with all restrictions going to be lifted it makes it harder to feel safe in public places, I don’t want to have to ask a stranger keep their distance and put a mask on around me! 
I don’t want to find out how ill I might get if I get Covid.. it’s all very worrying. 
Thank you all 

Michelle 

I discussed this with my consultant just now. The biggest issue is that "blood cancer" is a very broad term, and it is difficult to draw specific conclusions about any particular set of condition/treatment/vaccine. His view is that CML is one of the conditions least likely to reduce the effectiveness of the vaccine, but it is not impossible. He pointed out that we know I have had good immune response before (despite my 30 year plus chronic neutropenia) so I should do what I want to do but take what I see as appropriate precautions. So I won't be going to night clubs (but haven't done that for 20 years anyway). I'll wear a mask on public transport and probably if a theatre or cinema is busy. I will wash hands/sanitise regularly.  

Thanks for letting us all know what your Consultant said. I agree with your comments about mask wearing in crowded places. I am posting on behalf of my wife who is on Imatinib and has been PCR undetectable for more than 10 years.

David

Hi Alistair 

Your reply has given me some needed reassurance. I will be continuing to observe the same measures as you.. I had just begun to feel a little better after the whole shielding experience! 
I think over the next few months, perhaps I will use extra caution because of the increase of prevalence of covid infections there will inevitably be over the next few months. 
I feel the governments decision for not mandating masks on public transport and making it advisory, as well as the one metre rule being removed will make me feel more stressed when out… but the hope for cml vaccine having efficacy was my main concern. If only we could have a peak into the future for those of us living with cml and how covid will effect us if we get the virus. Fingers crossed it’s all going to be ok!

Thankyou 

Michelle

 

I also asked my consultant about the vaccine and i was told i could have an antibody test with my next set of bloods. The result showed there were anti bodies but there was a note with the results saying it was unknown what level was needed to create protection and also it was unknown how much of the protection relates to T cells rather than antibodies.  The advise was that any reduction in protections would probably be minimal. 

I am aware of a group of blood cancer charities in the UK working on this as the government has not provided any funds in this respect  as yet.

After reading this thread i started to worry that i may not have the full picture in respect of my immune response. I emailed my consultant who has advised that i had anti bodies and had some protection but it was not at the level expected to give me the majority of protection.  She said i would need the booster that will probably be done in September. I have been on Nilotinib for over 10 years and a PCR just below .02 so i hadn't really expected this. It does leave me concerned for the future.

I just thought i needed to make you aware as most of the people on here have had a more positive result.

There do seem to be a number of different measurements and scales for anti body tests so the results are a bit difficult to interpret without help.  My result  was stated as BAU/mL which is binding anti bodies and the numbers are very different to the AU/mL scale.  

Hi Christine et al

I too had an antibody test with my latest bloods and was advised that I had produced antibodies but it was not clear a) what level was required to achieve maximum protection and b) the relevance of T cells which were not tested.  I get more precise info when my other blood result comeback and I have my telephone consultation with Haematologist in  a couple of weeks but I did ask her by email whether All CML patients were getting tested for antibodies and if so what proportion had produced antibodies.  She replied no only those who like me have to travel abroad or have another reason  for justifying an antibody test get one as the hospital does not offer antibody tests routinely to CML patients. She said that  CML was the most likely Blood cancer to have a good antibody response but that her initial impression was that response was more age related than type of TKI or degree of MMR related.  So as a decrepit Granny who wants to visit to her family and  homeland I am advised to be cautious.  Flights are a terrifying thought but at least once  there I shall not have to be worried by the Gov's great gamble as I shall be among mask wearers in indoor spaces and a declining no of cases so I reckon going and stay present equal risks unless of course you go back to semi shielding while the UK cases and eventually hospitalisations and death rise exponentially.