Tag Archive for: immune suppression

CLL and Vaccines | Vital Advice for Protecting Patients

CLL and Vaccines | Vital Advice for Protecting Patients from Patient Empowerment Network on Vimeo.

 What do chronic lymphocytic leukemia (CLL) patients need to know about vaccines? Expert Dr. Ryan Jacobs explains CLL treatments that reduce vaccine response and his vaccine recommendations.

Dr. Ryan Jacobs is a hematologist/oncologist specializing in Chronic Lymphocytic Leukemia from Levine Cancer Institute. Learn more about Dr. Jacobs.

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Lisa Hatfield:

So we have another patient who has asked a series of questions. Her first question is, “Can you speak to immune vulnerability and the importance of regular vaccination for CLL patients?”

Dr. Ryan Jacobs:

Yes. So we know that having active CLL reduces a patient’s ability to respond to vaccination and increases redirection, we know being on treatment for CLL also produces varying risk depending on the treatment. The drugs that seem to do the most damage to the immune system, and specifically in terms of their ability to respond to vaccination or the antibody treatment like rituximab (Rituxan) and obinutuzumab (Gazyva), and their effects last for many months after that treatment is finished. Unlike the oral drugs which have a short half-life, the antibodies hang around for many months after being administered.

I in general am recommending, as does the CDC, to get boosted every six months for patients with any level of immune suppression and having CLL qualifies you as that. And then I recommend all of the general vaccines that come with age, like, for example, the Shingrix vaccine for shingles is now safe to give to CLL patients because it’s a conjugate vaccine, it’s not a live virus vaccine.

So we’re lucky now with just standard vaccines in the U.S., there are no live virus vaccines that the CLL patient has to worry about anymore, so I definitely encourage shingles, pneumonia vaccines, boosting for COVID. We’ll see if we get an RSV vaccine, that sounds like it’s on the horizon. Flu, of course. And the patient should just be aware based on what kind of treatment that they’re on, they may not have a good chance at responding to these vaccines, but I still try with my patients. The other important element to think about when you’re considering an infection risk and everything is just kind of what’s…obviously, the pandemic has been a very dynamic thing, and certain times there’s been a lot more risk than others. Thankfully, at the time of this recording, we’re doing on probably as good as we’ve done since the onset of COVID. So you have to make your decisions on the situations you put yourself into, based on your personal situation and what’s going on in the bigger picture, risk-wise. Flu season, COVID season, a lot of RSV going around or something like that.

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Key Questions to Ask Your Myeloma Doctor About Induction Therapy

Key Questions to Ask Your Myeloma Doctor About Induction Therapy from Patient Empowerment Network on Vimeo.

What key questions should you ask your myeloma care provider when choosing induction therapy? Expert Dr. Benjamin Derman discusses factors that are important for patients to consider when making treatment decisions along with their care team.

Dr. Benjamin Derman is a hematologist and oncologist specializing in multiple myeloma at the University of Chicago Medicine Comprehensive Cancer Center. Learn more about Dr. Derman.

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Let’s share some tips for having that conversation. I’d like to start with induction therapy, which is the first line of treatment for patients. What questions should patients ask when choosing therapy early in their diagnosis?

Dr. Derman:

Yeah, that’s a great question. And it’s of course – it’s really the patient priorities I would say. So, one of the things that I like to discuss with patients is, number one, what are the things that they value? And that’s a hard question to ask without any qualifiers.

So, one of the things that I often ask patients to think about is the – first of all, the number of visits to the medical center. Certain therapies are weekly, certain therapies may actually decrease in frequency overtime. So, if that is something, it’s hard to travel, it’s hard to get someone to take you or to come yourself, or you just don’t want to be in the clinic as much – right? If that’s your number one priority, there are going to be certain therapies that are – or regimens that may be better suited for that patient. If somebody says, “I don’t care how many times I have to come, my goal is the deepest response possible,” you can think about things from that standpoint.

I mentioned side effects. What are the things that are scary to you personally, as a patient? Some people may look at that neuropathy, as I mentioned, and say “No way. That sounds horrible. I can’t do my job.” Other people would say, “I already have some cardiac issues. I don’t want to take that risk.” Right? So, there are different side effects that we have to take into account.

Especially when it comes to talking about transplant, there is not just the acute issues that we have to deal with in terms of side effects, but also long-term immunosuppression. Meaning the immune system is suppressed, and there’s a risk of infections, and it’s going to be higher than if you had not gotten a transplant. So, those are at least some of the things that I encourage patients to be thinking about.

I would also say, on top of that, patients may be approached about clinical trials. And I work at a university where we really value enrolling patients in clinical trials. But that they do come with some inconveniences as well, even though I think they really help to advance the field forward, and sometimes offer patients options they wouldn’t normally be able to get. But there are typically more visits associated with that, more evaluations, more blood draws, more bone marrow biopsies, so those are things that you really have to take into account.