Monoclonal Antibodies for Blood Cancer Patients
- Mendelsohn has been battling a rare form of blood cancer, follicular lymphoma, since 2016. She tried to protect herself from COVID-19 with the vaccine, but did not have any antibodies until she recently tried monoclonal antibody treatments.
- Monoclonal antibody treatments can provide immunocompromised people, like blood cancer patients, with the COVID-fighting antibodies that their bodies may not produce on their own.
- The FDA authorized emergency use of AstraZeneca's Evusheld, a long-acting monoclonal antibody treatment, in December for the pre-exposure Covid prevention in certain adults and children, including the immunocompromised.
Mendelsohn, 50, has been battling a rare form of blood cancer, follicular lymphoma, since 2016. Chemotherapy and immunotherapy treatments in 2018 left her with no evidence of cancer, "but the challenge with follicular lymphoma is the fact it's still in me." Her doctors don't know whether the disease will return in full force, so she was continuing immunotherapy until the pandemic forced her to stop with the threat of the virus outweighing the benefits of her treatment.
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“Dropped by the @voguemagazine NYC office yesterday for an exciting new project!,” she wrote in a recent Instagram post. “After 2 years of working from home, 1 dose of Evusheld, and countless zoom calls…I finally have antibodies for COVID!”
Evusheld, a type of monoclonal antibody treatment, was successful in giving Mendelsohn anitbodies. But even still, she’s trying to minimize her risk as much as possible.
“Still being careful of course,” she wrote. “Everyone onsite was tested and wore masks, but I don't think I could have dreamed of a better first external day back! Stay tuned for more soon.”
Understanding Follicular Lymphoma
Mendelsohn's blood cancer, follicular lymphoma, is an extremely rare cancer and a slow-growing type of B-cell non-Hodgkin's lymphoma. Possible symptoms, if they occur, can include anemia, fatigue and a low platelet count.
All About Follicular Lymphoma: A Common Type of Non-Hodgkin Lymphoma
"Follicular lymphoma is a somewhat confusing disease to many patients and general oncologists, because it's cancer arising from a B-cell lymphocyte, but it can be very, very indolent, which means that the cells are dividing very slowly," Dr. Jakub Svoboda, a hematology specialist at Penn Medicine, previously told SurvivorNet.
Follicular lymphoma is usually considered to be more of a chronic disease, and not all patients even need treatment.
"Follicular lymphoma is not considered curable, but many patients live with this disease and go on to die of something else completely," Dr. Svoboda said.
In fact, even when follicular lymphoma is diagnosed at an advanced stage, the average survival is greater than twenty years. There are exceptions, however, and some people with follicular lymphoma will have a more difficult time managing the disease. Still, people with follicular lymphomas that do require treatment have many options with generally very good outcomes.
"There are all kinds of presentations and situations," Dr. Svoboda said. “These diseases may, in some patients, never need therapy.”
Blood Cancer and the COVID-19 Vaccine
Research indicates the COVID-19 vaccine doesn't provide the same benefits for people with cancer that affects the blood, bone marrow or lymph nodes particularly those with chronic lymphocytic leukemia so you should continue to protect yourself after receiving the vaccine if you have blood cancer.
"Some patients with blood cancers, specifically CLL, were less likely to develop antibodies to the COVID spike protein. And perhaps that means that those patients may be less protected by the vaccine," explains Dr. Thomas Martin, a hematologist-oncologist at the University of California San Francisco. "This is not news that is unexpected news at this point in time. What we anticipated is that patients with blood cancers, especially those getting therapy, would have a lower ability to produce antibodies or to respond to the vaccine compared to normal patients."
What Should Blood Cancer Patients Do After They Get the COVID-19 Vaccine?
The Leukemia and Lymphoma Society “encourages blood cancer patients and survivors to get all recommended COVID-19 vaccine doses as soon as they are eligible.” Below is a graphic designed to help people with blood cancer determine an appropriate course of vaccination. But, as always, you should consult with your doctor to discuss what option is best for you.
The LLS also advises blood cancer patients to “get vaccinated, act unvaccinated.” What this means is that even after you receive the recommended four doses of the vaccine three in a primary series plus a booster dose you should still take additional steps to avoid COVID-19 infection like avoiding large crowds, wearing a mask, maintaining social distancing and making sure all of the people you live with are fully vaccinated.
Monoclonal Antibody Treatments
Monoclonal antibody treatments are intravenous infusions or shots that can provide immunocompromised people with the COVID-fighting antibodies that their bodies do not produce on their own. Monoclonal antibodies are laboratory-made proteins that mimic the immune system's ability to fight off harmful pathogens such as viruses, according to the Food and Drug Administration.
Patients receive this treatment once if given via infusion, and the process takes about an hour. But if given via shot, the antibody is administered as two separate consecutive intramuscular injections (one injection per monoclonal antibody, given in immediate succession) and may be effective for pre-exposure prevention for six months.
These types of treatments have already been used to keep Covid patients from experiencing more extreme complications.
What Is Evulshed and How Did It Help Nicola Mendelsohn?
The U.S. Food and Drug Administration issued an emergency use authorization for AstraZeneca's Evusheld (tixagevimab co-packaged with cilgavimab) on December 8, 2021. Evusheld is a long-acting monoclonal antibody treatment for pre-exposure COVID-19 prevention in certain adults and children (12 years of age and older weighing at least 88 pounds.) It can be thought of as an alternative to the COVID-19 vaccine for patients who are immunocompromised or allergic to the traditional Covid vaccine.
In a previous interview with SurvivorNet, Dr. Heather Yeo, a surgical oncologist at New York-Presbyterian/Weill Cornell Medical Center, shared her thoughts on the approval.
"The question is really for whom this would be helpful," she said. "(The) vaccine is obviously more important. But for those who are allergic or who are unable to mount an immune response, this seems to offer promise… It's basically like giving your body the antibodies it needs to fight. So again, (the) vaccine (is) better."
Right now, Evusheld is authorized in the United States for those who are not currently infected with COVID-19 and who have not recently been exposed to someone with the virus. The authorization also requires that individuals are either "moderate to severely immunocompromised" due to a medical condition or immune-suppressing treatment people like cancer patients and may not mount an adequate immune response to the COVID vaccine OR “cannot be vaccinated with any COVID-19 vaccine according to the approved schedule or has had a severe allergic reaction to any vaccine component.”
With that being said, it seems that Mendelsohn must have consulted with her doctors after her COVID-19 vaccination proved to be unsuccessful at producing antibodies which she’s talked about previously. It can be assumed, then, that her doctors recommended Evulshed as a second attempt at giving her body those precious antibodies. Thankfully, it worked.
Contributing: Sydney Schaefer, Joe Kerwin
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