It is well recognised that the immune response to Covid 19 infection of individuals with CLL is markedly poorer than that of the general population, with associated increased hospitalisation rates, and increased mortality from the disease. It is thought that about 40% of patients with CLL do not develop an adequate antibody response to Covid 19 infection, or to Covid 19 vaccinations.

For this reason we can be much encouraged by the major recent therapeutic development of a monoclonal antibody to treat or reduce the risk of developing acute Covid 19 infection.

This antibody is known as Ronapreve in the UK and REGEN-COV in the US, and is a combination of two antibodies, casirivimab and imdevimab. It is produced by Regeneron Pharmaceuticals with Roche. Roche is the NZ distributor.

It can be given to at-risk patients as a single dose, IV or subcutaneously after any exposure to a Covid 19 infected individual or with the development of Covid 19 symptoms, in particular for those with a reduced/absent Covid 19 antibody response such as CLL patients. It has been shown to reduce dramatically the rates and duration of the clinical illness (80%), hospitalisation rates (70%), and mortality (25%).

Anyone with CLL who gets Covid 19 symptoms, or has close contact with someone with Covid 19 infection, should immediately self-isolate and call Healthline. But they should also ask the medical staff making their assessment about consideration of this monoclonal antibody as treatment for their condition.

Other monoclonal antibodies are also in the pipeline in relation to Covid 19, including tocilizumab, currently being considered by Pharmac for funding for cases of severe Covid 19 pneumonia.

There are additional aspects of Covid 19 infection risk-reduction that should also be part of all CLL patients’ plans/behaviour.  Vaccination is of course the big one, and is central to prevention and reduction in severity of Covid 19 infection. There is mounting evidence that CLL patients should have three vaccination shots, the third being a ‘booster’, which is believed to improve the vaccine response especially in the subgroup with a low antibody response.

I’m sure you will be more than familiar with the other now routine infection-prevention measures  such as wearing masks, avoiding crowds and poorly ventilated areas, regular hand washing and social distancing.

Stay safe!

With best wishes

Neil Graham