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Antibody test after Covid vaccine

zsazsa1
Posts: 553
Joined: Oct 2018

I have splenic marginal zone lymphoma, was treated with rituximab, last dose on Dec 9th, 2020.  I had a first Pfizer shot on Jan 24, 2021, and the second three weeks later.  There is a study going on which is testing for antibodies, and titers, after vaccination in people with leukemia and lymphoma.  

 

https://www.ciitizen.com/LLSCOVIDStudy/?utm_campaign=LLS%20National%20Patient%20Registry&utm_medium=email&_hsmi=116026146&_hsenc=p2ANqtz-8PSs3z09E1zBPKQi45sIDgO_0RWcoDXMphNVx9s8-NB4rrcc0bNJWFOROIBPPTrtPwY2QIs-dOAhTD853ReeDcN0m37Q&utm_content=116026146&utm_source=hs_automation&fbclid=IwAR177RB-Sx6NjFnh0EO7EMaLyF10Fpe8ppX1A7X8kivqMCZjEaK4CbL68yY

 

My result for both came back negative, meaning despite the fact that I was sick as a dog the day after the second shot, for about 12 hrs, I didn't mount a detectable antibody response.  I figure I'll get a 3rd, and maybe 4th dose in June, which will be six months after my last rituximab, and after appointments are for everyone  have been available in my state for over two months.

 

Others might consider signing up for this study.  The more info, the better.  It will help all of us.

 

Meanwhile, social isolation goes on for me...

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

DISCLAIMER: I have no first-hand knowledge about this testing but I am trying to get answers from LLS about what test(s) they are using. 

My understanding is that the existing antibody tests measure antibodies made in response to INFECTION. Antibodies made in response to VACCINE may be different and may not be detected by those tests

I hope to hear back from LLS about this and how to appropriately understand negative results.  In the meantime, please remember that antibodies are only part of your immune response.  T cells are incredibly important, both for fighting viral infection and for assisting B cells in the production of antibody.

I willl let you know if/when I hear from them but I encourage you to reach out yourself for more information.  And kudos for enrolling in the Registry.  Be well.

ShadyGuy
Posts: 684
Joined: Jan 2017

They sent me a lab Corp lab order. Anxious for Evarista's info on how to interpret the results. I have inquired too but no reply yet.

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

At least on the double-negative question.

Response from LLS is that they are using two LabCorp antibody tests: one for Spike antigen and one for Nucleocapsid antigen. The approach seems to be that a vaccine response will only give a signal for the Spike antibody test, while infection should give a positive on both tests (because the vaccines contain only the Spike antigen component of the virus).

No clarification on how to understand the negative for both following vaccine. However, there is language on LabCorp's website discussing the possibility of negative results. www. labcorp.com. Search for "164090" for description of the Spike test and "164068" for the Nucleocapsid test.

There is also a FAQ on the LLS website: "Will LLS let me know how to interpret the results? No. LLS will not be offering any medical advice. You should consult with your own healthcare team." Follow ZsaZsa's link to see this FAQ page.

I have signed up but have not been offered the antibody test as of yet.

The study is described at clinicaltrials.gov: https://clinicaltrials.gov/ct2/show/NCT04794387?term=lymphoma+covid+antibody&cntry=US&draw=2&rank=1

 

Wish I had more to offer. Hopefully more specific tests will be coming soon.

ShadyGuy
Posts: 684
Joined: Jan 2017

I have the lab order but cannot be near a LabCorp facility till next week. It has been 3 weeks tomorrow since my 2nd Pfizer shot. Test results should be interesting.

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

In case you missed it:  LabCorp operates out of Walgreen's drug stores in many areas.  List of locations here:  https://www.labcorp.com/Walgreens 

I'm scheduled this week for first testing.

ShadyGuy
Posts: 684
Joined: Jan 2017

Not in my area. However Labcorp has several stand alone locations.

zsazsa1
Posts: 553
Joined: Oct 2018

Since unfortunately the LLS study questionnaire didn't ask for date of last treatment, the only way for us to find out how long after last rituximab patients need to be, to respond to the covid vaccine, is through networking with each other.

From what I've found by networking with people, even people with blood cancers or lymphoma who have not had treatment yet, mount a robust anti-spike protein response.  I know of one other person with last rituximab about 7 weeks before first dose Pfizer, who also had NO detectable anti-spike antibodies aftter two doses of vaccine.

zsazsa1
Posts: 553
Joined: Oct 2018

I was able to obtain my results within 48 hrs by making a patient account with Labcorp.

The first result is for covid antibody, that one would only have if one had been infected.  A person with leukemia or lymphoma, especially if they had been recently treated with an anti B-cell therapy, might not make antibodies to covid, despite infection.  So a no doesn't necessarily mean you haven't had it (although probably you did not have it), but a yes does mean you had covid in the past (unless you have a false positive - I don't know what the false positive rate is for that test).

The second result is for your antibody titer in response to spike protein (what the vaccine is trying to get your body to make).  Many people have >250 as their result - this is as high as the test can measure.  But some people don't have any response at all - I had the two shots beginning 7 weeks after my final rituximab, and I didn't mount any response at all, so my antibody titer was <0.8, which is as low as the test can detect.  I'm interested in hearing if anyone who had been on rituximab in the previous 12 months was able to mount an antibody titer to spike protein, and if yes, how long had it been since there last rituximab infusion, before they had the vaccine.  This will help any of us who've recently finished rituximab consider when to go ahead and repeat the covid vaccine, in the hopes of mounting an antibody response.

T

ShadyGuy
Posts: 684
Joined: Jan 2017

I received my results very quickly too. However I am not sure how to interpret it or even if its relevant to this thread since its been over 2 years since my last chemo. I think LLS should have asked more questions to put more context in the results. Perhaps they will follow up as they have our email addresses. Mine came back  negative nucleocapsid and 8.82 on spike. So it seems I have some level of protection but not what is referred to as a "Robust Response". Since this test is not very reliable I plan to pay to have it done again and at a different lab to see if I get matching results.

tom9
Posts: 1
Joined: Oct 2018

I have SMZL but no treatment yet (although chemo in past for other cancer).  Following vaccine my doctor ordered a "SARS-CoV-2 Antibody, IgG" test.  LabCorp came back with a simple "Negative" result.  Yet it appears others are getting results with numerical data.  Can somewhat help with explanation?  Should I be asking my doctor for a different or additional test?   The LabCorp order written by Primary Care and not Oncologist.  Thanks.

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

It looks like that may be a different test and that it only reports out as Neg or Pos.  Look here and click on "Sample Report":  https://www.labcorp.com/tests/164055/sars-cov-2-antibody-igg-spike 

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

Digging into this, it seems that the Spike antigen test being used by LabCorp was developed by Roche:  Elecsys® Anti-SARS-CoV-2 S.  Roche's information about this test can be found here:  https://diagnostics.roche.com/us/en/products/params/elecsys-anti-sars-cov-2-s.html  Per Roche, the linear range for the assay is 0.4 to 250 U/ml.  My attempts to find more information in the peer-reviewed literature did not turn up publications that showed numeric results, so not sure where the comment "Many people have >250 as their result..." derives from. I would like to know, so if you have a reference for that, ZsaZsa, could you please share? Keep in mind that most (if not all) publications at this point will be data from infected people, not vaccinated. My result was similar to Shady's. Looking forward to more data in the not too distant future and will be watching for it.

About LLS not requesting information about your treatment:  if you do the part of the Registry that allows them to collect your clinical data, they should have the specifics of what/when/how you were treated.

A couple of publications from Roche's website:

https://academic.oup.com/cid/article/71/8/1930/5822173#210228293

https://jamanetwork.com/journals/jama/fullarticle/2765837%C2%A0%C2%A0

Edited to add:  the linear range information should not be construed as implying that any particular value within that range is either "high" or "low".  It does not mean that; it is simply the range over which the assay and the instruments running the assay work.  Have not yet found what the curves look like for patients & vaccinees.

ShadyGuy
Posts: 684
Joined: Jan 2017

who is highly involved in COVID treatment but not a researcher. She said that to her knowledge no one really knows what a "normal" antibody response to a covid vaccine is and also the medical professionals do not know if all the various vaccines produce the same antibody response. Most all available data on COVID antibodies comes from tests on persons who have had the actual disease. Perhaps antibody tests before and after vaccination of people with no COVID history would help fill the knowledge gap? I came away still in the dark about antibody response in persons who have a history of cancer treatments. Perhaps this LLS study we joined will help find some answers. As for me I am glad I had the vaccinations.

zsazsa1
Posts: 553
Joined: Oct 2018

There's a lot of chat about this on the Facebook groups for follicular, marginal zone, and splenic marginal zone groups.  The moderator for the non-Hodgkin's lymphoma Facebook group would not let me post about the study at all.  I don't know if people on that group know about it.  In addition, I've been in touch with some leukemia patients.  There's no compilation of data yet, but the anecdotes are showing that many people who are not yet very sick with their lymphoma/leukemia and haven't been on rituximab or similar agents, had spike protein levels of >250 (and no sign of prior infection).  People who were farther along with lymphoma or had fairly recent rituximab are reporting results in the single digits.  People who had recent rituximab are reporting no spike antibody response.

As I said, it's all anecdotes at this point.  Way too early for any study results yet.

ShadyGuy
Posts: 684
Joined: Jan 2017

The Roche test kit is supposedly able to detect in a range of .4 to 250. It does not go ">250". My reading is that even those recovered from the virus rarely ever test over 25. Lots of noise out there. Sorry to see Facebook censorship now includes health issues.

I am going to talk with some people who work for LabCorp on Tuesday. Also I have a close relative who is a pharmacist who may have some info.

Thanks for your info. Have a great day.

Results from a lab in UK where no subjects had the vaccine

Result Type Numeric Count Number of Samples
Negative – Antibodies not found Between 0 and 0.128 5,278
Between 0.128 and 1 193
Positive – Antibodies found Between 1 and 10 218
Between 10 and 100 449
Between 100 and 200 155
More than 200 16
Evarista's picture
Evarista
Posts: 317
Joined: May 2017

It is possible to get a numeric result of >250 using diluted sample. While this may not be done routinely for our clinical samples, it most certainly would be done for study purposes and would be necessary in order to get the data.  This same Roche "system" is used for other viral assays (HIV, HCV, etc) and patient samples are often rerun diluted if intial result is outside the range of the assay.

ShadyGuy
Posts: 684
Joined: Jan 2017

Do you know if the LLS used diluted samples? I assume they would only do that if the first results were above the max? Looks like my 8.82 was borderline no detect using the assumptions used for infected persons. No one seems to know if the same rules apply to cancer patients who have not had COVID-19 infection.

Evarista's picture
Evarista
Posts: 317
Joined: May 2017

Unless someone comes back with a report of a value larger than 250 U/ml.  For some tests, such as HIV viral burdens, samples are typically re-run diluted if the initial result exceeds the range of the assay.  In that case, getting the actual value is critical to the care of the patient, so done automatically I think.  With these antibody tests, absolute values do not seem critical; at least not yet. So samples may not be re-run diluted unless someone (researcher?) requests. Hopefully LLS is taking the "long view" and getting the values.

ShadyGuy
Posts: 684
Joined: Jan 2017

London (CNN)The Pfizer/BioNTech Covid-19 vaccine provides less protection in cancer patients than healthy individuals following a single dose, a new real-world study in the UK suggests, raising questions about whether the UK's strategy to delay second doses should apply to such patients. 

A second dose of the vaccine at three weeks, however, boosted their protection significantly, with the researchers calling for earlier boosts in this group in the UK. The UK's vaccine strategy currently involves a 12-week gap between doses of the coronavirus vaccines; Pfizer recommends 21 days between doses. 
The study analyzed the impact of the Pfizer-BioNTech vaccine on 205 participants — 54 healthy volunteers and 151 elderly patients with solid cancers, such as breast or prostate cancer, and haematological (blood) cancers, such as leukemia. The preprint study has not yet been peer-reviewed or published.
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