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The following is an exchange I have had regarding this Newsletter on LinkedIn. Interesting that people from other disease areas are finding this useful.

Dear Prof G

Many thanks for your summary and thoughts especially regarding anti-CD20 therapies and immune response towards the COVID-19 vaccine.

My husband is on Rituximab therapy for non-Hodgkin's lymphoma (NHL) and has been advised to skip the next dose in September, get a booster vaccination (as he is not producing sufficient levels of antibodies) around December and restart vaccination in late winter around February.

The T cell response has never been evaluated.

My question now would be: does this approach make sense to you? Or should he just keep on with Rituximab and trust on the T cells doing their work?

Kind regards

Mrs ****

Answer:

It all depends on his NHL. You don't want to compromise its treatment. If the oncologist is happy to delay treatment then it makes sense to do that for the booster. How long you delay is the next question. I suspect you will need to delay the booster for long enough to see some peripheral blood B cell reconstitution. But as for now he has done the right thing and had the vaccine; during the pandemic, it is better to have the vaccine and get some immunity than to be left vulnerable to the virus. As I have said many times before, partial immunity is better than no immunity.

I hope this helps

Prof G

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Jul 16, 2021Liked by Gavin Giovannoni

Thanks, Prof!

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Jul 17, 2021Liked by Gavin Giovannoni

Thank you, Prof G! This was golden.

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Jul 16, 2021Liked by Gavin Giovannoni

Thanks Prof G! I’ve been hoping for a post from you about exactly this. My Neuro in the United States told me to watch for your posts about this topic as I am keenly interested (PwMS taking ocrelizimab).

So helpful for me to read and learn and share.

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I understand that Ocrevus ramps up my T cells and ramps down my B cells. I was told that the T cells would be very effective against COVID 19. I have had 2 Phizer shots. I am overweight. Is a third shot a good option. Thanks for your summary. It is 5:30 am. Not sure I processed.

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Dear Prof G

My husband just had his first half dose of ocrevus and is due his next half in two weeks. How long after his infusion do you suggest he gets his first Pfizer Vaccine? We are in Sydney and in a hot spot and the Delta strain is all around us. We basically stay home as we are in lockdown.. I’ve had my first Pfizer shot to keep my husband safer, but we are just not sure if and how long after his Infusions he should have his shot.

Thanks in advance

Maggie

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Do you have any advisement on timing after infusion for the third jab for those on Ocrevus? It is now on offer where I live for those who are immune compromised & making a decision on when to get jabbed is now a reality.

Thank you again for this post - I just reread it!

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What about Alemtuzumab Prof. G? my husband finished his two courses 2 years ago and his lymph count is around 1.2 now.

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Thanks for this professor. I have question. I had never been on any anti-CD20 therapy when I got the vaccine. (Had been on Copaxone for years, then took a year off DMT). Four weeks after my second vaccine, I started Ocrevus for the first time. So should I assume that Ocrevus did not impact my body's vaccine response much?

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Does Kesimpta share the same exact safety profile?

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