Pneumonia Vaccines for CLL

Overseen By Catherine Cromar

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: University of Utah

Must be taking: Venetoclax

Must not be taking: Immunosuppressives

Disqualifiers: Severe allergic reaction, Active infection, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 8

Duration: 9 weeks

60 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial does not specify if you need to stop taking your current medications, but you cannot use immunosuppressive medication within 14 days before starting the trial, except for certain allowed steroids.

What data supports the effectiveness of the treatment Pneumococcal 13-valent Conjugate Vaccine and Pneumococcal Polyvalent Vaccine for patients with chronic lymphocytic leukemia (CLL)?

Research shows that the 13-valent pneumococcal conjugate vaccine (PCV13) triggers a better immune response than the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in patients with CLL. Although the overall immune response is low, PCV13 followed by PPSV23 is recommended to help prevent pneumococcal infections in these patients. ^{1 2 3 4 5}

Is the pneumonia vaccine safe for people with chronic lymphocytic leukemia (CLL)?

The pneumonia vaccines, PCV13 and PPSV23, are generally recommended for people with CLL to prevent infections, and they have been used since 2012. While the immune response may be lower in CLL patients, the vaccines are considered safe for use in humans. ^{2 3 4 5 6}

How does the pneumococcal vaccine treatment for CLL differ from other treatments?

The pneumococcal conjugate vaccine (PCV13) triggers a better immune response in patients with chronic lymphocytic leukemia (CLL) compared to the pneumococcal polysaccharide vaccine (PPSV23), making it more effective in preventing infections in these patients. ^{2 3 4 6 7}

What is the purpose of this trial?

This phase II trial tests whether the pneumococcal pneumonia vaccine series (PCV20 and PPSV23) works to mount an effective immune response in patients with chronic lymphocytic leukemia. PCV20 and PPSV23 are both vaccines that protect against bacteria that cause pneumococcal disease. Giving these vaccinations as series may make a stronger immune response and prevent against pneumococcal infections in patients with chronic lymphocytic leukemia.

Research Team

Daniel Ermann, MD

Principal Investigator

Huntsman Cancer Institute/ University of Utah

Eligibility Criteria

This trial is for adults aged 18+ with chronic lymphocytic leukemia who haven't had prior CLL treatment, or those treated with venetoclax for at least a year. Participants should not have used immunosuppressants recently, except certain steroids, and mustn't have had specific pneumonia vaccines in the last five years.

Inclusion Criteria

I have been treated with venetoclax for at least a year and my last dose was within the last 12 months.

I have been diagnosed with CLL or SLL as per the 2018 guidelines.

I have never received treatment for chronic lymphocytic leukemia.

Exclusion Criteria

I am currently on antibiotics for an infection.

I have had a pneumococcal vaccine (PCV13 or PCV20) in the last 5 years, or PPSV23 over a year ago.

I haven't taken strong immune-suppressing drugs recently, except for some allowed minor uses or low-dose steroids.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Patients receive pneumococcal 20-valent conjugate vaccine on day 1 and pneumococcal polyvalent vaccine on day 60

9 weeks

2 visits (in-person)

Follow-up

Participants are monitored for immune response and safety after vaccination

5 years

Every 6 months

Treatment Details

Interventions

• Pneumococcal 13-valent Conjugate Vaccine
• Pneumococcal Polyvalent Vaccine

Trial Overview The PROTECT CLL Trial is testing if a series of two pneumococcal vaccines (PCV20 and PPSV23) can effectively stimulate an immune response to prevent infections in patients with chronic lymphocytic leukemia.

Participant Groups

Group I: Arm II (PCV20, PPPSV23) Experimental Treatment 3 Interventions

Patients who have received or are receiving venetoclax therapy, receive pneumococcal 20-valent conjugate vaccine IM at study visit 1 and pneumococcal polyvalent vaccine IM at study visit 2 in the absence of disease progression or unacceptable toxicity.

Group II: Arm I (PCV20, PPSV23) Experimental Treatment 3 Interventions

Patients receive pneumococcal 20-valent conjugate vaccine IM on day 1. PnumoVax23 will be given as an intramuscular injection on Visit 2 (approximately Day 75)

Pneumococcal 13-valent Conjugate Vaccine is already approved in European Union, United States, Canada, Japan, China, Switzerland for the following indications:

Approved in European Union as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Approved in United States as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Approved in Canada as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Approved in Japan as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Approved in China as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Approved in Switzerland as Prevnar 13 for:

• Invasive pneumococcal disease
• Community-acquired pneumonia

Who Is Running the Clinical Trial?

University of Utah

Lead Sponsor

Trials

1,169

Recruited

1,623,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Findings from Research

In a study involving 32 patients with chronic lymphocytic leukemia (CLL), the addition of multiple doses of GM-CSF to the standard pneumococcal vaccine did not significantly improve the immune response, as less than 10% of patients showed a 4-fold increase in antibody levels.

Despite the low response to the vaccine, the administration of GM-CSF was associated with only minor side effects, indicating that it is a safe intervention in this patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multiple-dose granulocyte-macrophage-colony-stimulating factor plus 23-valent polysaccharide pneumococcal vaccine in patients with chronic lymphocytic leukemia: a prospective, randomized trial of safety and immunogenicity. Safdar, A., Rodriguez, GH., Rueda, AM., et al.[2021]

In a study of 128 untreated chronic lymphocytic leukemia (CLL) patients, the 13-valent pneumococcal conjugated vaccine (PCV13) produced a significantly stronger immune response compared to the 23-valent pneumococcal polysaccharide vaccine (PPSV23) for most serotypes, both one and six months after vaccination.

Both vaccines were well tolerated, but PCV13 is recommended for inclusion in vaccination programs for CLL patients due to its superior efficacy in eliciting immune responses against Streptococcus pneumoniae.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. Svensson, T., Kättström, M., Hammarlund, Y., et al.[2018]

In a study of 30 untreated patients with chronic lymphocytic leukemia (CLL), stimulation with the PPV23 vaccine led to significant changes in T and B cell activation markers, indicating a robust immune response.

Specifically, the study found that PPV23 stimulation increased the activation of B cells (CD19+CD69+) and the expression of CD95, suggesting that the vaccine may enhance immune function in CLL patients through Toll-like receptor pathways.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of the influence of peripheral blood mononuclear cell stimulation with Streptococcus pneumoniae polysaccharides on expression of selected Toll-like receptors, activation markers and Fas antigen in patients with chronic lymphocytic leukemia. Grywalska, E., Hymos, A., Korona-Głowniak, I., et al.[2019]

In a study of 24 treatment-naive CLL patients, 58.3% showed an adequate immune response to the PCV13 vaccine, compared to 100% of healthy subjects, indicating a reduced but still significant response in CLL patients.

The PCV13 vaccine was found to be safe, with no significant side effects reported, and it is recommended to be administered early after CLL diagnosis to enhance the likelihood of a better immune response.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antibody and plasmablast response to 13-valent pneumococcal conjugate vaccine in chronic lymphocytic leukemia patients--preliminary report. Pasiarski, M., Rolinski, J., Grywalska, E., et al.[2018]

In a study of 143 patients with Chronic Lymphocytic Leukemia (CLL), vaccination with PCV13 and PPSV23 resulted in a low overall serologic response of only 10.5%, indicating limited effectiveness in generating protective antibodies against pneumococcal disease.

The serologic protection rate was notably low, with only 13% of untreated CLL patients and 3% of treated patients achieving sufficient antibody levels, suggesting a need for improved vaccination strategies, such as multi-dose regimens with more effective vaccines.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Immunogenicity of the 13-Valent Pneumococcal Conjugated Vaccine Followed by the 23-Valent Polysaccharide Vaccine in Chronic Lymphocytic Leukemia. Haggenburg, S., Garcia Garrido, HM., Kant, IMJ., et al.[2023]

In a study involving 24 patients with chronic lymphocytic leukemia (CLL), the 23-valent pneumococcal polysaccharide vaccine (PPV23) given five years after the 7-valent conjugate vaccine (PCV7) did not significantly improve antibody responses against invasive pneumococcal disease (IPD).

Only 10% to 15% of CLL patients showed an antibody response considered protective after receiving PPV23, indicating that this vaccination strategy is ineffective for enhancing immunity in CLL patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antibody response to the 23-valent pneumococcal polysaccharide vaccine after conjugate vaccine in patients with chronic lymphocytic leukemia. Lindström, V., Aittoniemi, J., Salmenniemi, U., et al.[2023]

The 13-valent pneumococcal conjugate vaccine (PCV13) has been shown to be effective in preventing various forms of pneumococcal disease in a large study of over 84,000 adults aged 65 and older, demonstrating its strong immunogenicity and safety profile.

Based on its effectiveness and changes in disease patterns, health authorities now recommend PCV13 for all adults aged 65 and older, as well as for younger adults with certain health conditions that increase their risk for pneumococcal disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

13-Valent Pneumococcal Conjugate Vaccine: A Review of Its Use in Adults. Plosker, GL.[2018]

References

1. United States pubmed.ncbi.nlm.nih.gov

Multiple-dose granulocyte-macrophage-colony-stimulating factor plus 23-valent polysaccharide pneumococcal vaccine in patients with chronic lymphocytic leukemia: a prospective, randomized trial of safety and immunogenicity. [2021]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Pneumococcal conjugate vaccine triggers a better immune response than pneumococcal polysaccharide vaccine in patients with chronic lymphocytic leukemia A randomized study by the Swedish CLL group. [2018]

3. Poland pubmed.ncbi.nlm.nih.gov

Assessment of the influence of peripheral blood mononuclear cell stimulation with Streptococcus pneumoniae polysaccharides on expression of selected Toll-like receptors, activation markers and Fas antigen in patients with chronic lymphocytic leukemia. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Antibody and plasmablast response to 13-valent pneumococcal conjugate vaccine in chronic lymphocytic leukemia patients--preliminary report. [2018]

5. Switzerland pubmed.ncbi.nlm.nih.gov

Immunogenicity of the 13-Valent Pneumococcal Conjugated Vaccine Followed by the 23-Valent Polysaccharide Vaccine in Chronic Lymphocytic Leukemia. [2023]

6. United States pubmed.ncbi.nlm.nih.gov

Antibody response to the 23-valent pneumococcal polysaccharide vaccine after conjugate vaccine in patients with chronic lymphocytic leukemia. [2023]

7. New Zealand pubmed.ncbi.nlm.nih.gov

13-Valent Pneumococcal Conjugate Vaccine: A Review of Its Use in Adults. [2018]