Readers will know all about the problem of infection in CLL. Although there are many treatments that make the lymph nodes go away and the white count come down, although both hemoglobin and platelet counts can be restored to normal, although the marrow can be cleared of CLL cells, nothing makes the immune system normal.
Everybody agrees that it is worth being vaccinated against common infections including influenza, but tests show that responses to vaccines are poor. For this reason and inspired by an idea of Chaya's we are recruiting to a trial which attempts to enhance the response to flu vaccine.
The Jab and Dab trial is being sponsored by CLL Topics and details are laid out on Chaya's website. Briefly it involves the use of imiquimod, a cream used to treat rather indolent skin cancers, to be rubbed on the skin after the flue jab. Imiquimod activates one of the Toll-like receptors, TR7, which stimulates the immune response. The trial will be run by Dr Helen McCarthy in Bournemouth. The trial protocol and patient information sheet are available on line.
Dr McCarthy is one of the hematologists who replaced me when I retired from Bournemouth. She has a long standing interest in CLL and spent a year working with Dr Keating and Dr Wierda at MD Anderson. While there she discovered that high levels of AID could be detected in patients with unmutated IgVH genes.