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COVID-19 VACCINES FAQ FOR PATIENTS AND CAREGIVERS

IMPORTANT UPDATES: 

Pfizer-BioNTech vaccine now available for adolescents 12 through 15 years of age

As of May 2021 the Pfizer-BioNTech COVID-19 vaccine is authorized and recommended for use in children 12 to 15 years of age. Vaccine side effects in younger adolescents are consistent with the side effects seen in older adolescents and adults (pain at the injection site, tiredness, headache, chills, muscle pain, fever and joint pain). As with adults, side effects typically last 1 to 3 days and are more common after the second dose.

The Pfizer-BioNtech vaccine was 100% effective in preventing COVID-19 among vaccine recipients ages 12 to 15 in the clinical trial. It is important to remember that these results are in healthy children. As with adults, important questions remain about how well these vaccines induce immunity in children with cancer, particularly those undergoing treatment.

The vaccination schedule remains the same in children—two doses three weeks apart. LLS urges parents, guardians and/or caregivers to talk with their child’s health care team as soon as possible to make a vaccination plan.

Anti-Asian Discrimination

There is currently misinformation about how COVID-19 spreads, which has resulted in an increase in hate crimes against members of the Asian, Asian American and Pacific Islander community. No single person or group of people are more likely than others to spread COVID-19. We encourage our community to speak out against injustice and share accurate information about how COVID-19 is spread (read LLS’s statement about this here). You can find information about how the virus spreads here, and ways to help reduce stigma and discrimination here.

Gwen

 

Message from LLS Chief Medical Officer, Gwen Nichols

The Leukemia & Lymphoma Society (LLS) hears from blood cancer patients and caregivers each day about the profound effects of the pandemic on their cancer care and daily lives, including questions about COVID-19 vaccination and if they work for people with blood cancer.

LLS Chief Medical Officer, Gwen Nichols, MD, is addressing FAQs from blood cancer patients and caregivers based on what we know right now. We encourage blood cancer patients, parents of patients, and caregivers to discuss COVID-19 vaccination with their oncologist and healthcare team as early as possible so they can make an informed plan of action.

If you have a condition or are taking medications that weaken your immune system, you may not be fully protected even if you are fully vaccinated. Even after vaccination, you may need to continue taking all precautions, including continuing to wear a mask, practicing social distancing, and avoiding crowds and poorly ventilated indoor spaces. Blood cancer patients are at higher risk of developing more severe illness from COVID-19. This includes higher risk for severe infections and death, as well as being contagious longer.

We understand that you may be experiencing uncertainty about the impact of COVID-19 on your cancer care and may have many questions about if you should get a vaccine. As you continue to navigate your care during these challenging times, LLS offers a wide array of free education and support that can help. LLS Information Specialists – highly trained oncology professionals – are here to provide one-on-one support at (800) 955-4572 or by live chat/email here.

Last updated 6/16/2021

QUESTIONS FROM BLOOD CANCER PATIENTS WHO HAVE BEEN VACCINATED

I am a blood cancer patient who has been fully vaccinated and have a negative antibody response. What does this mean for me and what precautions should I be taking?

We urge everyone to share the results of their antibody tests with their physicians, but especially those whose spike antibody test is negative. You should also continue following CDC guidelines for mask wearing, social distancing and handwashing, and encourage those around you to get vaccinated for their own protection and yours.

Blood cancer patients may not respond fully to the vaccine. This does NOT mean that vaccination is futile. Some patients may have a diminished response, due to their type of blood cancer diagnosis and the type of treatment they have received.

In addition to creating spike antibodies, there are other ways our immune systems respond to vaccination that may provide protection. Immune cells known as T cells may play a role in the ability of our immune system to protect us against COVID-19. This is one of the questions LLS is studying through the LLS National Patient Registry, a project of the Michael J. Garil Patient Data Collective. After joining the Registry and providing consent, we are offering participants (adults age 18 and older) antibody testing before and after they get their COVID-19 vaccinations. We will be sharing findings from these research studies with patients and the medical community and have already shared preliminary safety data.

If you are an existing participant in the Registry and have additional questions about your antibody tests, please visit our COVID Study Frequently Asked Questions (FAQ) page.

Should patients with blood cancer consider a booster shot?

We encourage you to talk to your doctor about this. What we do know is that there is no data currently available about the safety or effectiveness a COVID-19 vaccine booster dose for people with blood cancer. However, LLS is working to develop a trial to test this for blood cancer patients.

A third booster shot was evaluated in a small number (30) solid organ transplant patients. Most (24 of the 30) did not have an antibody response after two vaccine doses. After the third dose, 12 had a “high-positive” antibody response and 2 had a “low-antibody” response. It is important to note this is a very small study and more data is needed. While the follow up is limited, most of the patients had typical antibody reactions to the booster. One patient had a significant reaction, but recovered. 

As a blood cancer patient, now that I’m vaccinated, can I resume “normal” activities such as going to sporting events and concerts?

Blood cancer patients who have been fully vaccinated against COVID-19 should continue to take preventive measures such as wearing masks, social distancing and handwashing. This is especially important since some blood cancer patients may not get optimal protection from the vaccines and may be more susceptible to COVID-19 infections after vaccination compared to the general public (see our statement on a recent UK study here).

I am a blood cancer patient who has been fully vaccinated. Does this mean I can stop wearing my mask?

While the CDC’s latest guidance says that fully vaccinated people can resume activities without wearing a mask or physically distancing (except where required by federal, state, local, tribal, or territorial laws, rules, and regulations), they note that if you have a condition or are taking medication that weakens your immune system, you should continue taking all precautions such as wearing a mask. LLS encourages you to talk to your healthcare team about the importance of remaining vigilant even after vaccination.

I am a blood cancer patient who is fully vaccinated against COVID-19. Can I resume travel?

While travel restrictions due to COVID-19 are slowly being lifted and the CDC updated its travel guidelines allowing fully vaccinated individuals to travel domestically, blood cancer patients should remain cautious about travel. While all of us are anxious to get back to normal, travel increases your chances of getting infected and spreading COVID-19. Before considering travel, if you are a cancer patient, survivor or caregiver, talk to your cancer care team about whether there are any additional precautions you should take. Always continue to take standard preventative measures: social distancing, wear a mask and wash your hand frequently.

Do I need a vaccine passport to travel or go to enter large venues?

Vaccine passports have been proposed as a way to make governments, citizens and travelers more comfortable with traveling and attending large-scale events. At this time, vaccine passports are not required for travel in the United States.

QUESTIONS ABOUT VACCINE AVAILABILITY AND ACCESS

What COVID-19 vaccines have been authorized or approved?

There are currently three vaccines authorized by the FDA in the US. to protect people against COVID-19. They are the Pfizer-BioNTech, Moderna, and Janssen (Johnson & Johnson) vaccines.

These vaccines mark an important step forward in the fight against COVID-19. Blood cancer patients are among those who are at increased risk of developing more severe illness from COVID-19. We encourage blood cancer patients and caregivers to discuss any questions about COVID-19 vaccination with their oncologist and healthcare team.

Who is eligible to get vaccinated?

The Pfizer-BioNTech vaccine is authorized for use in anyone 12 and older, while the Moderna and Johnson & Johnson vaccines are authorized for anyone 18 and older. Be sure to speak with your oncologist to discuss COVID-19 vaccination as early as possible to make an informed plan of action when a vaccine becomes available to you or your child.

Are there resources for immigrants who face barriers to getting vaccinated?

In response to concerns of access barriers some immigrants are facing regarding documentation requests prior to receiving COVID-19 vaccination and individuals inappropriately being sent bills for COVID-19 vaccine fees, Health Resources & Services Administration (HRSA) developed two fact sheets to help both patients and providers better understand their rights and responsibilities regarding, which are available in English and Spanish.

How can I get assistance signing up for my COVID-19 vaccination?

Once your doctor has recommended you receive the COVID-19 vaccine, it may still be difficult to find the vaccine available in your area. You can check with your local Public Health Department for availability and distribution locations in your area and how to make an appointment. The Centers for Disease Control (CDC) also has an online VaccineFinder “Where to go” resource.

How do I cope with pandemic fatigue while I wait for a vaccine?

If you’re experiencing feelings of anxiety, stress, fear, sadness and grief, know that you are not alone. Months of isolation and uncertainty can take a toll on anyone, and LLS is hearing from many patients and caregivers who are going through it right now. Taking care of yourself is one of the most important things you can do, and support is available to you. LLS has so many free resources to help you find the support that is right for you, including online chats, our social network LLS Community, a peer-to-peer support program, and so much more. LLS Information Specialists are here to help you and any blood cancer patients, survivors, caregivers, family members, and healthcare professionals at (800) 955-4572 or by live chat/email here.

Will COVID-19 vaccines become an annual vaccine like the flu?

Vaccine companies are already in the process of conducting clinical trials for booster shots. The decision about whether and when additional shots will be needed will ultimately be made by a team of independent scientists and the CDC. The CDC has confirmed that its Advisory Committee on Immunization Processes (ACIP), will meet and make a recommendation to CDC on booster shots, in the same way it has done with previously authorized COVID-19 vaccines after data from clinical trials is available. We will update this FAQ as we learn more.

What is LLS doing to help blood cancer patients gain access to COVID-19 vaccines?

LLS’s Office of Public Policy is doing its part by ensuring blood cancer patients’ interests are being heard by policymakers involved in the country’s vaccine rollout. A summary of our effort include the following:

White House

Only a national, comprehensive approach can address the range of challenges that have impeded access to COVID-19 vaccines. LLS – along with other partner organizations – is closely monitoring the Biden administration’s rollout process. We’ll communicate to the administration the strategies we believe will improve access to the vaccine, and we’ll update that guidance as the situation evolves. We’re also in touch with policymakers in state government.

Advisory Committee on Immunization Practices (ACIP)

Under ACIP’s guidelines, cancer patients are high-priority for vaccination, falling under the “Phase 1c” designation. States are encouraged, but not required, to follow ACIP’s recommendations. Back in January, we shared our views with ACIP. We applauded the committee for the high-priority designation it gave blood cancer patients. But we also reminded its members just how important it is for them to follow emerging data specific to the risk of COVID-19 to blood cancer patients. In addition, we urged ACIP to advise states on streamlining vaccine registration processes and keeping those processes from being overly burdensome for patients.

When will a vaccine be available for children under 12 years old? What about children with cancer?

Because children’s immune systems are different from those of adults, pediatric clinical trials are essential to establish safety and efficacy of COVID-19 vaccines among children. These trials are currently underway and health officials expect results later this year. While vaccines may not be available for all children until early 2022, some may be eligible sooner, including pre-teens, teens and those with high-risk conditions, it’s a good idea to begin discussing vaccination plans with your child’s oncologist. LLS continues to monitor for developments closely. We are keeping abreast of the ongoing studies, and advocating for the inclusion of cancer patients and survivors in clinical trials when it is safe to do so.

QUESTIONS ABOUT VACCINE EFFICACY AND SAFETY

Are COVID-19 vaccines safe for blood cancer patients?

All three vaccines were shown to be safe in clinical trials and more than 174 million Americans have received at least one vaccine dose so far. Blood cancer patients undergoing or having completed treatment, as well as survivors may be offered vaccination against COVID-19 if they have no other contraindications to these vaccines.

There is no reason to believe COVID vaccines will be any less safe in patients with blood cancer. LLS collected real world data from blood cancer patients and survivors through the LLS National Patient Registry. We found that the side effect profile of the currently authorized vaccines appears to be very similar in blood cancer patients and survivors compared to the general public. Most respondents received either the Pfizer (53%) or Moderna (44%) vaccine. Read more about the results here.

Data keeps coming in about how dangerous the virus is for cancer patients—particularly those with blood cancer, so vaccination will be very important. However,  clinical and its treatment can affect how well a patient’s immune system responds to vaccines. While some patients may experience decreased immune response to the vaccine, it may still provide some benefit and is important for reducing the risk or severity of COVID-19 to cancer patients. LLS encourages blood cancer patients to discuss COVID-19 vaccines with their oncologist and health care team.

Even after vaccination, cancer patients should continue to follow current guidance including wearing masks, social distancing and frequent hand washing to protect themselves from exposure to COVID-19. They should also encourage those around them to get vaccinated for their own protection and to reduce the risk of transmitting the virus to them.

Should I be concerned about the Janssen (Johnson & Johnson) COVID-19 vaccine following the recommended pause in the United States?

Following a thorough safety review, the FDA and CDC lifted the pause of the Janssen COVID-19 vaccine in the U.S. The FDA has determined that the available data show that the vaccine’s known and potential benefits outweigh its known and potential risks in individuals 18 years of age and older.

The pause was recommended after reports of six cases of a rare and severe type of blood clot thrombosis-thrombocytopenia syndrome (TTS) in individuals following administration of the Janssen COVID-19 vaccine. The brief pause was an example of the CDC’s extensive safety monitoring working—identifying even these small number of cases.

The FDA has added a warning to the vaccine’s label to note the potential risk of rare blood clots.

Are the COVID-19 vaccines effective for blood cancer patients?

While there is no reason to believe vaccine safety will be different in cancer patients, important questions remain about how well these vaccines induce immunity in patients with cancer, particularly those undergoing treatment. Most experts agree that the risks of COVID-19 outweigh any risks of vaccination and that any protection is better than no protection.

But It is important to know that some cancer patients may not develop a full immune response due to their cancer or cancer treatment. That’s why it’s important for cancer patients to continue to take other preventative measures like hand washing, wearing masks and social distancing, even after vaccination.

How is LLS helping the blood cancer community learn more about COVID vaccines?

The LLS National Patient Registry provides a unique opportunity for blood cancer patients (age 18 and older) to join LLS to increase scientific knowledge about how COVID-19 and COVID-19 vaccines affect them. Go to www.lls.org/registry to learn more. Please refer to the Frequently Asked Questions on the Registry website. For further support, call (855)-244-8493 or email LLSsupport@ciitizen.com.

If you are an existing participant in the Registry and have additional questions about your antibody tests, please visit our COVID Study FAQ page.

Our researchers are gathering data to improve our understanding of how people with different blood cancers respond to COVID-19 and the vaccines so that vaccination strategies and timing can be tailored to maximize their protection. We will be sharing findings from these research studies with patients and the medical community and have already shared preliminary safety data.

It is also critical to expand clinical trials and to collect data that includes patients with immunosuppression, including blood cancer patients undergoing treatment.

Should I be concerned about the AstraZeneca COVID-19 vaccine, since some countries in Europe temporarily suspended its use based on reports of blood clots?

The AstaZeneca vaccine has been authorized in more than 50 countries, including Canada. While it is not currently authorized in the United States, AstraZeneca is expected to seek authorization of the vaccine in the U.S.

Some countries in the EU temporarily suspending the use of the AstraZeneca COVID-19 vaccine as a precautionary measure based on reports of rare blood coagulation disorders in persons who had received the vaccine. Since March 2021, Germany, France and several other EU countries have lifted the suspensions on the AstraZeneca vaccine.

I have experienced severe allergic reactions to prior vaccines or injectable drugs. Can I still get the COVID-19 vaccine?

Currently, CDC considers a history of severe allergic reaction, such as anaphylaxis, to any vaccine or to any injectable therapy (e.g., intramuscular, intravenous, or subcutaneous) as a precaution, but not contraindication, to vaccination. However, severe allergic to any specific component of the Pfizer-BioNTech, Moderna or Johnson & Johnson COVID-19 vaccines is a contraindication to vaccination.

Some people receiving a COVID-19 vaccine have reported lymph nodes that are swollen on the underside of the arm where the vaccine was administered 2-4 days of receiving the vaccine. Lymph node swelling can be a common reaction, or side effect, to any vaccine and those who have reported swollen lymph nodes usually have them return to normal within four weeks. In most cases, no additional imaging tests are needed for swollen lymph nodes after recent vaccinations unless the swelling persists or there are other symptoms. Understandably, for cancer patients who have had lymph node enlargement as a sign of their cancer, any enlargement may be of concern. You should contact your health care team to determine how to follow up if you have post-vaccine lymph node enlargement.

LLS strongly encourages you to discuss any questions or concerns about the potential risks of vaccination with your healthcare provider.

How do these new vaccines work?

All vaccines have the same goal: to get the body to develop protective antibodies against a disease without us having to get sick. The Pfizer and Moderna vaccines both use a technology called messenger RNA (mRNA) to instruct cells in the body to build viral proteins. In this case, the cells learn how to make the so-called “spike protein” found on the surface of the COVID-19 virus. This is the first time this technology has been used for a vaccine. The Johnson & Johnson vaccine uses viral vector, which is a type of biological technology that has been used since the 1970’s. Similar to the mRNA vaccines, viral vector COVID-19 vaccines use genetic material to help train your immune system to recognize the spike protein found on the surface of the coronavirus and respond accordingly.

All three vaccines trigger an immune response, which produces antibodies, helping the body recognize and fight infection if exposed to the actual virus. The lightning speed at which the vaccines have become available is truly remarkable, but they are based on decades of rigorous and thoroughly reviewed research.

I read about a U.K. study which found that the Pfizer COVID-19 vaccine provides less protection in cancer patients after a single dose. Should I still get the vaccine as a blood cancer patient?

This study also showed that cancer patients had a much better immune response to the second vaccine dose. The U.K. is delaying the second dose, but the U.S. is following the recommended dosing intervals—21 days for the Pfizer-BioNTech vaccine and 28 days for the Moderna vaccine (the Johnson & Johnson vaccine is given as a single dose). But this study does demonstrate what many expected to be the case—some blood cancer patients will not be fully protected by vaccination.

However, blood cancer patients are at risk for more severe COVID-19 outcomes, including more prolonged periods of illness and higher death rates, so they must take every measure to protect their health. There is no indication that COVID-19 vaccines are any less safe in people with blood cancer. LLS encourages blood cancer patients to discuss COVID-19 vaccination with their doctor as early as possible. It’s also important to maintain recommended preventative measures like wearing a mask, social distancing, and handwashing, even after vaccination.

Full statement available here.

QUESTIONS ABOUT MONOCLONAL ANTIBODIES

What is a monoclonal antibody?

When you come in contact with an infection, including COVID-19, your body naturally makes antibodies to fight it. You may make a number of different types of antibodies to help fight off the infection.  Vaccines are designed to help you develop these same antibodies without the risk of getting sick from the actual infection. Monoclonal antibodies are a single type of antibody made in a laboratory either to fight the infection, or in the case of Rituximab, to fight malignant cells. They are administered to patients through an intravenous infusion. There are now single antibodies and antibody “cocktails” (combinations) which can be to given to patients for an immediate antibody boost against the virus that causes COVID-19.

Are there any approved monoclonal antibody treatments for COVID-19?

Currently, two monoclonal antibody (mAb) treatments—bamlanivimab and a combination of casirivimab and imdevimab—have been granted emergency use authorization by the FDA. These therapies can be administered to newly diagnosed COVID-19 patients (12 and older) who are at high risk for progressing to severe COVID-19. The treatment must be given within the first 10 days of symptom onset and patients must not have been hospitalized.

Who is eligible for monoclonal antibody treatments?

Monoclonal antibody (mAb) treatments can only be administered via intravenous infusions in specialized medical facilities. They currently can only be given to patients with a documented COVID-19 infection.  The FDA has authorized mAb treatment for mild-to-moderate COVID-19 in patients at “high risk of progression to severe disease.” The FDA define this as meeting at least one of the following criteria:

  • having a body mass index (BMI) equal to or greater than 35
  • having chronic kidney disease, diabetes, or a suppressed immune system
  • being older than 65 years
  • being older than 55 years and having cardiovascular disease, hypertension, chronic obstructive pulmonary disease, or another chronic respiratory disease
  • being aged 12–17 years and having a BMI equal to or greater than the 85th percentile for one’s age and sex, sickle cell disease, heart disease, a neurodevelopmental disorder, medical-related technological dependence, asthma, or another chronic respiratory disease requiring daily medication

Currently, there are no clinical trials involving cancer patients for preventative mAb treatment that are actively recruiting. We will update this page with more information if this changes.

QUESTIONS ABOUT COVID-19 AND ITS IMPACT ON BLOOD CANCER PATIENTS

Does COVID-19 produce different symptoms in cancer patients than in other people?

Overall, the symptoms of COVID-19 are the same in cancer patients as the general population. One exception might be patients who are taking steroids or other medications to treat leukemia or lymphoma. These treatments can suppress fevers. As a result, patients with COVID-19 who are taking these types of medications may not register a fever — or as high a fever — as others with the infection.

I am a patient with chronic lymphocytic leukemia (CLL) or multiple myeloma (MM) who has read about studies suggesting that mRNA-based vaccines may offer less protection for people with certain blood cancers. Should I be concerned?

LLS has heard from blood cancer patients and caregivers who are concerned about new research suggesting that mRNA-based vaccines may offer less protection for people with certain blood cancers. The findings from the new research confirm what LLS and other experts expected: that certain types of blood cancer and blood cancer treatments could affect how strong of an immune response a person gets from the vaccine.

LLS continues to recommend that all blood cancer patients and survivors talk to their healthcare team as soon as possible to make a plan for vaccination. People with blood cancers are at higher risk of serious outcomes from COVID, including death, so any vaccine protection is better than none. Read our full statement here.

How do I stay up to date on the latest developments about COVID-19?

Check this page often for the latest updates from LLS. You can also get answers to more frequently asked questions or learn more by visiting the pages of the Centers for Disease Control and Prevention (here) and by contacting your local Public Health Department. Additionally, The American Society of Hematology (ASH) has developed a series of frequently asked questions that are categorized by malignancy topic for patients with leukemia, lymphoma, multiple myeloma and myelodysplastic syndromes.

As you continue to navigate your care during these challenging times, LLS offers a wide array of free education and support that can help. LLS Information Specialists – highly trained oncology professionals – are here to provide one-on-one support at (800) 955-4572 or by live chat/email.

Does health insurance cover COVID-19 testing and care?

You may or may not have out-of-pocket costs if you get tested for COVID-19 or if you need medicines or other care to treat it. You’ll need to check with your health insurance company about coverage. Here are some tips and resources to get you started:

Call the toll-free number on the back of your insurance card

I’m seeing several studies about how COVID-19 affects blood cancer patients. What are some of the key updates and takeaways?

Every day, the medical and scientific communities are learning more about how COVID-19 impacts blood cancer patients. In fact, the 62nd American Society of Hematology Annual Meeting in December dedicated a number of sessions to this topic.

Some of the key takeaways include:

  • It’s essential for blood cancer patients and caregivers to continue following appropriate precautions to minimize exposure risk. More studies confirm that blood cancer patients, particularly those in active treatment, are at an increased risk of severe disease and death from COVID-19. What’s more, a patient’s ability to make protective antibodies to COVID-19 may be impacted by active treatment with lymphodepleting chemotherapy (including therapies that are not traditional chemotherapies).
  • Guidelines for COVID-19 isolation precautions may need to be revisited for immunocompromised patients. The length of viral shedding (how long you may remain infectious to others) in some cancer patients may be longer than other COVID-19 patients and this may require longer quarantine measures.
  • Stay in touch with your healthcare provider about COVID-19 symptoms. One study showed there may be a higher level of false negative COVID-19 testing by nasal swab among blood cancer patients, particularly those who are in active treatment. A false negative means that the test says the patient doesn’t have the virus when in fact they do. Because this study involved a small number of patients, more research is needed. The best advice right now is to talk with your healthcare provider if you have any symptoms that suggest COVID-19 infection, even if you have tested negative. Your provider can advise whether repeat testing or more sensitive testing should be considered.
  • It’s essential to increase scientific knowledge about how COVID-19 and COVID-19 vaccines affect cancer patients. The LLS National Patient Registry provides a unique opportunity for blood cancer patients to join LLS to increase scientific knowledge about how COVID-19 and COVID-19 vaccines affect them. Go to www.lls.org/registry to learn more.

I am a lymphoma or leukemia patient who has received the COVID-19 vaccine. Should I be tested for antibodies to determine the effectiveness of the vaccine?

Having antibodies to SARS-CoV-2, the virus that causes COVID-19 appears to offer some degree of protection from getting the virus and from having severe disease. For those patients who do not have antibodies or do not produce as robust an antibody response, we don’t yet know if you will be protected. There are other types of immunity which may provide protection. Immune cells known as T cells play a role in the ability of our immune system to protect us against COVID-19. This is one of the questions LLS is studying through the LLS National Patient Registry. After joining the Registry and consenting to share medical records, we are offering participants antibody testing before and after they get their COVID-19 vaccinations. We will be sharing findings from these blood draws with patients and the medical community.

QUESTIONS ABOUT COVID-19 & VACCINATION WHILE UNDERGOING BLOOD CANCER TREATMENT

I am a newly diagnosed blood cancer patient – should I get vaccinated for COVID-19 before treatment?

Since the situation for every person is different, we recommend discussing the risks and benefits of getting the COVID-19 vaccine with your oncologist. Generally, it is best to vaccinate before treatment as the immune response to the vaccine may be impaired in patients receiving chemotherapy.

I am a blood cancer patient undergoing active chemotherapy. Am I more prone to COVID-19 infection?

A study presented at the American Association for Cancer Research (AACR) COVID-19 and Cancer meeting showed no increased risk of getting COVID-19 among cancer patients on active chemotherapy treatment. With proper precautions in the clinical setting, disruptions in lifesaving cancer treatment should be minimized during the COVID-19 pandemic. We encourage you to discuss any questions regarding your cancer care with your oncologist and healthcare team.

I am a cancer patient who has received lymphocyte-depleting therapy (e.g. rituximab, blinatumomab, anti-thymocyte globulin, alemtuzumab, etc.). When should I get vaccinated?

According to COVID-19 vaccine interim guidelines from Memorial Sloan Kettering Cancer Center in New York City, for patients who have received lymphocyte-depleting therapy, it is reasonable to consider deferring vaccination until six months after completion of therapy or until there is evidence of lymphocyte reconstitution. We encourage you to discuss specific questions or concerns with your medical team as every patient’s experience is unique.

I am a lymphoma patient on rituximab (Rituxan) or obinutuzumab (Gazyva). Will the COVID-19 vaccine still be effective for me?

According to data presented at the American Association for Cancer Research (AACR) COVID-19 and Cancer meeting, CD-20 targeting agents such as rituximab and obinutuzumab were tied to severe COVID-19 in lymphoma patients. Patients with lymphoma may develop immune deficiency due to particular features of their disease or due to their treatment regimen, which can lead to increased incidence and increased severity of infections.

Certain lymphoma therapies, particularly rituximab and obinutuzumab may diminish the immune response to vaccines due to their effects on normal B cells. This observation has been noted in some patients with other vaccines.

However, since not many cancer patients were included in clinical trials of COVID-19 vaccines, we do not presently know if or how much treatment with rituximab or obinutuzumab would affect the efficacy of a vaccine.

I am a CLL patient who has tested positive for COVID-19. Should I continue treatment with BTK inhibitors (BTKis) including ibrutinib and acalabrutinib?

Recently published reports suggest a possible benefit from BTKis (ibrutinib and acalabrutinib) in people with severe COVID-19 infection. While controlled studies are needed to confirm those results, ASH’s current recommendation is to continue BTKis in patients with CLL diagnosed with COVID-19.

Should COVID-19 vaccines be administered to autologous HCT, allogeneic HCT, and CAR T cell recipients?

HCT or CAR T cell recipients are often immunosuppressed for months following treatment due to maintenance therapies and immunosuppressive drugs, among other factors. Based on current evidence, the available vaccines could be offered as early as three months following HCT or CAR T cell therapies, although efficacy may be reduced compared to results in general populations.

If you are a HCT or CAR T cell patient, please discuss any questions regarding vaccination with your oncologist and healthcare team.