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COVID-19 VACCINES FAQ FOR PATIENTS AND CAREGIVERS

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Message from LLS Chief Medical Officer, Gwen Nichols

As you continue to navigate your cancer care during these challenging times, The Leukemia & Lymphoma Society (LLS) offers a wide array of free education and support that can help. LLS Information Specialists – highly trained oncology professionals – can be contacted here. 

This page is updated frequently based on guidance from the CDC and FDA. LLS cannot give medical advice and does not provide medical services. Patients and caregivers should address specific questions with their cancer care team.

Last updated September 19, 2022

FAQ topics include:

Downloadable Resources from LLS

LATEST UPDATES

Updated Moderna and Pfizer/BioNTech booster shots are recommended for everyone aged 12 and older (18 and older for the Moderna vaccine). The new bivalent boosters are formulated to provide broader protection against SARS-CoV-2 viruses, including the currently circulating Omicron subvariants and the original strain of the COVID-19 virus. Monovalent booster doses will remain available only for children younger than age 12, though CDC said it expects to recommend bivalent boosters for them in the coming weeks.

Bivalent booster vaccines may be administered to anyone 12+ who has completed a primary vaccination series, as long as two months has passed since their last dose. The booster may be given at the same time as annual flu shots. Either the Moderna or the Pfizer/BioNTech bivalent booster may be used after any primary vaccine series – Moderna, Pfizer/BioNTech, Novavax or J&J — and regardless of previous monovalent boosters given. 

The bivalent vaccines were updated and approved the same way as annual flu shots, meaning the foundation of the vaccine remains unchanged, only the target strains have been changed. Experts do not expect the safety profile to be different than earlier vaccines. 

The new booster vaccines are designed to broaden protection among the American public ahead of the winter when a surge of COVID-19 cases is expected. The U.S. is experiencing nearly 60,000 new infections and more than 350 COVID-related deaths every day and officials expect that infection rates will rise again as children return to the classroom and people spend more time indoors. 

LLS encourages blood cancer patients to continue getting COVID-19 vaccines as recommended to maintain and boost their protection. Because blood cancer patients, especially those with B-cell malignancies which are known to weaken the immune system, may have a suboptimal response to the new bivalent vaccines (as they did to the monovalent one), they should continue to take additional precautions even when fully vaccinated, including masking and avoiding crowded indoor spaces.

How is monkeypox spread and how can I protect myself?
Monkeypox spreads mainly through close, intimate contact with someone who has monkeypox. This includes direct contact with a monkeypox rash, scabs or bodily fluid, as well as prolonged face-to-face contact. This means it does not spread as easily as other viruses, like COVID, influenza and the common cold, but also that masking will not protect against it the way it does against COVID. 

CDC recommends three steps to prevent monkeypox

  1. Avoid close, skin-to-skin contact with people who have a rash that looks like monkeypox.
  2. Avoid contact with objects and materials that a person with monkeypox has used.
  3. Wash your hands often.

What are the symptoms of monkeypox?
Monkeypox symptoms include a rash and may include several other symptoms common of many illnesses, such as fever, chills, muscle aches, headache and swollen lymph nodes. Most people with monkeypox will get better on their own, but babies, children and people with weaker immune systems are at higher risk of more serious illness. Therefore, LLS recommends that people with blood cancer, especially those with weakened immune systems, should remain vigilant.

Who can get vaccinated against monkeypox?
If you have been in close physical contact with someone who has symptoms of monkeypox, contact your healthcare team right away. Vaccination can prevent the illness if it is given within 4 days of exposure to monkeypox. Vaccination given between 4 and 14 days after exposure may reduce symptoms of the disease, but not prevent it completely. 

In some situations, vaccine may be given to people who have had multiple sex partners within that past 14 days in areas where monkeypox transmission is occurring, even if a case has not been documented in one of their direct contacts. Per CDC, these recommendations are specific to “certain gay, bisexual and other men have sex with men.” Latest CDC recommendations hereUnless you are at risk as defined above or you have been exposed to the monkeypox virus, vaccination is not given as prophylaxis (general prevention) at this time.

What vaccines are available?
There are two vaccines that can protect against monkeypox (ACAM2000 and Jynneos). Jynneos is made using a virus that does not replicate efficiently in humans, making it a better choice for anyone with immunosuppression. If vaccination is indicated, blood cancer patients should receive Jynneos vaccine. 

Globally and in the U.S., the supply of Jynneos is currently limited, but it is expected to increase in the coming weeks. Federal health officials are shipping vaccine to states and local jurisdictions based on estimates of local populations needing vaccination. Patients seeking vaccine should check with their healthcare provider or their state or local public health department.
 

COVID-19 ILLNESS IN PEOPLE WITH BLOOD CANCER AND SURVIVORS

Overall, blood cancer patients are at risk of more severe COVID outcomes—including hospitalization and death, but the risk is not the same across all types of blood cancer. LLS recommends that blood cancer patients and survivors protect themselves by getting vaccinated and encouraging those around them to get vaccinated as well. They should also continue to take other preventive precautions such as wearing masks, social distancing, hand washing and avoiding crowds and poorly ventilated indoor spaces.

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 medical facilities, 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.

Taking CD-20 targeting agents such as rituximab and obinutuzumab has been tied to an increased risk of severe COVID-19 in lymphoma patients. Patients with lymphoma may develop immune deficiency due to their disease or due to treatment with these medications, which can lead to increased incidence and severity of infections.

COVID-19 VACCINATION FOR BLOOD CANCER PATIENTS AND SURVIVORS

Yes! COVID-19 vaccines are safe and offer protection to the majority of blood cancer patients and survivors. However, since not everyone will get full protection, LLS recommends that blood cancer patients and survivors get vaccinated plus layer on additional protections like wearing masks and social distancing. 

The risk of serious illness from COVID-19 is high for people with blood cancer, so unless you have a true medical contraindication for the vaccine, which is very rare, LLS encourages you to get vaccinated.

The FDA has severely limited use of the J&J COVID-19 vaccine because of an increased, but still rare risk of a blood clot syndrome that occurs in approximately 3 per million doses of the vaccine. Otherwise, the FDA and the CDC state no preferences among Pfizer-BioNtech, Moderna and Novavax COVID-19 vaccines for people with or without immunocompromising conditions. 

By “acting unvaccinated” we mean that in addition to getting vaccinated for COVID-19, blood cancer patients should continue to take preventive measures such as wearing masks, social distancing, hand washing and avoiding crowds and poorly ventilated indoor spaces. This is especially important since some blood cancer patients may not get optimal protection from the vaccines and may be more susceptible to breakthrough infection after vaccination compared to the general public. 

According to COVID-19 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 recovery of lymphocyte numbers and function. However, if there is any opportunity to be vaccinated BEFORE therapy starts, this should be done. We encourage you to discuss specific questions or concerns with your medical team as every patient’s experience is unique.

Certain lymphoma therapies, particularly rituximab and obinutuzumab, impair antibody response to vaccines even after discontinuation. This does not mean people being treated with these medications should not get vaccinated or that the vaccines will not offer them some protection. However, patients should consider themselves still at risk and remain vigilant even after vaccination. 

Revaccination may be an option for patients who received one or more doses of the COVID-19 vaccine while undergoing treatment with these therapies. The CDC recommends that revaccination should start about six months after completion of therapy. However, a patient’s clinical team is best positioned to determine a need for revaccination and appropriate timing of revaccination.

Published reports suggest a possible benefit from BTKis (ibrutinib and acalabrutinib) in people with severe COVID-19 infection. While more rigorous studies are needed to confirm those results, the American Society of Hematology’s (ASH) recommendation is to continue BTKis in patients with CLL diagnosed with COVID-19.

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, COVID-19 vaccines could be offered as early as three months following HCT or CAR T-cell therapies, although their effectiveness may be reduced compared to results in general populations.

It is very important to follow the vaccination schedule recommended by your healthcare team, and in the case of HCT, your transplant team. Transplant teams in particular are very knowledgeable about when and how to go ahead with re-immunization following transplant.

And even after vaccination, LLS recommends that you continue to follow additional safety precautions, like masking. 

QUESTIONS ABOUT VACCINE EFFECTIVENESS

COVID-19 vaccines offer at least some protection to the majority of blood cancer patients. The LLS National Patient Registry has shown, though, that immune response to vaccination varies based on a patient’s type of cancer and treatment received. That’s why LLS recommends that all blood cancer patients and survivors get vaccinated, act unvaccinated.

Yes. A study published by LLS showed that most blood cancer patients benefit from a third mRNA COVID-19 vaccine dose (Pfizer or Moderna) as part of the primary vaccine series. However, since some blood cancer patients will not mount a full antibody response even after a third dose, it is important to continue taking other precautions like wearing a mask and social distancing. A third primary dose is not recommended for people who receive the Novavax vaccine.

Yes. As of September 2, 2022, COVID-19 vaccination booster dosing has been simplified. The newly available bivalent booster vaccine is recommended once for everyone aged 12 years and older, regardless of their immune status. The bivalent booster should be given at least two months after completing the primary vaccine series or two months after the last booster dose. The original (monovalent) booster is available only for children younger than 12 years of age.

This LLS vaccine dosing chart helps people with blood cancer determine how many COVID-19 vaccine doses they need, and when.

On September 2, 2022, a new bivalent booster dose was recommended for everyone 12 years and older, regardless of immune status or which vaccine they received as their primary series. The bivalent booster adds Omicron-specific protection along with protection against the original COVID-19 strain. The most important thing everyone can do is to get all vaccine doses—including booster shots—as soon as they are eligible. COVID-19 vaccines have saved millions of lives around the world.

Some patients may have a diminished or even no antibody response due to their type of blood cancer or the type of treatment received. This does NOT mean that vaccination is futile. It is very important to continue receiving all COVID-19 vaccine doses as recommended.

Antibodies are just one piece of the puzzle and there are other ways our immune systems respond to vaccination that may provide protection. A study from The LLS National Patient Registry shows that some blood cancer patients without detectable antibodies after vaccination develop T-cells that are designed to attack the COVID-19 virus.

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.

Antibody testing does not need to be done unless recommended and prescribed by your healthcare provider. Antibody tests should be interpreted with caution. Having antibodies to SARS-CoV-2, the virus that causes COVID-19, appears to offer some degree of protection from getting sick and from having severe disease. However, having antibodies does not eliminate your risk of a COVID-19 breakthrough infection completely. 

All vaccines have the same goal: to get the body to develop protection against a disease without us having to get sick. The Pfizer and Moderna vaccines use messenger RNA (mRNA) to instruct cells in the body to make the so-called “spike protein” found on the surface of the COVID-19 virus. The Johnson & Johnson COVID-19 vaccine uses genetic material to help train your immune system to recognize and respond to the spike protein. The Novavax vaccine includes harmless fragments of COVID-19 to trigger an immune response. 

All four vaccines prepare your body to fight infection if you are exposed to the actual virus or to minimize its effects. The lightning speed at which the vaccines became available is truly remarkable, but they are built on decades of rigorous and thoroughly reviewed research.

VACCINE ELIGIBILITY, TIMING AND AUTHORIZATIONS

The Pfizer-BioNTech COVID-19 vaccine (Comirnaty) and the Moderna COVID-19 vaccine (Spikevax) are FDA approved.The Novavax vaccine is authorized for use by the FDA. The Johnson & Johnson vaccine is also authorized by the FDA, but it is no longer recommended.

As the primary vaccination series, the Pfizer-BioNTech and Moderna vaccine can be administered to individuals 6 months and older, while the Novavax vaccine can be administered to individuals 18 years and older. Pfizer-BioNTech bivalent booster is for anyone 12 and older and the Moderna bivalent booster is for anyone 18 and older. The Pfizer-BioNTech monovalent booster is available for children younger than 12 only.

The U.S. Food and Drug Administration has severely limited use of the J&J COVID-19 vaccine because of an increased, but still rare risk of a blood clot syndrome that occurs in approximately 3 per million doses of the vaccine. Officials have limited use of the J&J vaccine because there are other safer options. J&J may be given to adults 18 and older who either cannot or will not receive other types of vaccine and would otherwise go unvaccinated. Rare individuals who have received vaccines similar to J&J have developed the syndrome typically within 10-16 days after vaccination. Therefore, those patients who have received the J&J vaccine in the distant past are not believed to be at risk of developing this complication.

Most blood cancer patients and survivors should follow the COVID-19 vaccination schedule for people who are moderately to severely immunocompromised. This schedule includes an extra vaccine dose as part of the primary Pfizer-BioNTech or Moderna series

for people who are moderately to severely immunocompromised. This schedule includes an extra vaccine dose as part of the primary series. There is no extra primary dose for Novavax. Patients should talk to their healthcare team if they are unsure of their risk. You can also click here for a helpful tool from the CDC to find out when you can get your booster.

Because the immune system is very complex, there is no simple answer to who is moderately to severely immunocompromised. The National Institutes of Health COVID-19 guidelines include all blood cancer patients who are on active treatment in this category as well blood cancer patients who may have sub-optimal responses to COVID-19 vaccines regardless of their treatment status, such as those with chronic lymphocytic leukemia (CLL) and non-Hodgkin lymphoma.
 
The immune system is also compromised in anyone who has had a stem cell transplant or who takes medicine to suppress their immune system. Blood cancer treatments that suppress the immune system include: Bruton tyrosine kinase (BTK) inhibitors (e.g., Imbruvica, Calquence, Brukinsa), anti-CD20 antibody treatments (e.g., Rituxan) and certain CAR T-cell treatments (Breyanzi, Kymriah, Tecartus, Yescarta).

LLS strongly encourages all blood cancer patients, regardless of where they are in their treatment, remission or recovery (or “watch and wait” period, which is common for CLL patients), to talk with their blood cancer treatment team about the status of their immune system and whether additional vaccine doses and the preventive monoclonal antibody Evusheld are right for them.
 
Anyone with a compromised immune system should also continue masking and social distancing even after vaccination. 
 

If you received either Pfizer-BioNTech or Moderna vaccines, the same brand is preferred for all three primary series doses. If the same vaccine product is not available or is unknown, either mRNA COVID-19 vaccine (Pfizer-BioNTech, Moderna) may be administered. If you received the Johnson & Johnson vaccine, all additional doses should be with either Pfizer or Moderna vaccines. If you receive Novavax vaccine, you should receive two doses of the same product. Booster doses may be mixed and matched as long as all age and minimum dosing intervals rules are followed.

Immunocompromised individuals who received the Johnson & Johnson COVID-19 vaccine should receive either Moderna or Pfizer-BioNTech for all additional doses. They need an additional vaccine dose at least 28 days later, and for those 12 and older, a bivalent booster dose at least two months after that. Children younger than 12 may continue to receive the older (monovalent) booster dose.

Yes, you should continue to get COVID-19 vaccines as recommended even if you had COVID. People who were recently infected with COVID-19 can wait 3 months before getting their bivalent booster vaccine, compared to the standard recommendation of "at least 2 months for others."  This is because the natural antibody response to COVID should provide protection for several months. After that, a booster dose can increase protection again. It is best to talk to your own healthcare team to decide the best timing for you.

Yes. Any COVID-19 vaccine, including the new bivalent booster, can be given with other vaccines without regard to timing, but it’s always best to check with your healthcare provider. This includes giving vaccines like flu and COVID-19 on the same day, as long as the shots are given in different limbs, or if in the same limb, at least 1 inch or more apart.

These are extremely important questions. Since the situation for every person is different, we recommend discussing the timing of your COVID-19 vaccination with your healthcare team. Generally, it is best to vaccinate before treatment as the immune response to the vaccine may be impaired in patients receiving cancer treatments that affect the immune system. 

However, if you are already undergoing treatment that does not mean you should forego vaccination. Even if your immune system does not respond fully to vaccination, some protection is better than none, especially for a disease as serious as COVID-19, which tends to strike cancer patients harder. For this reason, it is advisable for patients with blood cancer to encourage family, friends and others they come in close contact with to get vaccinated too. 

VACCINE SIDE EFFECTS AND SAFETY

More than 600 million COVID-19 vaccine doses have been administered in the United States including to more than 29 million children.

LLS collected real world data from blood cancer patients and survivors through the LLS National Patient Registry. We found that the vaccine side effect profile is very similar in blood cancer patients and survivors compared to the general public. Read more about the results here.

The U.S. FDA has severely limited use of the J&J COVID-19 vaccine because of an increased, but still rare risk of a blood clot syndrome that occurs in approximately 3 per every million doses of the vaccine administered. Clinicals trials showed an increased risk of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of the tissue surrounding the heart) following administration of Novavax COVID-19 vaccine, but these events were exceptionally rare and there was insufficient evidence to conclude that the vaccine caused them. 

Severe allergy to specific components of any COVID-19 vaccines are rare, but is a contraindication to vaccination. Please discuss your specific risk with your healthcare provider. 

Some people receiving a COVID-19 vaccine have reported swollen lymph nodes on the underside of the arm where the vaccine was administered 2-4 days after 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.

STAYING SAFE AFTER VACCINATION 

Even when fully vaccinated against COVID-19, CDC and LLS recommend that blood cancer patients and survivors should continue wearing a mask and taking other precautions to avoid infection. This is especially important since some blood cancer patients may not get optimal protection from the vaccines and may be more susceptible to infection and severe outcomes of COVID-19 after vaccination compared to the general public.

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, talk to your cancer care team about whether there are any additional precautions you should take. Always continue to social distance, wear a mask, wash your hand frequently, and avoid crowds and poorly ventilated indoor spaces.

While vaccines offer at least some protection to most blood cancer patients, some patients may not get optimal protection from the vaccines and will be more susceptible to infection and severe outcomes of COVID-19 after vaccination compared to the general public. LLS encourages everyone to respect and protect blood cancer patients and others with weakened immune systems that put them at increased risk from COVID.19. 


Vaccination for everyone, including friends and family is important. By getting vaccinated, those with normal immunity can reduce the risk that they transmit COVID-19 to those whose immunity is impaired.

TREATMENT AND PREVENTION OF COVID-19

The National Institutes of Health COVID-19 expert panel recommends prompt treatment with antivirals or monoclonal antibodies for non-hospitalized patients with mild to moderate COVID-19 who are immunocompromised.

The FDA has approved or authorized several treatments for patients with COVID, and many are specially approved for patients who are increased risk of serious outcomes of the infection, such as blood cancer patients and survivors. These include monoclonal antibodies and antiviral medications. To be effective, these treatments must be started as quickly as possible after a positive COVID-19 test or the onset of symptoms. There is also an infusion called high titer convalescent plasma that may be helpful in certain patients. 

In addition to these treatment options, there is also one monoclonal antibody, called Evusheld, that can help prevent COVID-19 infection in people who either cannot be vaccinated or who are not expected to mount an adequate immune response to vaccination.

Yes, you will need a prescription to receive any COVID-19 treatment or prevention. Physicians, advanced practice registered nurses and physician assistants may prescribe these medications as authorized under individual state laws. You do not need a prescription to receive vaccines.

LLS has heard from patients who are having difficulty accessing treatment and prevention because of uneven supply across the country. Federal officials distribute Evusheld, as well as monoclonal and antiviral treatments, to states according to their population. State officials then distribute that supply. 
Patients can contact their local healthcare team or health department to inquire about availability in their area. In addition, this HHS locator can help patients find all COVID-19 therapeutics, while this locator is specifically designed to help locate doses of Evusheld.

Because availability can change quickly, LLS cannot guarantee the timeliness of the information in these external resources.

COVID-19 antivirals work by disrupting the replication of the virus inside the body. This lowers the amount of virus in the body (also called the viral load), which can help reduce the severity of COVID-19 symptoms and shorten the length of the illness. To be effective, antiviral medicines generally need to be taken very soon after a positive COVID-19 test or the onset of symptoms.

There are three antiviral medicines available to treat COVID-19 in people who are at high risk of progression to severe infection and outcomes, such as blood cancer patients. Paxlovid (ritonavir-boosted nirmatrelvir, for people 12 and older) and Lagevrio (molnupiravir, for people 18 and older) are oral medicines for use only in non-hospitalized patients; both are taken for five days. Veklury (remdesivir), which can be used in adults and pediatric patients as young as 28 days of age, is given by IV or injection at a healthcare facility for three days. 

In clinical trials, a small percentage of patients (1-2%) rebounded—meaning their COVID-19 returned a few days after they appeared to be better—whether or not they were treated with Paxlovid. Public health officials are tracking data from across the country to determine if rebound is more likely, or any different, in patients who have been treated with Paxlovid. As of May 24, CDC reported no serious disease in patients who have rebounded after treatment with Paxlovid.

Paxlovid is one of the most effective treatments available for people with mild-to-moderate COVID; it is almost 90% effective at preventing hospitalization. 
 

Immunosuppressed patients should speak with their oncology healthcare team about whether getting a repeat PCR test to be sure they have cleared the virus is warranted. If the virus is not cleared after Paxlovid or monoclonal antibody treatment, additional treatment such as convalescent plasma may need to be prescribed. 

When you come in contact with an infection, including COVID-19, your body naturally makes antibodies to help fight off the infection. Vaccines are designed to help you develop these antibodies before you come in contact with COVID-19 and get sick. Monoclonal antibodies are made in a laboratory and can be given as an infusion to add another layer of defense against COVID-19. Because these are “ready-made” antibodies, they can generally begin working in your body right away, while vaccines take time to work. However, they are not as long-lasting as the antibodies your body makes itself after vaccination.

Several monoclonal antibodies have been authorized by the FDA to treat mild to moderate COVID-19 in non-hospitalized patients who are high risk of progressing to severe disease, such as blood cancer patients and survivors, and others with weakened immune systems. However, recommendations for their use may change depending on their activity against currently circulating variants. LLS has developed this Monoclonal Antibody Therapy table with the latest information.

Monoclonal antibody treatments work best when given as soon after exposure or the onset of symptoms as possible. If you believe you have been exposed or if you have symptoms of COVID-19, you should contact your healthcare team as soon as possible

Yes, an antibody treatment called Evusheld is authorized for prevention of COVID-19 in certain adults and children ages 12 years or older. This antibody is not to be used in people who were recently exposed to the COVID-19 virus or who have tested positive. It is given as two injections, one immediately after the other and should be repeated every six months. LLS has developed this Monoclonal Antibody Therapy table with the latest information about available therapies.

Antibody treatments are not a substitute for COVID-19 vaccination. Vaccines are the best defense against COVID-19 for most people, including blood cancer patients. However, Evusheld is an important new option for blood cancer patients who do not mount an adequate immune response to vaccination either because of their cancer type or its treatment (immune suppressing agents, like BTK inhibitors, anti-CD20 antibody treatments, certain CAR T-cell treatments). These patents should discuss this treatment with their healthcare team.

Monoclonal antibody treatments are administered via intravenous infusion or injection in specialized medical facilities. They work best when given as soon after exposure or the onset of symptoms as possible, so blood cancer patients and survivors should not delay in seeking care.

No. Anti-CD20 treatments such as rituximab are not expected to reduce the effectiveness of Evusheld. Rituximab, and other drugs like it, affect the immune system’s ability to generate its own antibodies, but will not affect the antibodies that a patient gets from an Evusheld infusion. 

Protection starts quickly; likely within one hour of the injection. However, as with vaccines, breakthrough infection is possible. So even after receiving Evusheld, blood cancer patients should continue taking additional precautions like masking and social distancing for another layer of protection.

Medically, it does not matter where Evusheld is administered. However, while the drug itself is free, some sites will be charging an "administration fee." Please check with your healthcare provider and the administration site about any costs associated with receiving your additional dose.

Having an antibody test after receiving Evusheld is unlikely to provide any useful information. Since Evusheld is a direct infusion of antibodies, everyone who receives it would be expected to have detectable antibody levels, with antibodies expected to last about six months. 

What is important to know is that while Evusheld has been shown to be effective in reducing the risk of COVID-19 and its severe outcomes, breakthrough infection is possible. In a large clinical trial in immunocompromised people that was completed before the omicron variant began circulating, Evusheld reduced the risk of having symptomatic COVID-19 by 77%, and none of the breakthrough cases were severe. Evusheld appears to maintain its activity against Omicron variants, but likely is less effective against them than earlier strains that were circulating during the clinical trial.

The maker of Evusheld and others are working to develop newer antibody treatments to provide better protection against the evolving COVID-19 strains. There is not clear timing yet for when they will be available.

Monoclonal antibodies are only effective for a few months and provide only one type of protection (antibodies). Vaccines, and boosters in particular, may stimulate antibodies, which are made by B cells, and T cell immune responses.

It is unlikely Evusheld and vaccines would interact in any way and make vaccine side effects worse. However, the FDA and the manufacturer are monitoring safety data closely. When possible, blood cancer patients should get vaccinated first. There is a waiting period of two weeks after vaccination before getting Evusheld.

You should wait to receive Evusheld for at least two weeks after any COVID-19 vaccine dose (primary, bivalent booster or monovalent booster). There is no waiting period in the other direction—COVID-19 vaccines, including the new bivalent booster, may be administered at any time after Evusheld administration as long as age and minimum dosing intervals between vaccine doses are followed. The guidelines are the same regardless of whether you are received your first or second Evusheld dose.

LLS has been advocating on behalf of patients to ensure that policymakers at every level of the federal and state governments understand the unique challenges blood cancer patients face. LLS is urging the Administration and other regulatory bodies across public and private sectors to increase procurement and distribution of all monoclonal antibodies to help prevent COVID-19 infection and its worst outcomes in people with moderately to severely compromised immune systems, including blood cancer patients and survivors.

High titer COVID-19 convalescent plasma (CCP) is collected from blood donors who have recovered from COVID-19 infection. Plasma from donors who have not only recovered from COVID, but who also are vaccinated, has extremely high levels of antibodies that so far have been shown to neutralize all known COVID variants. CCP use is recommended for immunocompromised patients by several medical societies, including the Infectious Disease Society of America. CCP evolves with the virus because recently collected plasma contains antibodies to recently circulating viruses.

Treatment with high titer convalescent plasma is an effective option in situations where other therapies are either not available or no longer effective or cannot be used due to drug interactions. For example, several recent studies have shown the effectiveness of high-titer plasma in treating immunosuppressed patients, including blood cancer patients, who have had breakthrough infection despite vaccination, and in whom monoclonal antibody and antiviral treatment have not been effective in clearing the virus.

Immunosuppressed patients who have received appropriate treatments, but who continue to have COVID-19 symptoms and prolonged positive test results (measured by PCR-based viral testing not home test kits) may benefit from high titer convalescent plasma. Immunosuppressed patients may have breakthrough infection despite appropriate treatment, and this can lead to illness in the affected patient and continued risk of spreading the virus to others. Prolonged infection may also give the virus an opportunity to create variants that can then spread to others.

Talk to your healthcare team if you believe high-titer convalescent plasma is right for you. The U.S. FDA has authorized its use for the treatment of COVID-19 in patients with immunosuppression due to disease or receiving immunosuppressive treatment, either in the outpatient or inpatient setting. 

COVID-19 convalescent plasma needs to be ordered by a healthcare professional from a blood bank. If high-titer convalescent plasms is not available locally, your healthcare provider may be able to work with the local blood center to obtain it through the Blood Center of America (for more information http://bca.coop/products-services/ccp or via email: covidplasma.bca.coop).
 

LLS COVID-19 PROGRAMS, RESOURCES AND RESEARCH

The LLS National Patient Registry, research developed and led by LLS, provides a unique opportunity for blood cancer patients ages 18 and older to join LLS to increase scientific knowledge about how COVID-19 and COVID-19 vaccines affect them. Read more registry study results and ongoing research here

Go to www.lls.org/registry to learn more about joining the registry. For further support, call (844) 696-7228 or email PACT@LLS.org If you are an existing participant in the Registry and have additional questions about your antibody tests, please visit our COVID Study FAQ page.

LLS is investing in the work of world-class researchers across the globe to provide answers about how COVID-19 and COVID-19 vaccines impact blood cancer patients. For example, LLS-funded researchers are looking at how the course of COVID illness differs in immunocompromised blood cancer patients and whether they would benefit from targeted prevention and treatment options compared to those with normal immune systems. 

Because blood cancer patients were not included in the clinical studies leading to authorization of COVID-19 vaccines, LLS is focused on funding research to understand how vaccines work in people with all types of blood cancer. LLS is helping to answer questions such as: Do blood cancer patients need more vaccine doses than the general public? Should they get their vaccines on a more compressed schedule? How does antibody response and activation of disease-fighting T-cells differ in people with different types of cancer after vaccination? You can read about current LLS grants for COVID-19 and other research topics here.
 

LLS 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 efforts include the following:

White House
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.

Vaccine Requirements
Some blood cancer patients won’t produce COVID-19 antibodies even after receiving all COVID-19 vaccine doses, making it particularly important for those around them to be vaccinated. Public health measures like vaccine requirements play an important role in reducing the risk of COVID-19 to cancer patients, cancer survivors, and other immunocompromised people. LLS supports proven public health strategies like vaccine requirements, and it opposes policies that undermine vaccine requirements.

In response to concerns about 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, which are available in English and Spanish.

You can check with your local Public Health Department for availability and distribution locations in your area and how to make an appointment. The CDC also has an online VaccineFinder “Where to go” resource.

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:

For more information, check out our COVID-19 Resource Page