Cancer experts offer guidance on COVID-19 vaccination for patients with blood cancer
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A collaborative team of cancer experts from leading academic institutions and organizations has released recommendations for optimal protection against COVID-19 among individuals with blood cancer.
The group, which included representatives of University of California, Los Angeles, Emory University, New York University, Stanford University, National Cancer Institute and The Leukemia & Lymphoma Society, published the recommendations in part as a reminder that individuals with blood cancer continue to face elevated risk for serious illness or death due to COVID-19, even if they are vaccinated.
A literature review of 24 series showed patients with hematologic malignancies have suboptimal responses to COVID-19 vaccination and boosters.
“The recommendations were made now because many [patients with blood cancer] take immunosuppressive drugs and are eligible for booster vaccination,” Lee Greenberger, PhD, chief scientific officer of The Leukemia and Lymphoma Society (LLS), said in an interview with Healio. “However, as described in our recently published paper, it is likely that approximately 50% of the patients with hematologic malignancies who did not make anti-spike antibodies to the initial vaccination will make antibodies after booster vaccination. We believe it is critically important for these [patients with blood cancer] to be aware that they still may be vulnerable to COVID-19 infections more so than the general population.”
Awareness and vigilance
In response to the elevated risk patients with blood cancer continue to face, the group of experts recommended the following:
- priority administration of additional vaccine doses to patients with blood cancer;
- ongoing compliance with masking and social-distancing protocols;
- frequent COVID testing, even among those vaccinated, and prompt treatment with monoclonal antibodies, convalescent plasma and antiviral therapies for infected individuals;
- vaccination of those in frequent proximity to individuals with blood cancer, including caregivers and household members aged 12 years and older;
- required COVID-19 vaccination for all health care system staff, and a call to provide staff with priority vaccine administration to maintain high levels of protection in this group; and
- increased awareness of the entire immune response to vaccination in patients with blood cancer, including a better understanding of the correlation between the level of antibodies after vaccination and possible breakthrough infections in such patients.
The recommendations state that patients with blood cancer should not be deterred by the pandemic from continuing their cancer treatments. However, because certain treatments may affect vaccine response, treatment may be postponed, if feasible, to allow for maximal vaccine response.
“Additional studies are in progress to understand the full immune response to vaccination in [patients with blood cancer], as well as examine if more breakthrough infections occur in these patients that could be associated with worse outcomes compared to the general population,” Greenberger said.
Not yet back to ‘normal’
Greenberger cautioned that the currently available vaccines may confer less protection against the delta variant than against the original strain of the virus.
“With the delta variant emerging and a large portion of the population still unvaccinated in pockets of the country, LLS urges [patients with blood cancer] to remain vigilant and to see their doctor immediately if they have been exposed to anyone with COVID,” he said.
According to Nikki Yuill, director of LLS’s Information Resource Center, patients with blood cancer cannot safely assume that the COVID-19 vaccine will fully protect them against the virus.
“When the vaccines first became available, many [patients with blood cancer] did believe they were fully protected,” Yuill told Healio. “As the data and information began to come in on [patients who were immunocompromised/had blood cancer], it became clear that these patients were not completely protected after the initial dose or after both doses. Patients were terribly disappointed to realize that despite having received the vaccine, their lives were not going to go back to ‘normal.’”
Greenberger said although the vaccine might not result in a return to normalcy, it remains the most effective approach for [patients with blood cancer].
“While there is evidence that protection against serious infections mediated by vaccination to the delta variant is decreased compared to the original strain of the virus, vaccination still offers the best strategy to avoid infections and serious complications,” Greenberger said. “Beyond that, vaccinations, including booster vaccination, are safe for [patients with blood cancer].”
For more information:
Lee Greenberger, PhD, can be reached at the LLS National Office, 3 International Drive, Suite 200, Rye Brook, NY 10573; email: lee.greenberger@lls.org.
Nikki Yuill can be reached at LLS National Office, 3 International Drive, Suite 200, Rye Brook, NY 10573; email: nikki.yuill@lls.org.
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