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 when they will be available to them.
While it’s been an incredibly trying time, there is optimism ahead
as the supply of vaccinations and rate of vaccination will continue to
increase. As of February 28, 2021, three COVID-19 vaccines have been authorized
by the U.S. Food & Drug Administration. While we may not have all the
answers at this time, LLS Chief Medical Officer, Gwen Nichols, MD, is
addressing a few FAQs from blood cancer patients and caregivers based on what
we know right now. We encourage blood cancer 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.
It’s also critical for blood cancer patients and their caregivers
to continue taking precautions such as wearing a mask, maintaining
social distancing, and washing your hands frequently. Data continues to show
that 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 and when it will be available to you. 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.
Important Update: 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.
Last updated 3/25/2021
QUESTIONS ABOUT VACCINE AVAILABILITY AND ACCESS
What COVID-19 vaccines have been authorized or approved?
On Dec. 11, 2020, the FDA granted emergency use
authorization (EUA) to a vaccine from Pfizer-BioNTech – the first COVID-19
vaccine authorized in the U.S. One week later, on Dec. 18, 2020 the FDA granted
EUA to a vaccine from Moderna. Both vaccines were more than 90% effective in preventing
illness from COVID-19 among clinical trial participants. Both are given in two
doses 3- to 4-weeks apart. On Feb. 28, 2021, the FDA authorized a vaccine from
Johnson & Johnson. This is given as a single dose. Public health experts
like Dr. Anthony Fauci are encouraging everyone to take whichever vaccine is
available to them because all are highly effective at preventing severe
disease, hospitalization and death from COVID-19.
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 COVID-19 vaccination with their oncologist
and healthcare team as early as possible so they can make an informed plan of
action.
Who is eligible to get vaccinated?
The Pfizer-BioNTech vaccine is authorized for use in anyone 16 and
older, while the Moderna and Johnson & Johnson vaccines are authorized for
people 18 and older. The U.S. Centers for Disease Control and Prevention (CDC)
provided recommendations on who should get vaccinated with
limited vaccine supplies.
Ultimately, states and local governments have the final say over
who is eligible to get vaccinated and many are expanding eligibility regularly.
Be sure to speak with your oncologist to discuss COVID-19 vaccination as early
as possible so they can make an informed plan of action when a vaccine becomes
available to you.
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. This resource is being updated
regularly.
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?
Studies are still ongoing about the durability of responses to the
vaccines, so we don't have the answer yet. In the next six months or so, we’ll
begin to see one-year data from those who started the early-phase studies to
see how long their antibodies have lasted.
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? 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 we don’t
know when trials will begin that include children with cancer, 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
Will COVID-19 vaccines be safe for blood cancer patients?
All three vaccines were shown to be safe in clinical trials and
more than 85 million Americans have received at least one
vaccine dose so far. At this time, patients undergoing cancer treatment 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.
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,
COVID-19 vaccine clinical trials have not included many cancer patients. Cancer
treatment can affect how well a patient’s immune system responds to
vaccines. While some immunocompromised 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 your
oncologist and healthcare 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.
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 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. 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. LLS is committed to sharing results with
the medical and patient communities as soon as possible.
It is also critical to expand clinical trials and to collect data
that includes patients with immunosuppression, including blood cancer
patients undergoing treatment. If you are interested in participating in a
clinical trial studying COVID vaccine response in blood cancer patients, you
can reach out to our Clinical Trial Support Center.
Should I be concerned about the AstraZeneca COVID-19 vaccine,
since some countries in Europe have 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 on an emergency
basis in the U.S.
At this time, the World Health Organization (WHO), considers the benefits
of the vaccine outweigh the risk of side effects. This report comes in response
to 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. We will be
keeping up to date on information as it is available and update this blog when
we know more.
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 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).
mRNA vaccines use a snippet of the virus’s genetic code 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 a technology that comes out of decades of research and
that the company has used in other approved and investigational vaccines.
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 science is progressing is truly
remarkable.
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 COVID-19 AND ITS IMPACT ON BLOOD CANCER PATIENTS
I am a blood cancer patient who has been fully vaccinated against
COVID-19. Can I resume “normal” activities and in what capacity?
Blood cancer patients who have been fully vaccinated against
COVID-19 should continue to take preventive measures and discuss recommended
precautions with their oncologist or other healthcare providers. 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 recent UK study here). Until we can get the data necessary to determine
which patients fall into this category, all blood cancer patients should
continue wearing masks, social distancing, and handwashing.
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 the development of 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.
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
·
Read
about Medicare coverage of coronavirus-related needs
·
See Medicaid’s frequently asked questions about COVID-19
·
Learn about coronavirus and your Marketplace health plan coverage
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.
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 speaking, 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 recent 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, 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.
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