Covid vaccine and blood cancer

Our research spans:

• 11 collaboratively funded studies
• 3 international studies
• a meta-analysis that pulls together findings across all the individual studies
• Q-Covid, which is analysing covid outcomes in people with blood cancer using GP records
• National Cancer Covid Antibody Survey, which is analysing the antibody status of people with blood cancer who’ve had the vaccine or a covid infection
• MELODY study, which is analysing covid vaccine response in people who are immunosuppressed.

A large review of 250 other studies conducted since the vaccines first became available has summarised the main factors that can affect vaccine efficacy in people with cancer.

For people with blood cancer, these factors increase the risk of having a reduced antibody response after vaccination:

• Lymphoproliferative blood cancers (especially non-Hodgkin lymphoma) as opposed to myeloid blood cancers
• Having active disease
• Being older
• Being male
• Having reduced immunoglobulin or lymphocyte levels
• For people with plasma cell disorders (like myeloma), having had more than four lines of therapy.

For people who’ve had a donor stem cell transplant, these factors increase the risk of having a reduced antibody response after vaccination:

• Being older
• Active GvHD (graft-versus-host-disease).
• Having reduced lymphocyte levels.

For people who’ve had recent cancer treatment (not just blood cancer) the below factors increased the risk of having a reduced antibody response after vaccination, to different extents depending on the treatment.

Reduced antibody response likely (in more than 50% of patients, mostly in patients currently having treatment):

• Monoclonal antibodies (eg anti-CD20), BTK inhibitors or BCL inhibitors
• BCMA-targeted therapies
• CD38-targeted therapies
• JAK inhibitors.

Reduced antibody response possible (in less than 50% of patients, probably dependent on dosing):

• Chemotherapy
• Steroids
• CDK4/6 inhibitors that are associated with lower binding antibody levels
• PARP inhibitors that are associated with lower binding antibody levels.

Reduced antibody response uncommon (in less than 50% of patients, probably dependent on dosing):

• TKIs
• Immune checkpoint inhibitors
• Immunomodulatory drugs
• Hormone (endocrine) therapy
• Proteasome inhibitors.

Stem cell transplants and CAR-T therapy

• CAR-T therapy causes a reduced immune response to vaccination, but how long this effect lasts after treatment is unknown
• Stem cell transplants with stable engraftment don’t seem to cause long-term problems with mounting an antibody response to vaccination. Soon after the transplant, antibody responses to vaccination are reduced, but after 6-12 months the response matches that seen in healthy people of the same age.

Latest results from the UK’s COV-BOOST trial found that having a fourth dose of an mRNA covid vaccine provides a stronger level of protection than a third dose, particularly in the over-70s.

COV-BOOST is a multi-centre, randomised and controlled trial carried out at 18 sites across the UK to measure response to the covid vaccines.

The trial showed that a fourth dose (second booster) with an mRNA vaccine (Moderna or Pfizer) generates a strong antibody and T cell response.

The latest COV-BOOST findings are published in the Lancet Infectious Diseases journal where the authors state “peak responses after the fourth dose were similar to, and possibly better than, peak responses after the third dose … Our results for immunogenicity are also consistent with the little observational evidence on vaccine effectiveness available from Israel, which indicates increased protection against symptomatic infection and severe illness from a fourth-dose booster.”

A study called CAPTURE, run by the Francis Crick Institute in London, has recently published data looking at how well people with blood cancer are able to destroy the Omicron covid variant. For people with blood cancer, if they’d had two doses of the covid vaccine, only 19% could neutralise Omicron, but in those who'd had a third dose of the vaccine, this increased to 56%. This clearly shows the benefit of having a third vaccine dose. It is hoped that a fourth booster dose could increase this proportion even further.

Those who had anti-CD20 treatment in the previous 12 months were unlikely to have antibodies against Omicron, although this was only based on data from 10 people. Those who had active disease were also less likely to develop antibodies than those who were in remission from their disease.

The team also looked at four people who developed covid after two vaccine doses. None of these people had antibodies against Omicron or Delta before infection, but their symptoms of covid were mild, suggesting there are other factors beyond just antibodies that help people fight infection (which could include T cells). After covid infection, all of these people had protective antibodies against Omicron.

This study doesn't tell us how effectiveness varies between different types of blood cancer. The study also didn't look at T cells in addition to antibodies, which could play an important role in protecting against infection. The study only included 84 people with blood cancer, so this is still a small study.

A study in the US has looked at the effectiveness of booster vaccines in 49 people with blood cancers that affect their B cells.

Findings

The study compared the levels of antibodies in the blood 27 days before and 28 days after a booster vaccination. 38 out of the 49 people taking part (around 78%) had no antibodies after their first two vaccinations. After the booster dose, over half (55%) of these people developed an antibody response, having had none before.

The team also found that people having anti-CD20 treatment (such as rituximab) were less likely to develop an antibody response after a booster vaccination, particularly if they'd had this treatment in the last 6 months. Having BTKi treatment (such as ibrutinib) also affected antibody response.

While this data can give you some idea of how likely people are to develop antibodies after vaccination, it's very hard to really know your personal response to the vaccine, or your personal level of risk if you do catch covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

Who took part in the study?

The study included 25 people with CLL, 18 with Hodgkin lymphoma, 7 with Waldenström macroglobulinaemia, 4 with myeloma, one with CLL and marginal zone lymphoma, and one with Epstein-Barr virus-associated lymphoproliferative disease. The age of the participants ranged from 31 to 80 years old, with an average age of 66. 91% of participants (more than nine out of ten) were Caucasian. Everyone who took part had previously received two doses of the Pfizer-BioNTech or Moderna vaccine, except one who had received the Janssen vaccine.

What do the results mean?

The results suggest that even if people with blood cancer do not develop antibodies to the first two vaccine doses, an additional dose can improve their vaccine response.

What we don't know

• The results look promising, but the number of people involved in this study is small, so research studies involving a larger and more diverse population are needed to confirm the team's conclusions.
• More research is needed into the effects of specific blood cancer treatments on vaccine efficacy. This could help us learn if the timing of vaccination could be significant for people on treatment for blood cancer.
• The study only looked at antibody responses. It did not look at other measures such as T cell responses.

A study called OCTAVE DUO is looking at how effective a third dose of the vaccine might be for people with suppressed immune systems.

OCTAVE DUO is co-funded by the government’s Vaccines Taskforce and UK Research and Innovation (UKRI). We've worked hard to make sure people with blood cancer were included in this trial, and we are happy to report that the trial has been underway since July 2021.

What is the OCTAVE DUO study trying to find out?

The OCTAVE DUO study is looking at whether, in a group of people with a range of immunosuppressive diseases (including blood cancer), a third vaccine dose will increase the immune response (antibody and T cell) in people with no or low antibodies after two prior vaccine doses. It will also investigate how long the immune response lasts by following whether any participants are later diagnosed with covid.

When will we get the results and what could they mean?

Recruitment to this study is ongoing and we are yet to see results published, but when they are, this will be one of the larger studies looking at vaccine effectiveness in people with suppressed immune systems, including over 1,000 people who are immunosuppressed with different conditions including blood cancer.

Results from this trial could help us give more personalised advice to people with blood cancer, as we could learn which blood cancer patients get a good level of protection after three doses, and which don't. Find out more about how research in this area has progressed and what Blood Cancer UK have been working on.

Who is included in the study, and can I take part?

Recruitment for OCTAVE-DUO is closed. Up to 1,200 patients have been recruited to the study via other trials already running and hospitals that were already involved. The reason for this approach is that it was much quicker to get the trial up and running and therefore quicker to get results.

Patients included had conditions such as arthritis, vasculitis, inflammatory bowel disease, kidney disease, solid tumour cancers, blood cancers, or had a stem cell transplant in the past.

For blood cancers, OCTAVE DUO includes people with aggressive non-Hodgkin lymphoma, indolent non-Hodgkin lymphoma, chronic lymphocytic leukaemia, Hodgkin Lymphoma, myeloma, and people who've had a stem cell transplant or CAR-T therapy in the past.

This study is looking at people with lymphoid blood cancers, rather than myeloid blood cancers. The reason for this is that the study is looking at people with low or no antibodies after their two covid vaccine doses, and most people with low or no antibodies after vaccination are people with lymphoid blood cancers. Looking at the third dose in lymphoid blood cancer patients is therefore the best way to measure its effectiveness in blood cancer patients with immunosuppression.

People with myeloid blood cancers are more likely to have antibodies after vaccination. Blood Cancer UK still hope to capture data on how well a third vaccine works in people with myeloid blood cancers through other studies we are funding, and we will update our information when we know more. Further down this page we cover other studies in myeloid blood cancers.

Why test a third dose in people with blood cancer, if the first two haven’t worked?

Studies done specifically in people with blood cancer (explained further down this page) have continued to show that while many people with blood cancer have not had a good antibody response to the covid vaccine, there is a jump in immunity from first dose to second dose, and the second dose is important in increasing the antibody response to the vaccine for people with blood cancer. More recent studies also covered on this page have shown that the third vaccine dose raises immunity for people with blood cancer even further.

How will OCTAVE DUO affect the government’s decisions?

The government has already announced that people who are immunosuppressed should get a third primary dose and a fourth booster dose of the covid vaccine.

OCTAVE DUO started in July 2021 and continues in 2022, so it should find out how well the third dose has worked and how long the protection has lasted. This will help inform policy about future vaccination and other options to support people with blood cancer.

What other options are there for people with blood cancer, if a third does doesn't improve vaccine efficacy?

Monoclonal antibody treatments and antiviral treatments can protect people with blood cancer who do not respond to the vaccines. Many people with blood cancer are already eligible for these after a positive covid test. Read more about antibody and antiviral treatments to prevent covid.

Recent findings about CLL and ALL include:

• Those who’ve had more recent treatment for their blood cancer are less likely to respond to the vaccine.
• When people with B cell blood cancers do produce antibodies after a vaccine, they are often not effective at fighting covid. So having antibodies after a vaccine does not equal protection from coronavirus.

Themes from across several CLL studies include:

• The proportion of people who developed an antibody response ranges from 39% to 75% across the three CLL-only studies.
• The second dose of the vaccine is important in increasing vaccine effectiveness.
• People on watch and wait produced antibodies more than people on treatment.
• People with CLL in remission might have a better response than people on active treatment.
• The fifth study mentioned below found just 23% of people with CLL developed antibodies, but this was a small study.

Findings from CML studies include:

• The first CML study below found that in a small group of patients, 88% developed antibodies and 93% developed T cells after their first vaccination. This was despite all patients being on TKIs.
• The second CML study mentioned found that 75% of CML patients developed antibodies, despite all of them being on treatment.

While this data shows some themes in who responds better to the vaccine, it's not possible to say exactly what your level of protection will be, or what your risk would be if you caught covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

Findings from the latest data from the CLL-VR study, which included several hundred patients with CLL:

• An antibody response was seen in 66% of people with CLL after their first two vaccine doses. After a third dose, this increased to 80%. After three vaccine doses, 20% of people with CLL still had no detectable antibody response.
• After a fourth vaccine dose, there was no further increase in the number of people with CLL who developed antibodies, suggesting that the proportion of patients who develop antibodies after vaccination plateaus after the third dose.
• Three patients in the study who didn’t have antibodies after the fourth dose went on to get covid, and following infection, still didn’t develop antibodies. This suggests that these patients cannot develop antibodies, if they haven’t done so by their third vaccine dose.
• Factors that made people less likely to develop antibodies after their vaccines include having a low amount of IgM (immunoglobulin M) antibodies, having a BTKi (BTK inhibitor) treatment, having anti-CD20 treatment, or having treatment very soon after vaccination.
• For patients who did develop antibodies after their second vaccine dose, their amount of antibodies increased significantly after a third dose, to a similar level seen in people without blood cancer.
• The best response rate to vaccination was seen in people on watch and wait (no active treatment).
• Hospitalisation rates in this trial were high before Omicron, at 32% for the pre-Omicron variants, but falling to 7.7% during the Omicron wave. Monoclonal antibody treatments became available in the community in December 2021 and may have contributed to the reduced rate of hospitalisation, although only 36% of those testing positive during the same period received therapy.
• During the trial, 14% of the patients got covid over the 14 months since the first vaccine dose was given. Most of these happened during the Omicron wave, but the rates of hospitalisation in this wave was the lowest (only 7.7% of those infected needed hospitalisation (3 people out of 39 that were infected)).
• Although 20% of people with CLL did not develop antibodies (putting them at higher risk of catching covid), T cell response in people with CLL after vaccination was similar to people without blood cancer – this is important because it’s your T cells that can mean you have a milder illness with covid if you do get it. We explain more about antibodies and T cells above.
• After vaccination, the antibodies’ ability to fight Omicron was lower than their ability to fight the strain which the vaccine was developed from. But T cells’ ability to fight Omicron vs other strains was equal. T cell response could therefore be important in protecting people from future covid strains.

A study from the University of Birmingham has been published looking at antibody response to covid vaccines in 299 people with chronic lymphocytic leukaemia (CLL) who had two doses of either the Pfizer or AstraZeneca vaccine. 13 of these people had their first and second doses three weeks apart and the rest had them 12 weeks apart.

Findings

The team found that after one dose of the vaccine, 34% of people with CLL had an antibody response to vaccination which rose to 75% after the second dose. In comparison, 100% of healthy donors had an antibody response after the two doses of the vaccine.

While 75% of people developed an antibody response, the actual quantity of antibodies produced was lower compared with those without blood cancer.

Those who were receiving a BTK inhibitor (BTKIs) as treatment for their CLL were less likely to develop antibodies, as were those who had an “IgA deficiency”, which is a deficiency of one kind of antibody that is characteristic of CLL.

For people on watch and wait, 83% of them developed antibodies.

Update: October 2021

The team has now looked at 500 people with CLL following two vaccine doses and found that 67% developed an antibody response. Although most people produced antibodies after two doses, the number of antibodies produced was 3.7 times lower than in healthy people.

The study also looked at whether the antibodies were able to kill covid in the lab. Most destroyed the original variant of covid, but were less good at destroying the Delta variant, the main variant of covid in the UK at present.

The results also showed that some people with CLL were less likely to produce covid antibodies than others. These included:

• men
• people being treated with BTKIs
• people on antibiotics
• people with low levels of IgA and IgM antibodies.

What this might mean

• Both phases of the study suggest that lots of people with CLL do develop antibodies, although in lower numbers than people who don't have CLL.
• People on watch and wait produce more antibodies than people on treatment.
• The second dose of the vaccine is important in increasing vaccine effectiveness.
• The antibodies produced may not provide good protection against the Delta variant.

What we don't know

• We don't yet know how many antibodies are needed to fight off covid, so it's still hard to say how much protection the vaccines give people with CLL.
• We can't draw firm conclusions about the risk level for people with CLL on different treatments because this is a relatively small scale study.
• The study didn’t look at the number of T cells people had, it only looked at antibody levels. T cells are also thought to be important in protecting people from covid.

The Blood Cancer UK Vaccine Research Collaborative will continue to try and find answers to these questions over the coming months. As we wait to get answers to these questions, it’s important for all people with CLL, whether on treatment or not, to remain cautious.

Research from Hugues de Lavallade at King’s College London, which included 61 patients (24 with CML, 11 with ET, 13 with PV and 13 with myelofibrosis) found that:

• After one vaccine dose, 81.1% of patients had developed covid antibodies. After two vaccines doses this rose to 91.7%. When split by condition, 96% of CML patients developed antibodies, and 89.2% of MPN patients developed antibodies. The second vaccine dose was also important in increasing the actual concentration of antibodies.
• Despite the high rates of antibody development after vaccination, people taking ruxolitinib, regardless of their age, sex, diagnosis or other treatments, were more likely to not have an antibody response to the vaccine.
• People who had a previous natural infection with covid had significantly higher antibody levels after their two vaccine doses than others.
• After two vaccine doses, 88.3% of all patients had a T cell response to the vaccine. We explain more about the role of antibodies vs T cells above.
• MPN patients taking ruxolitinib had a significantly greater likelihood of having an undetectable or borderline antibody result after vaccination.
• CML patients taking TKIs (tyrosine kinase inhibitors) had a good antibody and T cell response to the vaccines, which TKIs didn’t seem to affect.
• Overall, MPN patients and CML patients respond well to the vaccines, both with an antibody response and a T cell response, but those taking ruxolitinib were more likely to not develop antibodies. We explain more about the role of antibodies and T cells above.

The COV-VACC study was looking at antibody response to the vaccine in 55 people with B cell blood cancers such as acute lymphoblastic leukaemia (ALL), high-grade NHL, low-grade NHL, chronic lymphocytic leukaemia (CLL) and Waldenström macroglobulinaemia (WM). Their ages ranged from 27 to 82, with half being over 60 and half under 60.

This study is part of the Blood Cancer UK Vaccine Research Collaborative.

Everyone on this trial had received cancer treatment in the last 24 months. Just under half were on treatment at the time of vaccination. Around a third had treatment within the last 6 months, and less than a quarter had treatment more than 6 months ago.

Out of 55 patients, almost all were taking rituximab. Some were also taking a BTKi (Bruton tyrosine kinase inhibitor), or had had CAR-T therapy. Because most people in the study had rituximab, it’s not possible to compare how different types of treatment affect vaccine efficacy.

The team found that overall, 36% of people had antibodies after one vaccine dose, and this rose to 42% after two doses.

Those who had treatment more than six months ago were more likely to develop antibodies.

This study also took ‘neutralisation assays’. This tests how good the antibodies that are produced after a vaccine are at fighting coronarivus. Of those who had antibodies after one dose, only 41% could destroy the virus. Of those who had antibodies after two doses, 57% could destroy the virus.

People who finished treatment more than 6 months ago were more likely to have antibodies that could fight coronavirus than people who finished treatment less than 6 months ago.

What it might mean

• People with B cell blood cancers often do not produce antibodies after having a covid vaccine.
• The second dose of the vaccine is important in raising the chances of vaccine effectiveness.
• Those who’ve had more recent treatment for their blood cancer (within the last 6 months) are less likely to respond to the vaccine.
• When people with B cell blood cancers do produce antibodies after a vaccine, they are often not effective at fighting covid. So having antibodies after a vaccine does not equal protection from coronavirus.
• People who finished treatment more than 6 months ago are more likely to produce antibodies that can fight covid after a vaccine, but they still often don’t.
• People with B cell blood cancers who’ve had both vaccine doses could still be at high risk of coronavirus, even if they’ve developed antibodies.

This study suggests that all clinically vulnerable patients, regardless of vaccination status, should be considered for neutralising monoclonal antibody therapies (such as Evusheld) if they develop covid-19. It also suggests that booster doses or full re-vaccination should be done for patients who’ve been vaccinated less than 6 months after their cancer treatment.

What we don’t know

• Almost everyone in this study had rituximab as part of their treatment, so it’s not possible to compare the impact of different treatments on vaccine efficacy.
• More analysis on larger numbers of patients is needed to confirm some of these findings. These initial findings also only report on antibody response to the vaccine, but T cell response is also important. This study will continue to look at T cell response and a higher number of patients.

Findings

In this study from New York, researchers looked at 44 people with chronic lymphocytic leukaemia (CLL) who had two doses of either the Pfizer or Moderna vaccines. They found that 52% of people developed antibodies 21 days after their second vaccination. Those who hadn't had any treatment for their disease and those under the age of 70 were most likely to develop antibodies. 94% of people who had never had any treatment developed antibodies, compared with just 23% people who had received treatment. This fell even more in people who had received treatments in the last 12 months.

What it might mean

• This is a small study but it could suggest that having treatment for CLL reduces vaccine efficacy.

What we don't know

• With such a small study, it's difficult to draw any firm conclusions.
• This study looked at antibodies but not T cells.

Findings

This study looked at 167 people with chronic lymphocytic leukaemia (CLL) who had received both doses of the Pfizer vaccine 21 days apart. Of these 167 people, an antibody response was only seen in 39.5%. Those who were in remission following treatment had a better response than those who were on active treatment.

What it might mean

• People with CLL may not respond as well to the covid vaccine as other people.
• People with CLL in remission might have a better response than people on active treatment.

What we don't know

• This study looked at antibodies but not T cells.

Findings

A new study, published by scientists in America, looked at antibody response in 67 people with blood cancer who had received two doses of either the Moderna or Pfizer covid vaccines. 36 people did have an antibody response following vaccination but 31 did not. The team also found that older people were less likely to produce an antibody response to the vaccine. The majority of people who took part in the study had myeloma, lymphoma or chronic lymphocytic leukaemia (CLL).

Just 23% of people with CLL developed antibodies. This was 52% in lymphoma and 65% in myeloma. However, there were only 13 CLL patients in this study, 21 lymphoma patients and 29 myeloma patients.

What it might mean

• People with blood cancer may not respond as well to the covid vaccines as other people.
• Older people may not respond as well to the vaccine as younger people.

What we don't know

• This study looked at antibodies but not T cells, which might also be important for protection against covid.
• Blood cancer type may play a role in vaccine effectiveness, but the numbers are too small for firm conclusions.

Findings

A new, small study looked at vaccine effectiveness in 16 people with chronic myeloid leukemia (CML). The team looked at both antibody and T cell response, both thought to be important for providing protection from covid. The results were positive, with 88% of people developing antibodies and 93% developing T cells at 21 days after their first vaccination. The study is small and only looked at people who had received the Pfizer vaccine, but these results are promising for people with CML.

All of the people who took part in the study were receiving TKI’s as part of their treatment and this study is the first to show that despite receiving a TKI, people with CML still produce a strong response to the covid vaccine.

What it might mean

• In this small number of patients, a high proportion of people with CML produced antibodies and T cells after their first vaccine dose.
• Being on TKIs does not seem to stop people with CML responding well to the vaccine.

What we don't know

• This study includes a very small group of patients. Larger studies are needed before we can make conclusions.
• This study only looked at the Pfizer vaccine, and only after the first dose. We need to see what happens after the second dose, and how long protection lasts.

We are supporting this group to do more research through the Blood Cancer UK Vaccine Research Collaborative.

Findings

This study looked at antibody response in people with chronic myeloid leukaemia (CML), myeloproliferative neoplasms (MPN) and myelodysplastic syndrome (MDS). The study looked at 59 people and 71% were on treatment. Overall, two weeks after one dose of the Pfizer or AstraZeneca vaccine, 58% of people developed an antibody response, compared to 97% of healthy adults.

When you look at this by disease type:

• CML - 12 patients - all 12 on treatment - 75% of people had an antibody response
• ET - 16 patients - 13 on treatment and 3 off treatment - 63% had an antibody response
• MF - 7 patients - 5 on treatment and 2 off treatment - 50% had an antibody response
• MDS - 13 patients - 10 on treatment and 3 off treatment - 46% had an antibody response
• PV - 11 patients - all 11 on treatment - 46% had an antibody response

Among patients who were not on any treatment, some still did not produce antibodies.

There was no difference in antibody response according to which vaccine was given - Pfizer or AstraZeneca.

For people with an MPN, treatment type had an effect on antibody response. For example:

• 88% of ET patients on interferon developed an antibody response
• 36% of people on hydroxycarbamide developed an antibody response (this included six ET patients, five PV patients and one MF patient)
• Nobody receiving ruxolitinib developed a response (this included one ET patient, two PV patients and two MF patients)

What it might mean

• CML, MPN and MDS patients who aren't on treatment can produce antibodies, although not all do.
• CML, MPN and MDS patients on treatment can produce an antibody response too, although not all do.
• Different types of blood cancer may have different success rates with the vaccine, for example CML patients on treatment had a better vaccine response than PV patients on treatment.
• There is no difference in effectiveness between the Pfizer and AstraZeneca vaccines.
• For people with MPN, treatment type could make a difference to vaccine response.

What we don't know

• This study only looked at response after one dose of the vaccine - we need to see what happens after the second booster dose.
• This study only looked at antibody response, not T cell response, which could also be important to protect people.
• People in this study were aged 52 to 73, so we don't know what the responses are like in younger people.
• This study includes a small number of patients. When you break the data down into disease type or treatment type, the numbers become very small, so they can only give an indication, not a firm conclusion.
• Until more monitoring is done, we don't know how much reduced antibody responses will actually increase the risk of covid infection.

Dr Simon Stanworth is leading a study called PACE. PACE is a study that was funded with the aim to assess the impact of COVID-19 on patients with acute myeloid leukaemia (AML) undergoing chemotherapy. They are expanding this study to now look at the effectiveness of the covid vaccines in people who are part of the PACE clinical trial. They will look at antibody and T cell response to vaccination. We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

Dr Helen Parry and Professor Paul Moss are looking at vaccine effectiveness in people with chronic lymphocytic leukaemia (CLL). The study is looking at both antibody and T cell response by taking blood samples at different time points. The study has recruited around 500 people. Above you can read some of their initial results under 'University of Birmingham study'.

Professor Claire Harrison and Dr Dragana Milojkovic are both studying how the covid vaccines work for people with chronic myeloid leukaemia (CML). Dragana has a particular focus on those who are receiving tyrosine kinase inhibitors (TKIs) as part of their treatment. Both studies are small, local studies. We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

Dr Hugues de Lavallade (King’s College London) will look at vaccine effectiveness in people with chronic myeloid leukaemia (CML) and myeloproliferative neoplasms (MPN). We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

Top findings include:

• Those who’ve had more recent treatment for their blood cancer (in the last six months) are less likely to respond to the vaccine.
• When people with B cell blood cancers do produce antibodies after a vaccine, they are often not effective at fighting covid. So having antibodies after a vaccine does not equal protection from coronavirus.
• People with curable lymphomas such as Hodgkin lymphoma and fast-growing B-cell non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma) can develop good antibody responses as early as 6 months after treatment ends.
• People with slow-growing B-cell lymphomas (such as follicular lymphoma) may not have a good antibody response to the vaccine, even if they are not having any treatment or had treatment some time ago.
• People who've had CAR-T therapy in the past may not get a good antibody response to the vaccine.
• In the third study mentioned below, 52% of lymphoma patients were found to have antibodies after vaccination.

While this data can give you some idea of how likely people are to develop antibodies after vaccination, it's very hard to really know your personal response to the vaccine, or your personal level of risk if you do catch covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

PROSECO stands for The Prospective Observational Study Evaluating COVID-19 Vaccine Immune Responses in Lymphoid Cancer (PROSECO). We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative. The study, led by Dr Sean Lim from the University of Southampton, is looking at how people with lymphoma respond to the covid vaccines. The study will look at both antibody and T cell response.

The latest data from this study covers 457 patients with lymphoma that received two or three covid vaccine doses.

Participants had Hodgkin lymphoma, aggressive B cell non-Hodgkin lymphoma (including diffuse large B cell lymphoma) indolent B cell non-Hodgkin lymphoma (including follicular lymphoma, CLL, mantle cell lymphoma, marginal zone lymphoma and lymphoplasmacytic lymphoma) and peripheral T-cell/natural killer (NK) cell lymphoma.

Patients were split into two groups on the trial – people who were 'on treatment' (ongoing treatment, completed treatment less than six months before vaccination, or started treatment less than 4 weeks after vaccination) and people with 'no treatment' (completed treatment more than six months ago or had not had any treatment).

Main findings

• A notable proportion of patients who were vaccinated while receiving or having recently completed treatments that target or deplete B cells, such as anti-CD20 monoclonal antibodies and BTKis (BTK inhibitors), do not have detectable antibodies after vaccination.
• Having treatment reduces your antibody response to the vaccine, but not your T cell response. We explain more about the antibodies and T cells above.
• After two vaccine doses, among patients having active treatment, 52% had an undetectable antibody response.
• After two vaccine doses, among patients who had anti-CD20 treatment in the last 12 months, 60% had an undetectable antibody response.
• When people had not had systemic treatment within 24 weeks of their vaccination, the proportion with an undetectable antibody response was just 9%. The significant impact of treatment timing on antibody response persisted when looking at the third vaccine dose too.
• People with slow-growing B-cell lymphomas (such as follicular lymphoma) did not have good antibody responses to the vaccine, regardless of whether they had treatment recently or no, which could suggest it is to do with the disease rather than the treatment.
• After a third vaccine dose however, 70% of patients with indolent (slow-growing) lymphomas had an improved antibody response after the third vaccine dose.
• Across all patients, 63% still had a T cell response to vaccination, which increased after their third vaccine dose, regardless of whether they had treatment recently or not. For people without detectable antibodies, having a T cell response could be an important protection from covid. We explain more about the antibodies and T cells above.

The study published some previous results in June 2021 after looking at antibody response in 129 people with lymphoma who had received both doses of either the Pfizer or AstraZeneca vaccine (with the doses 10-12 weeks apart).

Antibody levels were compared between people who were 'on treatment' (ongoing treatment or completed treatment less than six months before vaccination) and people with 'no treatment' (were not having treatment or completed treatment more than six months ago).

Findings

In the 'on treatment' group, people who had chemotherapy and/or anti-CD20 therapy in the last six months had no detectable antibodies, and those who had ibrutinib on its own in the last two months had no detectable antibodies.

In the 'no treatment' group, people with Hodgkin lymphoma or fast-growing B-cell non-Hodgkin lymphoma who were no longer on treatment developed a strong antibody response to the covid vaccine. However, if people with these diseases had received CAR-T therapy in the past, they were less likely to develop a response. People with slow-growing B-cell lymphomas had low antibody levels after the vaccine, even when not on treatment, or when treatment was over three years ago.

What it might mean

• People with curable lymphomas such as Hodgkin lymphoma and fast-growing B-cell non-Hodgkin lymphomas (such as diffuse large B-cell lymphoma) can develop good antibody responses as early as 6 months after treatment ends.
• People with slow-growing B-cell lymphomas (such as follicular lymphoma) may not have a good antibody response to the vaccine, even if they are not having any treatment or had treatment some time ago.
• People who've had recent treatment (in the last six months) before vaccination may not produce antibodies as well as people who aren't on treatment.
• People who've had CAR-T therapy in the past may not get a good antibody response to the vaccine.

What we don't know

• These results are just about antibodies, not T cells. This study is continuing to look at T cells however.
• More data is needed before we can draw conclusions on the differences between different types of lymphoma such as fast-growing and slow-growing lymphomas.

The COV-VACC study was looking at antibody response to the vaccine in 55 people with B cell blood cancers such as acute lymphoblastic leukaemia (ALL), high-grade NHL, low-grade NHL, chronic lymphocytic leukaemia (CLL) and Waldenström macroglobulinaemia (WM). Their ages ranged from 27 to 82, with half being over 60 and half under 60.

This study is part of the Blood Cancer UK Vaccine Research Collaborative.

Everyone on this trial had received cancer treatment in the last 24 months. Just under half were on treatment at the time of vaccination. Around a third had treatment within the last 6 months, and less than a quarter had treatment more than 6 months ago.

Out of 55 patients, almost all were taking rituximab. Some were also taking a BTKi (Bruton tyrosine kinase inhibitor), or had had CAR-T therapy. Because most people in the study had rituximab, it’s not possible to compare how different types of treatment affect vaccine efficacy.

The team found that overall, 36% of people had antibodies after one vaccine dose, and this rose to 42% after two doses.

Those who had treatment more than six months ago were more likely to develop antibodies.

This study also took ‘neutralisation assays’. This tests how good the antibodies that are produced after a vaccine are at fighting coronarivus. Of those who had antibodies after one dose, only 41% could destroy the virus. Of those who had antibodies after two doses, 57% could destroy the virus.

People who finished treatment more than 6 months ago were more likely to have antibodies that could fight coronavirus than people who finished treatment less than 6 months ago.

What it might mean

• People with B cell blood cancers often do not produce antibodies after having a covid vaccine.
• The second dose of the vaccine is important in raising the chances of vaccine effectiveness.
• Those who’ve had more recent treatment for their blood cancer (within the last 6 months) are less likely to respond to the vaccine.
• When people with B cell blood cancers do produce antibodies after a vaccine, they are often not effective at fighting covid. So having antibodies after a vaccine does not equal protection from coronavirus.
• People who finished treatment more than 6 months ago are more likely to produce antibodies that can fight covid after a vaccine, but they still often don’t.
• People with B cell blood cancers who’ve had both vaccine doses could still be at high risk of coronavirus, even if they’ve developed antibodies.

This study suggests that all clinically vulnerable patients, regardless of vaccination status, should be considered for neutralising monoclonal antibody therapies (such as Evusheld) if they develop covid-19. It also suggests that booster doses or full re-vaccination should be done for patients who’ve been vaccinated less than 6 months after their cancer treatment.

What we don’t know

• Almost everyone in this study had rituximab as part of their treatment, so it’s not possible to compare the impact of different treatments on vaccine efficacy.
• More analysis on larger numbers of patients is needed to confirm some of these findings. These initial findings also only report on antibody response to the vaccine, but T cell response is also important. This study will continue to look at T cell response and a higher number of patients.

Findings

A new study, published by scientists in America, looked at antibody response in 67 people with blood cancer who had received two doses of either the Moderna or Pfizer covid vaccines. 36 people did have an antibody response following vaccination but 31 did not. The team also found that older people were less likely to produce an antibody response to the vaccine. The majority of people who took part in the study had myeloma, lymphoma or chronic lymphocytic leukaemia (CLL).

Just 23% of people with CLL developed antibodies. This was 52% in lymphoma and 65% in myeloma. However, there were only 13 CLL patients in this study, 21 lymphoma patients and 29 myeloma patients.

What it might mean

• People with blood cancer may not respond as well to the covid vaccines as other people.
• Older people may not respond as well to the vaccine as younger people.

What we don't know

• This study looked at antibodies but not T cells, which might also be important for protection against covid.
• Blood cancer type may play a role in vaccine effectiveness, but the numbers are too small for firm conclusions.

Professor Sean Lim is continuing a large-scale study in people with lymphoma called PROSECO, which will include people with both Hodgkin lymphoma and non-Hodgkin lymphoma (see above). They have started collecting samples in a small number of people but hope to increase the size of the study. Professor Emma Morris will also capture some data on how well the vaccines work, particularly in those with non-Hodgkin lymphoma and some other blood cancers.

Professor Andy Pettitt is leading a study called PETReA. PETReA is a phase III clinical trial that is studying whether a PET-CT scan can help to tell who needs to have rituximab after their initial treatment for lymphoma. Andy will look at vaccine effectiveness in people who are on this trial.

We are supporting all of this research through the Blood Cancer UK Vaccine Research Collaborative.

Top findings about myeloma include:

• In the PREPARE study (October 2021), 92.7% of people with myeloma had an antibody response and 61.4% of people had a T cell response after two doses of the vaccine.
• Previous studies show a lower number of antibodies after vaccination, but these are smaller studies and one was undertaken after just one dose of the vaccine.
• There doesn't seem to be a difference in effectiveness between the Pfizer and the AstraZeneca vaccines in people with myeloma.
• People who are not on treatment may respond better to the vaccine than people on treatment.

While this data shows some themes in who responds better to the vaccine, it's not possible to say exactly what your level of protection will be, or what your risk would be if you caught covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

The PREPARE study at the University of Oxford looked at how effective covid vaccines were in 214 people with myeloma (204 people) or smouldering myeloma (10 people).

After two vaccine doses, 92.7% of people in the study had an antibody response, and 61.4% of people had a T cell response. People who had an antibody response were more likely to also have a T cell response.

Overall, about 60% of people had a positive antibody and T cell response, about 30% had a positive antibody response but a negative T cell response, and about 10% had neither an antibody nor a T cell response. We explain more about the role of antibodies vs T cells above.

If people had a partial response to myeloma treatment, had relapsed or were having chemotherapy, they were likely to produce a lower level of antibodies and also less likely to produce a T cell response. Men seemed to develop lower levels of antibodies than women following vaccination, and antibody production reduced with age.

A reduced T cell response happened more in those who had anti-CD38 or anti-BCMA treatments. We explain more about the role of antibodies vs T cells above.

What it might mean

• It's reassuring that the vast majority of people with myeloma in this study showed an antibody response to two doses of the vaccine, and most also had a T cell response. But around 10% of people had neither an antibody or a T cell response.

What we don't know

• This study didn’t look at people’s responses after their third vaccine dose, which we think would improve things further.
• More research is needed to understand what the different levels of T cell response mean for people with myeloma.

We supported this research through the Blood Cancer UK Vaccine Research Collaborative.

Research from the University College London looked at antibody response to vaccination in 188 patients (10 with smouldering myeloma or MGUS, 155 with multiple myeloma, 18 with AL amyloidosis, and 5 with other plasma cell disorders).

After the first vaccine dose, 67% of patients developed an antibody response to the vaccine.

After the second vaccine dose, 89% of patients had an antibody response. The quantity of antibodies people had after their second dose was also increased.

Factors that made people less likely to have an antibody response to treatment included:

• chemo-immunotherapy
• having had four lines of therapy
• having a less than complete disease response
• light-chain myeloma
• being male.

Findings

In April 2021, a study was published in the Lancet Haematology journal that looked at antibody response in 93 people with myeloma.

This study looked at levels of different types of antibodies after one dose of either the Pfizer or AstraZeneca vaccine. It found that 56% of people showed IgG antibodies after the vaccine, and when other types of antibodies were looked at, this rose to 70%. We don’t yet know if other antibodies are as important as IgG ones, but there is growing evidence to suggest they might be important.

Similar rates of effectiveness were seen for both the Pfizer and AstraZeneca vaccines, showing that they work equally well in people with myeloma.

The team also found that people who had stable disease not requiring treatment were more likely to develop antibodies than those who were receiving treatment. The type of treatment someone was given didn’t affect this.

What it might mean

• People with myeloma may not respond as well to the vaccine as people without blood cancer.
• There doesn't seem to be a difference in effectiveness between the Pfizer and the AstraZeneca vaccines in people with myeloma.
• People who are not on treatment may respond better to the vaccine than people on treatment.

What we don't know

• The study did not look at T cells, which are also important for vaccine response.
• This study only looked at antibodies after the first vaccine dose. We need to see what happens after the second dose, and how long protection lasts.

Read our blog about the study: Do people with myeloma have an antibody response to the Covid vaccine?

Findings

A new study, published by scientists in America, looked at antibody response in 67 people with blood cancer who had received two doses of either the Moderna or Pfizer covid vaccines. 36 people did have an antibody response following vaccination but 31 did not. The team also found that older people were less likely to produce an antibody response to the vaccine. The majority of people who took part in the study had myeloma, lymphoma or chronic lymphocytic leukaemia (CLL).

Just 23% of people with CLL developed antibodies. This was 52% in lymphoma and 65% in myeloma. However, there were only 13 CLL patients in this study, 21 lymphoma patients and 29 myeloma patients.

What it might mean

• People with blood cancer may not respond as well to the covid vaccines as other people.
• Older people may not respond as well to the vaccine as younger people.

What we don't know

• This study looked at antibodies but not T cells, which might also be important for protection against covid.
• Blood cancer type may play a role in vaccine effectiveness, but the numbers are too small for firm conclusions.

Professor Pam Kearns and Professor Gordon Cook are leading the cancer arm of a larger study called OCTAVE. As part of this, the team will look at antibody response in 425 people who have myeloma and will look at T cell response in around 150 of these people. This study isn’t recruiting anymore but we will keep you updated if anything changes.

Data from the SOAP study showed that people with MDS are able to mount an antibody response to vaccination, with 100% of study participants mounting an antibody response if vaccinated with an mRNA vaccine (Pfizer), and 76% mounting an antibody response if vaccinated with the AstraZeneca vaccine. This was only after two vaccine doses. Later in 2021 people with blood cancer were given a third primary dose followed by booster shots, for which the AstraZeneca vaccine wasn’t used.

Out of the patients who did develop antibodies, all but four of them could neutralise all covid variant strains (meaning the antibodies they developed could destroy covid).

However, antibody levels as well as their ability to destroy covid were still generally weaker in both Pfizer and AstraZeneca groups compared with healthy individuals, highlighting the need for additional vaccine doses.

When looking at T cells rather than antibodies, around 70% of MDS patients had a T cell response to vaccination, regardless of the type of vaccine, compared with 95% of healthy controls.

Five MDS patients who didn’t develop antibodies after an AstraZeneca vaccine did still mount a T cell response which could provide important protection.

This study included 38 people with MDS and analysed their response to vaccination two weeks after their second vaccine dose. Later in 2021 people with blood cancer were given a third primary dose followed by booster shots, which we saw increased the response further.

Findings

This study looked at antibody response in people with chronic myeloid leukaemia (CML), myeloproliferative neoplasms (MPN) and myelodysplastic syndrome (MDS). The study looked at 59 people and 71% were on treatment. Overall, two weeks after one dose of the Pfizer or AstraZeneca vaccine, 58% of people developed an antibody response, compared to 97% of healthy adults.

When you look at this by disease type:

• CML - 12 patients - all 12 on treatment - 75% of people had an antibody response
• ET - 16 patients - 13 on treatment and 3 off treatment - 63% had an antibody response
• MF - 7 patients - 5 on treatment and 2 off treatment - 50% had an antibody response
• MDS - 13 patients - 10 on treatment and 3 off treatment - 46% had an antibody response
• PV - 11 patients - all 11 on treatment - 46% had an antibody response

Among patients who were not on any treatment, some still did not produce antibodies.

There was no difference in antibody response according to which vaccine was given - Pfizer or AstraZeneca.

For people with an MPN, treatment type had an effect on antibody response. For example:

• 88% of ET patients on interferon developed an antibody response
• 36% of people on hydroxycarbamide developed an antibody response (this included six ET patients, five PV patients and one MF patient)
• Nobody receiving ruxolitinib developed a response (this included one ET patient, two PV patients and two MF patients)

What it might mean

• CML, MPN and MDS patients who aren't on treatment can produce antibodies, although not all do.
• CML, MPN and MDS patients on treatment can produce an antibody response too, although not all do.
• Different types of blood cancer may have different success rates with the vaccine, for example CML patients on treatment had a better vaccine response than PV patients on treatment.
• There is no difference in effectiveness between the Pfizer and AstraZeneca vaccines.
• For people with MPN, treatment type could make a difference to vaccine response.

What we don't know

• This study only looked at response after one dose of the vaccine - we need to see what happens after the second booster dose.
• This study only looked at antibody response, not T cell response, which could also be important to protect people.
• People in this study were aged 52 to 73, so we don't know what the responses are like in younger people.
• This study includes a small number of patients. When you break the data down into disease type or treatment type, the numbers become very small, so they can only give an indication, not a firm conclusion.
• Until more monitoring is done, we don't know how much reduced antibody responses will actually increase the risk of covid infection.

While this data can give you some idea of how likely people are to develop antibodies after vaccination, it's very hard to really know your personal response to the vaccine, or your personal level of risk if you do catch covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

Dr Elspeth Payne is studying a small number of people with myelodysplastic syndromes (MDS). Beth runs a clinic for people with MDS at UCLH in London which is where she is doing the study. At the moment this is small scale and will just collect antibody data, but we hope there may be an opportunity to get some more data on T cell response in the future.

Dr Sheeba Irshad (King’s College London) will look at vaccine effectiveness in people with myelodysplastic syndromes (MDS).

Top findings:

• In the first, small study, 76% of people with MPN produced antibodies after their first vaccine dose, and 80% had a 'memory T cell' response.
• In the second study mentioned, the proportion of MPN patients who developed antibodies ranged from 46% to 63% depending on the type of MPN. This study also found that ET patients had better responses to the vaccine, but people on hydroxycarbamide or ruxolitinib did not have good responses.

While this data shows some themes in who responds better to the vaccine, it's not possible to say exactly what your level of protection will be, or what your risk would be if you caught covid. Read our information about making decisions about different risks and coping with uncertainty and talk to your doctor for personal advice.

Findings

A study on MPN patients has looked at antibody and T cell response to the first dose of the Pfizer vaccine in 21 people with myeloproliferative neoplasms (MPNs). The study showed that 76% of people developed antibodies and 80% of people had some kind of “memory T cell” response. Memory T cells can "remember” their first encounter with the vaccine so they’re able to fight covid if they were to encounter it again. The study found that people with myelofibrosis (MF) tended to produce a higher quantity of antibodies, although four of these people were thought to be infected in the past which could play a role. The team didn’t find anything to suggest treatment had an impact on vaccine response.

What it might mean

• In this small number of patients, a high proportion of people with MPN produced antibodies and memory T cells after their first vaccine dose.

What we don't know

• This study includes a very small group of patients. Larger studies are needed before we can make conclusions.
• This study only looked at the Pfizer vaccine, and only after the first dose. We need to see what happens after the second dose, and how long protection lasts.

We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

Findings

This study looked at antibody response in people with chronic myeloid leukaemia (CML), myeloproliferative neoplasms (MPN) and myelodysplastic syndrome (MDS). The study looked at 59 people and 71% were on treatment. Overall, two weeks after one dose of the Pfizer or AstraZeneca vaccine, 58% of people developed an antibody response, compared to 97% of healthy adults.

When you look at this by disease type:

• CML - 12 patients - all 12 on treatment - 75% of people had an antibody response
• ET - 16 patients - 13 on treatment and 3 off treatment - 63% had an antibody response
• MF - 7 patients - 5 on treatment and 2 off treatment - 50% had an antibody response
• MDS - 13 patients - 10 on treatment and 3 off treatment - 46% had an antibody response
• PV - 11 patients - all 11 on treatment - 46% had an antibody response

Among patients who were not on any treatment, some still did not produce antibodies.

There was no difference in antibody response according to which vaccine was given - Pfizer or AstraZeneca.

For people with an MPN, treatment type had an effect on antibody response. For example:

• 88% of ET patients on interferon developed an antibody response
• 36% of people on hydroxycarbamide developed an antibody response (this included six ET patients, five PV patients and one MF patient)
• Nobody receiving ruxolitinib developed a response (this included one ET patient, two PV patients and two MF patients)

What it might mean

• CML, MPN and MDS patients who aren't on treatment can produce antibodies, although not all do.
• CML, MPN and MDS patients on treatment can produce an antibody response too, although not all do.
• Different types of blood cancer may have different success rates with the vaccine, for example CML patients on treatment had a better vaccine response than PV patients on treatment.
• There is no difference in effectiveness between the Pfizer and AstraZeneca vaccines.
• For people with MPN, treatment type could make a difference to vaccine response.

What we don't know

• This study only looked at response after one dose of the vaccine - we need to see what happens after the second booster dose.
• This study only looked at antibody response, not T cell response, which could also be important to protect people.
• People in this study were aged 52 to 73, so we don't know what the responses are like in younger people.
• This study includes a small number of patients. When you break the data down into disease type or treatment type, the numbers become very small, so they can only give an indication, not a firm conclusion.
• Until more monitoring is done, we don't know how much reduced antibody responses will actually increase the risk of covid infection.

Professor Claire Harrison is planning on studying effectiveness in people with all kinds of myeloproliferative neoplasms (MPN). They plan to recruit around 100 people.

Dr Hugues de Lavallade (King’s College London) will look at vaccine effectiveness in people with myeloproliferative neoplasms (MPN) and chronic myeloid leukaemia (CML).

We are supporting these researchers through the Blood Cancer UK Vaccine Research Collaborative.

This study looked at 23 people who had an allogeneic (donor) stem cell transplant between 19 and 172 months before they were vaccinated. The study found that although their response to one dose was low, after two doses of the Pfizer or AstraZeneca vaccines, 81% people had an antibody response, compared with 39% after one dose. The study also looked at T cell responses in 17 participants, and found that 82.3% had a significant T cell response after two doses of the vaccine, compared with 35.3% after one dose.

For people with chronic GvHD following a transplant, while the antibody and T cell responses were lower, most people showed an adequate response after two doses.

Overall, this is encouraging news, and suggests an even better response might be seen after three doses of the vaccine. However it is a small scale study, and more research is needed to confirm these results and what they mean for people who have had an allogeneic stem cell transplant, including those with chronic GvHD.

The OCTAVE study is now looking at the effectiveness of the third vaccine dose in people with blood cancer, including people who've had stem cell transplants. We haven't got results yet, but will keep this page updated when they are published.

OCTAVE also looked at the efficacy of the first and second doses in people who'd had a stem cell transplant. They found that after a stem cell transplant, most people still produced covid antibodies after their vaccinations, although in smaller quantities. The findings of this study are explained more fully below under 'Larger studies across multiple types of blood cancer'.

This study looks at both antibody response and T cell response to the covid vaccine. The study is funded by the Medical Research Council, which is responsible for coordinating and funding medical research in the UK. They are linked to but independent from the UK government.

The trial includes over 2,500 people from across the UK, recruited between February and August 2021, with conditions that affect the immune system (or have treatments that do). Conditions include arthritis, inflammatory bowel disease, end stage kidney disease, solid tumour cancers, blood cancer, and people who’ve had a stem cell transplant. This includes 139 cancer patients (solid tumour patients and blood cancer patients) and 160 people who’ve had a stem cell transplant. The blood cancer patients had acute myeloid leukaemia or myeloma.

The results released today are only based on 455 people from the trial, for whom all the necessary blood test results are available. This includes 18 blood cancer patients (acute myeloid leukaemia or myeloma) and 42 people who’ve had a stem cell transplant.

Everyone’s antibody response to the covid vaccine was measured 4 weeks after their second vaccine dose. Where possible, people’s antibody response was also measured in between their first and second dose, and before their first dose. Most people had either the Pfizer or AstraZeneca jab. These results were compared against 93 healthy individuals. Read about the findings below.

These are only the first set of results to come out of OCTAVE. The study is ongoing and will publish more data in the future. We are cautious about drawing conclusions from this very small sample, but the results do confirm that even when blood cancer and stem cell transplant patients do produce antibodies after vaccination, the quantity of antibodies is lower. It’s positive to see a good T cell response, although we don’t know what this means alongside a poorer antibody response.

This study reinforces the need to find alternative methods to protect people with blood cancer from covid, through extra vaccinations or alternative preventative methods such as antibody treatments.

Overall:

• 100% of the 93 people in the healthy group developed antibodies against covid after both doses of the vaccine
• 89% of all 455 people in the OCTAVE group developed antibodies against covid after both doses of the vaccine
• 11% of all 455 people in the OCTAVE group did not develop antibodies after their covid vaccines.

Looking at blood cancer and stem cell transplants specifically:

• 89% (16 out of 18) blood cancer patients developed antibodies against covid after both doses of the vaccine
• 88% (37 out of 42) stem cell transplant recipients developed antibodies against covid after both vaccine doses.

When looking at those who did produce antibodies in the OCTAVE group:

• 40% of those patients generated lower levels of antibodies than healthy subjects.
• 33% of blood cancer patients generated a lower level of antibodies than the lowest level seen in the healthy group
• 17% of stem cell transplant recipients generated a lower level of antibodies than the lowest level seen in the healthy group
• It’s important to remember we don’t currently know the minimum level of antibodies needed for protection against covid. So these lower levels of antibodies may still be effective at fighting covid, or they may not.

T cells are also an important part of the immune system for fighting covid. When looking at this, patients in the trial responded just as well as the healthy subjects in generating T cells for covid. This is positive news, but we don’t fully understand the impact of this alongside a poor antibody response.

• This study confirms that people with blood cancer are unlikely to respond as well to the covid vaccines as the general population.
• Although a high proportion of people with blood cancer and stem cell recipients produced antibodies after their covid vaccine, in many people the level of antibodies produced was much lower than the levels a healthy person produces after vaccination.
• People with blood cancer and stem cell recipients seem to produce a good T cell response to the covid vaccines, which matches the response seen in healthy people.

• Although many people with blood cancer and stem cell transplant recipients produced antibodies after vaccination, the quantity of antibodies they produced was much lower. We don’t actually know what this means in terms of fighting covid though - these lower levels of antibodies may still be effective at fighting covid, or they may not.
• These results are only based on 18 blood cancer patients. This low number means we can’t draw strong conclusions. The results about blood cancer patients also only relate to people with AML or myeloma.
• The results about stem cell transplant recipients are based on 42 people, which is still a small number. We also don’t know how long ago these people’s transplants were.

In March 2021, a study was published which suggested people with blood cancer do not have a strong response to the first dose of the vaccine. The SOAP trial, run by King’s College London and the Francis Crick Institute, looked at vaccine response in 205 people who received the Pfizer vaccine, including 151 people with cancer. Of these, 56 had blood cancer. Most people in the study were older people, and around half of them had received treatment recently. Several different types of blood cancer were included, so the numbers of people with each blood cancer was small. The study has however been through scientific peer review at Lancet Oncology.

The study found that three weeks after a first dose of the Pfizer vaccine, an antibody response was only seen in 13% of people with blood cancer (compared with 39% of people with solid cancers and 97% of people without cancer). A T cell response was seen in 50% of people with blood cancer.

What it might mean

• People with blood cancer may not respond as well to the covid vaccines as other people.
• Having the second dose significantly increased efficacy in solid cancer patients (too few blood cancer patients had a second dose to measure this).

What we don't know

• The percentages given above are averages across all blood cancer patients, but different types of blood cancer may have different success rates with the vaccine.
• This study was only looking at the effects of the first dose of the vaccine on blood cancer patients. We need to know what happens after the second dose.
• We don't know which cells give most protection against the coronavirus - antibodies or T cells. If T cells are found to be more important, then these results are more promising.
• People in the study were mostly older people, and over half had treatment recently. The response may be different in younger people or people who haven't had treatment recently.

In October 2021, further results were published, which include details of vaccine effectiveness in 51 people with blood cancer following both vaccine doses. This group includes a number of people with different types of blood cancer, making the results more difficult to attach meaning to, but the team found that following both vaccines, only 43% of people developed an antibody response. They also found that someone was less likely to produce an antibody response if they received treatment in the 15 days prior to vaccination. 70% of people with blood cancer developed a T cell response, which is another measure of vaccine response and may provide some protection from covid.

Interestingly, this team of researchers were able to compare if the interval between vaccine doses affected someone’s response to vaccination. They found that delaying the second vaccine to 12 weeks, instead of 3 weeks as it was initially, showed no obvious added benefits for people with cancer.

The study shows how important it is for people with blood cancer to continue being cautious. It also shows a clear increase in antibody response between the first and second vaccine doses (13% to 47%), which gives us real reason to believe that a third vaccine dose will allow even more people to develop an antibody response. 

We are supporting this group to do more research through the Blood Cancer UK Vaccine Research Collaborative.

• The three points at which we expect to have data to analyse are: 2-4 weeks, 6 months and 12 months after the second dose of the vaccine. Studies are already releasing data from the first data point, as people with blood cancer have had both doses of the vaccine now. We continue to report on any findings. In around November, we expect to have data from the second point (6 months after vaccination).
• Now that people with blood cancer are having third doses of the vaccine, it will be important to understand how this impacts their immunity over the coming months. As part of the national roll-out of third doses, a proportion of people with immunosuppression will be part of a trial, so we should learn how effective the booster jabs are for this group.
• In August 2021, we got results from the PROVENT trial, which found that the an antibody treatment was successful at stopping people with compromised immune systems getting covid. Read more on antibody treatments to prevent covid.
• We are also funding some research using a database called QResearch, which holds anonymised GP patient data from 45 million people in the UK, to look at people with blood cancer and how effective the vaccines have been.
• With all of the research that's been done, our team will liaise with the NHS and JCVI, which may include advising that some people should be given additional doses of the vaccine, or be given different treatments to protect them from coronavirus.
• By the end of 2021, we are hopeful of having a clearer picture of vaccine efficacy for people with blood cancer.

We understand it's very difficult at the moment for people with blood cancer to be told the vaccine may not work for them, but that we don't fully understand this, and that it will take several months to get a clearer picture. We have more information about making decisions about different risks and coping with uncertainty.

If you have concerns about the vaccine and what it might mean for you, or if you are struggling emotionally, you can contact our free and confidential helpline on 0808 2080 888 or send us a message.

• Remember that you can speak to your consultant, your clinical nurse specialist (CNS), or your GP. Try all of them. If you are only in contact with your nurse for example, ask for your doctor to give you a call. If you don’t have a CNS or any other named key worker, you can ask for one.
• Explain how the uncertainty is affecting you mentally. If it's making you feel anxious, isolated, or it's affecting your mental health, then use these words. If it's stopping you exercising, eating well or socialising, then say this. Make it clear how the situation is affecting you mentally and physically. And ask for more support if you feel you need it.
• For tips and support with these conversations, watch our Ask the Experts session on managing effective communication with your treating team.
• There are services that provide support and information for people who have concerns about their care. In England this is the Patient Advice and Liaison Service (PALS), in Scotland it’s the Patient Advice and Support Service (PASS), and in Wales it’s the Community Health Councils (CHCs). In Northern Ireland, you need to ask your hospital for a copy of their complaints procedure.
• If you feel communication with your medical team has broken down to the point where there's nothing more you can try, it may be an option to move to another consultant or hospital, or change GP.
• Speak to us about what you can say or do to open a helpful conversation with your medical team. We can also talk through how to transfer to another hospital or GP.

Some people say their friends and family are struggling to understand why coronavirus is still an issue for people with blood cancer. This is probably because of the general assumption that the vaccine has changed things. We and other charities are trying to get the message out to the general public that the vaccine isn't as effective for people with weakened immune systems (immunosuppressed people).

It can be upsetting if you’re taking extra precautions to stay safe and the people around you don’t take your concerns seriously. It can also be frustrating if you feel you keep having to explain your situation. Here are some things that might help:

1. Direct people to our online information for friends and family. Here, our Support Service answers typical questions friends and family may have about blood cancer and coronavirus, so they get a better understanding of the ongoing risks.
2. Watch our Ask the Experts session from December last year for tips on managing personal relationships in challenging times.
3. Talk to us about how to stick to your boundaries as covid restrictions relax and people try to encourage you to do more.
4. Tell your family and friends they're also welcome to contact us by phone or email for information and support around covid vaccine efficacy, and what it means for people with blood cancer.