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Covid vaccine and blood cancer

We're here for you if you want to talk

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Covid vaccine efficacy and blood cancer

This page is about how covid vaccine effectiveness is being monitored in people with blood cancer, what we know so far, and what Blood Cancer UK are doing in this area. We update this page regularly.

Page updated 18 June 2021

Will the covid vaccine work for people with blood cancer?

While the vaccines have been extremely effective at protecting the general population from covid, we still don’t know how successful they will be at protecting people with blood cancer. Research so far suggests that the covid vaccines may not work for everyone with blood cancer.

If you're in long-term remission

If you're in remission from a blood cancer you've had in the past (but don't have any more), we don't yet know how effective the covid vaccine will be for you. It may be that it works fine, or it may be less effective if your immune system still doesn't work fully.

The length of time it takes for your immune system to recover after cancer and its treatment varies depending on the type of cancer, the treatment given and you as an individual. There's no specific time frame, but generally it takes a few months to a year to recover.

Many people’s immune system recovers to a normal level after treatment, but some people have ongoing problems with their immunity. Whether the covid vaccine will be fully effective depends on how well your immune system functions. Talk to your doctor if you have questions about this.

Most of the research currently underway is with people who currently have blood cancer and are therefore immunosuppressed. We have asked study leads to include people in remission and will report on any findings that come through. The PROSECO study with lymphoma patients has published some findings about people in remission and is explained further down this page.

Antibody tests

You may have taken, or be thinking about taking, an antibody test to check how you've responded to your vaccinations. If so, you may find it helpful to read our blog about what covid antibody tests results mean for people with blood cancer.

Speak to your doctor about how the vaccine might work for you

At the moment, research shows the covid vaccines don't work fully in everyone with blood cancer. Talk to your specialist doctor, nurse or GP about this if you are worried.

With the backing of the British Society for Haematology, we’ve written to haematology teams and GPs to highlight how important this issue is - see below. You may want to share this with your team or GP, or alternatively share a link to this page.

What research is being done into vaccine efficacy in people with blood cancer?

Back in January 2021, we convened a group of the UK’s leading haematologists to work out how we can get our community the answers they need. The research that Blood Cancer UK is funding and coordinating is collecting data in a way which means that once finished, we’ll be able to compare results across different types of blood cancer and types of treatment. We are also making sure these studies look at both antibody response to vaccination and T cell response to vaccination, which are both important measures of protection from covid.

Through this research, we will monitor people's vaccine response over time, to understand when the peak response is for people with blood cancer, and how long a response lasts. Many of the studies will take blood samples from people at regular intervals to try and understand how long people with blood cancer have protection for.

Find out more about the Blood Cancer UK Vaccine Research Collaborative.

Research and data so far

Below we explain the research currently being done into covid vaccine effectiveness in people with blood cancer and what we've learned so far. Some of the studies are only just starting, and some have published findings.

We explain research that is funded and coordinated by Blood Cancer UK as well as other relevant research being done by others. You can find out which research Blood Cancer UK are funding: Together we're investing £800k in vaccine efficacy research.

SOAP study findings - various types of blood cancer

Findings

In March 2021, a study was published which suggested people with blood cancer do not have a strong response to 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.

Read our blog about the study: Does this new study mean blood cancer patients aren't protected by the covid vaccine?

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

Study on chronic myeloid neoplasms - CML, MPN, MDS

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.

University of Pittsburgh School of Medicine findings - myeloma, lymphoma, CLL

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.

Leukaemia and covid vaccine efficacy

University of Birmingham study - chronic lymphocytic leukaemia (CLL)

Findings

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.

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.

Whilst 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 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.

What it might mean

  • This study suggests that lots of people with CLL do develop antibodies, although still at a lower rate than people who don't have CLL.
  • The second dose of the vaccine is important in increasing vaccine effectiveness.
  • People on watch and wait produced antibodies more than people on treatment.

What we don't know

  • We can't draw firm conclusions about the risk level for people with CLL on different treatments because of the small numbers.
  • This 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.
  • When people with CLL did produce antibodies, the quantity produced was lower, but we don't know how much this matters to protect you from covid. It could be that even though the quantity was lower, they are still effective enough to fight covid. Equally, it could be that they aren’t effective.
  • This study looked at antibodies using “dried blood spots” which is a technique that involves people pricking their own fingers and sending a spot of blood to be analysed. This technique isn’t as accurate as taking fresh blood from people.

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.

Memorial Sloan Kettering Cancer Center study findings - chronic lymphocytic leukaemia (CLL)

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.

Israeli study findings - chronic lymphocytic leukaemia (CLL)

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.

King’s College London findings - chronic myeloid leukemia (CML)

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.

Leukaemia research in progress

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 Lavalland (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.

Lymphoma and covid vaccine efficacy

PROSECO study - lymphoma

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.

Dr Sean Lim from the University of Southampton wants to understand how people with lymphoma respond to the covid vaccines. She aims to look at 680 people with lymphoma (both Hodgkin and non-Hodgkin) and will look at their immune response at several time points to understand when the peak response to vaccination is, and how long this response lasts. This study will look at both antibody and T cell response.

Findings

The study published some 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).

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.

If you have a lymphoma and you've either not had your first or second dose of the covid vaccine, or you’ve had your second dose less than 4 weeks ago, you might be eligible. No individual results will be given to people who take part in this research. Rather, it will feed into a wider study which will help us understand the effectiveness of covid vaccines in people with blood cancer.

The trial would involve taking a blood sample 2-4 weeks, 6 months and 9 months after the second dose of your vaccine, and if we haven’t missed it, before and 4 weeks after you’ve had your first dose of vaccine. If you’re a lymphoma patient at one of the following hospitals, please speak to your clinician to discuss taking part in the trial: University Hospital Southampton, Southampton, Queen Alexandra Hospital, Portsmouth, Norfolk and Norwich University Hospital, Norwich, Leicester Royal Infirmary, Leicester, Queens Medical Centre, Nottingham, John Radcliff Hospital, Oxford or the Freeman Hospital, Newcastle.

Lymphoma research in progress

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.

Myeloma and covid vaccine efficacy

Royal Marsden study findings - myeloma

Findings

In April 2021, a study was published in the Lancet Haematology journal that looked at antibody response in 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?

Myeloma research in progress

The PREPARE study led by Dr Karthik Ramasamy at the University of Oxford is looking at how the vaccines work in people with myeloma and is looking for people to take part in his study. Find out more about how you can join the study. Karthik will study the levels of antibodies in people with myeloma and in a smaller group, will look at the levels of T cells as well. We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

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.

Myelodysplastic syndromes (MDS) and covid vaccine efficacy

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).

Myeloproliferative neoplasms (MPN) and covid vaccine efficacy

MPN study

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.

MPN research in progress

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 Lavalland (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.

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Transplants and covid vaccine efficacy

OCTAVE, the study looking at vaccine effectiveness in people with myeloma, are also studying 400 people who have had bone marrow transplants or CAR-T therapy. The hope is that this will help us understand the most appropriate time to vaccinate people who have undergone a transplant as part of their blood cancer treatment.

Other bone marrow disorders and covid vaccines

Professor Pete Hillmen will also study vaccine effectiveness in some other blood disorders including aplastic anaemia and Paroxysmal Nocturnal Haemoglobinuria (PNH). We are supporting this research through the Blood Cancer UK Vaccine Research Collaborative.

Children with blood cancer and covid vaccines

At the moment, covid vaccines are not offered to anyone under the age of 16. However, if they are licensed for use in children and young people, Dr Jessica Bate plans to look at how effective they are in children with blood cancers.

What if these studies show that the vaccines don’t work?

All of these studies are trying to find answers for people with blood cancer. Based on knowledge we have on how people with blood cancer respond to other vaccines, we know that the immune response to the covid vaccine in people with blood cancer is unlikely to be as good as in people without blood cancer. If this is true, there are other preventative treatments being studied that could protect people with blood cancer from covid.

PROVENT is a trial looking at an antibody treatment made by AstraZeneca called AZD7442 which contains antibodies capable of destroying covid. The PROVENT trial is looking at whether this can offer protection to people if the vaccine doesn’t work and people with cancer are included in this trial. Find out more about PROVENT.

We will keep this page up to date as and when we learn more about these studies. If you have concerns about the vaccine and what it might mean for you, you can contact our free and confidential helpline on 0808 2080 888 or [email protected]

How will safety be monitored now that people with blood cancer are having the covid vaccine?

Now that people are receiving the vaccine, there are processes in place to monitor safety and effectiveness on an ongoing basis, just like when any new meditation enters clinical practice.

The Yellow Card Scheme is the main way the MHRA collects information on suspected side effects and adverse reactions to medicines. This relies on healthcare professionals and patients reporting any side effects they notice. This is how we learn about rarer side effects in certain patients as larger and larger numbers of people are given a medicine. If there are any adverse reactions in people with blood cancer that are concerning, these should be reported to the Yellow Card Scheme.

We have more information about what we currently know about covid vaccine safety and effectiveness in people with blood cancer.

Keep updated about coronavirus and blood cancer

Join our mailing list for key updates about coronavirus for people with blood cancer, what we're doing to help, and ways you can help, including campaigns you may be interested in.

Support for you

You might find our section on coping with your emotions about coronavirus helpful. It talks about coping with uncertainty and feeling vulnerable.

Call our free and confidential support line on 0808 2080 888. We are currently receiving a very high volume of calls related to coronavirus, so if you're not able to get through straight away, please leave a message and we'll get back to you as soon as we can.

You can also email us if you prefer to get in contact that way. We'll usually get back to you within two working days, but due to the current rate of calls and emails we are currently receiving it may take us longer.

Talk to other people with blood cancer on our Online Community Forum – there is a group for coronavirus questions and support.

You can also find out what's helping other people affected by blood cancer through coronavirus and beyond in our pages on living well with or after blood cancer.

The following companies have provided funding for our coronavirus support, but have had no further input: AbbVie, AstraZeneca, Celgene, Gilead, Incyte, Kyowa Kirin, Novartis, Pfizer, Sanofi, Takeda.

We're here for you if you want to talk

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