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Covid vaccine and blood cancer

We're here for you if you want to talk

0808 2080 888

[email protected]

Covid vaccine efficacy and blood cancer

This page covers what we know so far about covid vaccine effectiveness in people with different types of blood cancer, and what Blood Cancer UK are doing in this area. We update this page regularly.

Page updated 7 September 2021

On this page

  • 1 September 2021: Third vaccine dose this autumn
  • 25 August 2021: Study announced to test third dose
  • 24 August 2021: New findings published from OCTAVE
  • Will the covid vaccine work for people with blood cancer?
  • If you're in long-term remission
  • Antibody tests
  • Other treatments to prevent covid in people with blood cancer
  • When will we have the full picture?
  • Problems talking to other people about your level of risk
  • Leukaemia and covid vaccine efficacy
  • Lymphoma and covid vaccine efficacy
  • Myeloma and covid vaccine efficacy
  • Myelodysplastic syndromes (MDS) and covid vaccine efficacy
  • Myeloproliferative neoplasms (MPN) and covid vaccine efficacy

Recently diagnosed with blood cancer?

If you have been diagnosed with blood cancer, order our free booklet 'Your blood cancer diagnosis - what happens now?' It tells you the key things to know about blood cancer, including tips from other people who've been diagnosed.

1st September 2021: Third vaccine dose this autumn

The government has announced that people with severe immunosuppression aged 12 and over will get a third dose of the covid vaccine this autumn. The advice covers the whole of the UK.

Who can get the third dose?

It's our understanding that this includes people who had weakened immune systems at the time of their first or second vaccination, because:

  • they were having treatment for blood cancer, or were in remission after having treatment in the previous 12 months
  • they had either an allogeneic or autologous stem cell transplant in the previous 24 months
  • they had a stem cell transplant more than 24 months before, but had ongoing immunity issues
  • they were on watch and wait (active monitoring) for any type of blood cancer.

We've been assured that there is room for clinical judgement on who gets the third vaccination. So groups that aren't specifically mentioned in the guidance but are considered to be at high risk can get a third dose. This means people who were in remission for longer than 12 months when they had their previous vaccinations will be eligible if their GP or hospital team recommend it.

Why should I get a third dose of the vaccine?

People with blood cancer tend to be immunosuppressed, which means their immune system doesn't work as effectively as it should. This means you may or may not have developed antibodies to the virus from your first two doses.

But research so far tells us that some people who have no antibodies after the first dose do develop some after the second dose. So it's reasonable to hope that a third dose of the vaccine will increase your level of protection. That's why another dose is being offered, and why it's a good idea to book your third dose when you can.

Key things to know

You should receive a letter from your GP or hospital. Keep hold of this letter as it proves your eligibility.

  • If you're 18 or over, you'll probably have the Pfizer BioNTech or Moderna vaccine. You may have Oxford-AstraZeneca if you've had it before.
  • For 12 to 17s, the Pfizer vaccine is the preferred option.
  • Research shows there are no safety concerns about mixing vaccines, so you may have a vaccine that's different from your first and second doses.
  • The third dose should be given at least 8 weeks after the second dose.
  • If you're currently having treatment, your specialist should advise on the best time to have the vaccine.
  • You may still get a booster vaccine in around 6 months' time.

More information

Our recent news article answers some key questions about the third dose. We will keep you updated as we find out more.

We also have information about how to book your third dose.

The efficacy of the third dose will be monitored by the OCTAVE DUO study, explained below. Research is also going on to find other ways to prevent and treat coronavirus for people who don't get full protection from covid vaccines.

25 August 2021: OCTAVE DUO study announced to test a third dose in people with suppressed immune systems

A study called OCTAVE DUO is looking at how effective a third dose of the vaccine might be for people with suppressed immune systems. This news comes after the OCTAVE study (explained below) found that people with suppressed immune systems don’t get as much protection from the first two doses as healthy people do.

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.

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.

We expect to have the first results in September, which would tell us the short-term impact of a third dose on covid antibody and T cell levels. The study would continue to monitor people after this, to see how long any protection lasts.

Results from this trial could also 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. We are hoping that a third dose will improve things for people with blood cancer.

Find out more about how research in this area has progressed and what Blood Cancer UK have been working on.

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 or CAR-T therapy 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.

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. This gives us reason to believe that a third dose could increase this protection even more and be important for people with blood cancer.

The government has already announced that people who are immunosuppressed should get a third dose of the covid vaccine this autumn.

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

Monoclonal antibody treatments are one type of treatment that may have benefits for people with blood cancer who do not respond to the vaccines. This treatment involves an injection which includes antibodies that have been engineered to give you long-lasting protection against coronavirus. A study called PROVENT recently showed positive results. Read more about antibody treatments to prevent covid.

24 August 2021: New findings on vaccine response in people with impaired immune systems from the OCTAVE trial

The ongoing OCTAVE study has today published its first results on vaccine effectiveness in people with impaired immune systems. The study found that a significant proportion of people with immunosuppression have a low or undetectable antibody response after two doses of the covid vaccine.

The study is important because it is a multi-centre, UK-wide trial, and one of the largest studies in the world so far into covid vaccine efficacy in immunosuppressed patients. It looked at both antibody response and T cell response to the covid vaccine. This 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 OCTAVE 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 here:

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.

Will the covid vaccine work for people with blood cancer?

Research so far suggests that the covid vaccines may not work for everyone with blood cancer.

Not knowing what level of protection you have is understandably difficult. This page tells you what we know so far, but also about other ways we may be able to protect people with blood cancer in addition to the vaccine. We have more information about making decisions about different risks and coping with uncertainty.

We will keep this page updated as and when we learn more about these studies. If you have concerns about the vaccine and what it might mean for you, contact our free and confidential helpline on 0808 2080 888 or send us a message.

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, in which case we expect the vaccine to work fine.

But some people have ongoing problems with their immunity. If your immune system isn't working fully, then the covid vaccine may not be as effective for you. If you don't know whether your immune system is functioning fully:

  • Consider whether you've continued to get more colds or bugs since you finished cancer treatment.
  • Were you previously advised to shield during the pandemic? If so, this could be because your healthcare team thinks you have a compromised immune system (although it could be for another reason).
  • Talk to your GP or medical team - only they can give you the right advice about your immune system, as they know your personal situation.

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 we will report on any findings that come through. So far, the PROSECO study (explained below) has published some findings about people in remission from lymphoma.

Read our 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, contact our free and confidential helpline on 0808 2080 888 or send us a message.

What are Blood Cancer UK doing about it?

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. You can find out which research Blood Cancer UK is funding:

Below we explain what we've learned so far about covid vaccines and different types of blood cancer.

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 blogs about these:

Other treatments to prevent covid in people with blood cancer

It's important to remember that while the vaccines are one of the main ways to protect against covid, they are not the only way. For people with blood cancer, even if the vaccine is less effective, there are other options:

  • Antibody treatments put the covid antibodies into your body, rather than relying on your immune system to create the antibodies (as with the vaccine). These treatments could be important for people in whom the vaccine may not work, and recent trials have shown they work. Find out more about antibody treatments to prevent covid.
  • Treatments for coronavirus are being constantly improved. Some new covid treatments have been found to be successful in people with compromised immune systems. Find out more about antibody treatments for covid.

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

With the backing of the British Society for Haematology, we’ve written to haematology teams and GPs to highlight how important this issue is. Share this letter with your team or GP:

When will we have the full picture?

The studies below give us helpful indications about vaccine efficacy in people with different types of blood cancer, but there are also limitations to these studies at the moment.

The blood cancer community understandably needs stronger and clearer evidence than this, in order for people to understand their individual level of risk. This is why Blood Cancer UK and others are funding and coordinating vaccine research that will provide the answers we need. These studies look at both antibody response to vaccination and T cell response to vaccination, which are both important measures of protection from covid.

This research does take time. While we won't get the full picture overnight, we are continually learning, and we will keep updating you and the NHS with the latest evidence.

There are certain time points in the future when we think we'll have more answers:

  • 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).
  • Read about the meta-analysis we'll be doing with all of these studies. After analysis, the 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.
  • 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.
  • In Autumn 2021, people with blood cancer will get a third booster jab. As part of this national roll-out, 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.
  • 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.
  • 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.

Problems talking to other people about your level of risk

Tips on communicating with your healthcare team or your family and friends about vaccine efficacy and why you're still concerned:

  • 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.
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Five reasons to be hopeful

As difficult as it feels today, there is real reason to hope the next few months could bring better news.

Read our blog

Leukaemia and covid vaccine efficacy

Below we explain results from one study that covered ALL, four studies about CLL, and two studies about CML and vaccine efficacy.

If you have an acute leukaemia, research is underway, and one study so far has released findings - the first study mentioned below.

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.

Professor Emma Morris and her team have published a study 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 PROVENT) 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 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 able to say if someone has antibodies or not, but is not able to give information on the levels of antibodies in the blood.

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.

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.

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Lymphoma and covid vaccine efficacy

Below we explain results from three studies on lymphoma and vaccine efficacy.

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.

Professor Emma Morris and her team have published a study 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 PROVENT) 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.

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.

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.

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Myeloma and covid vaccine efficacy

Below we explain results from two studies about myeloma and vaccine efficacy.

Top findings about myeloma include:

  • In the first, larger study, 56% of people with myeloma developed antibodies after their covid vaccine.
  • In the second study mentioned, 65% of people with myeloma developed antibodies.
  • 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.

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.

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

The findings we have about MDS so far are from a study about CML, MPN and MDS, explained below, which found that 46% of MDS patients had an antibody response after vaccination, in a group that were mostly on treatment.

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 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

Below we explain results from two studies about MPNs and vaccine efficacy. Top findings about MPNs include:

  • 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.

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.

Study that looked at blood cancer in general

This study was one of the first major studies to show that people with blood cancer might not respond to the covid vaccine. The findings are general to blood cancer as a whole.

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.

Children with blood cancer and covid vaccines

At the moment, covid vaccines are not offered to any children under the age of 12 in the UK. Older children aged 12 to 17 can have the vaccine if they are immunosuppressed, which includes having blood cancer.

If vaccines are licensed for children under 12, Dr Jessica Bate plans to look at how effective they are for children with blood cancers.

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.

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 risk and uncertainty as lockdown eases 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 send us a message if you prefer. 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.

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