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COVID Shots May Not Be Effective For All Blood Cancer Patients. Everyone Still Needs One

An unseen person in a white tank top with a Band Aid on their exposed arm.

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Key Takeaways

  • About 1 in 4 blood cancer patients will not develop antibodies to COVID-19 after receiving the vaccine.
  • Experts say that blood cancer patients should still receive the COVID-19 vaccine and should continue to practice mask-wearing, social distancing, and frequent, proper hand hygiene.
  • The research on COVID vaccines and immunocompromised patients is ongoing.


Many blood cancer patients have suppressed immune systems, which might affect how well a COVID-19 vaccine protects them. To address this concern, researchers with the Leukemia and Lymphoma Society (LLS) wanted to see if blood cancer patients would respond to the COVID-19 vaccine by forming antibodies against the virus, or if they would remain unprotected despite receiving the vaccine.

After over four months of research, the study found that about one in four people with blood cancer will not develop antibodies after getting vaccinated against COVID-19.

The researchers published their findings in the journal Cancer Cell.

The Study

In March of 2021, the LLS asked blood cancer patients to contribute to the LLS National Patient Registry, a voluntary databank that is used to track trends and yield topics for future clinical trials.

Since the LLS registry opened, 8,000 blood cancer patients have contributed to the registry, and so far, 85% (about 7300 patients) have reported that are fully vaccinated (the remaining patients have not reported their vaccination status yet).

By May 5 (during the course of the study), 1,445 patients who had been fully vaccinated for at least two weeks agreed to have their blood tested for antibodies to COVID-19.

The researchers found that about 25% of the blood cancer participants who received the COVID-19 vaccine did not produce any detectable antibodies to SARS-CoV-2.

Type of Blood Cancer Affects Vaccine Response

Gwen Nichols, MD, chief medical officer for the Leukemia and Lymphoma Society and an author of the study, tells Verywell that a person's response to the COVID-19 vaccine mostly depends on the type of blood cancer they have and whether it impacts the immune cells that form antibodies to COVID-19.

“The B-lymphocytes leukocytes are the white blood cells that make antibodies, so the diseases that impair those cells put you at higher risk for not making antibodies," says Nichols. "This, unfortunately, means a lot of lymphoma and CLL [chronic lymphocytic leukemia] patients are skewed towards not making antibodies, and those are the highest percentage of patients we have in the registry."

Gwen Nichols, MD

I am in awe and so thankful for those folks who said, ‘I want to be a part of the solution.’ They aren’t doing it just for themselves.

— Gwen Nichols, MD

The researchers found that patients with malignancies that affect their B-cells—particularly non-Hodgkin lymphoma and chronic lymphocytic leukemia (CLL)—were less likely to develop immunity to COVID-19 after receiving the vaccine. Based on data collected prior to the authorization of the vaccines, those patients were also more likely to have poorer outcomes if they did get COVID-19.

On the other hand, the researchers also found that people with multiple myeloma and Hodgkin lymphoma were more likely than people with other types of blood cancer to produce antibodies in response to the COVID vaccine.

Treatment Matters

Nichols says that the type of therapy a patient is receiving, and which cells it targets, seems to be more significant than the dose or frequency of treatment for determining how they will respond to the COVID-19 vaccine.

“We think people who are actively taking therapies that target B cells are at higher risk [for not developing COVID antibodies]," says Nichols. "But we were surprised at how many myeloma patients make antibodies because the plasma cells where myeloma develops come from B lymphocytes."

Comparing COVID Vaccines

The data showed that 98% of the patients who submitted vaccine data to the LLS registry during the study period had received either the Pfizer or Moderna mRNA vaccines. Therefore, Nichols says that the researchers have limited information on the Johnson & Johnson vaccine and blood cancer patients.

Gwen Nichols, MD

No one should use this data to say they shouldn’t get vaccinated.

— Gwen Nichols, MD

Some patients also reported that they received a third dose of an mRNA vaccine or a second dose of the Johnson & Johnson out of an abundance of caution. However, Nichols warns there is not enough data yet to say whether such a "booster" dose is helpful.

“We are lobbying the National Institutes of Health to study this in a logical way,” says Nichols. “We think it will be safe, but we just don’t know, and we don’t want to give people another vaccine if it won’t help them.”

The Future of the LLS Registry


Nichols says that much is still unknown about COVID vaccines and blood cancer patients. However, they are optimistic that the LLS registry will help researchers find answers to these questions.

“Unfortunately, because this is a survey and we do not yet have all the medical records for the patients, we can’t deep dive into their data,” says Nichols.

Still, all the information that the patients are contributing is valuable. “There are folks who may not make antibodies, but they may have other types of immunity," says Nichols. "For example, we are studying T-cell immunity in patients that didn’t develop antibodies to COVID when they received the vaccine.”

As more data becomes available, researchers can improve recommendations for all individuals with blood cancer.

“The most amazing part of this story is how many patients agreed to participate," says Nichols. "I am in awe and so thankful for those folks who said, ‘I want to be a part of the solution.’ They aren’t doing it just for themselves."

Nichols adds that the data is "a living registry" and that the researchers will be "presenting data as we have enough. We are collecting data and getting information out as rapidly as we can.”

The researchers are continuing to monitor antibodies in additional patients on the registry, and the results have remained consistent with the already-published results. Nichols says that the LLS will update their findings later in the year.

Why Patients Should Still Get Vaccinated

Even if the study shows that they might not form antibodies, Nichols strongly recommends that blood cancer patients get the COVID vaccine.

Gwen Nichols, MD

We don’t know the long-term effects of the COVID vaccine, but we do know the long-term effects of a COVID-19 infection, and they can be terrible.

— Gwen Nichols, MD

“No one should use this data to say they shouldn’t get vaccinated,” says Nichols. “We have safety data on over 8,000 patients who have received the vaccine, and for the majority of them, it is safe and similar to people without blood cancer. We don’t know the long-term effects of the COVID vaccine, but we do know the long-term effects of a COVID-19 infection, and they can be terrible.”

After getting vaccinated, blood cancer patients should still continue to take other precautions, like wearing a mask, social distancing, and practicing proper handwashing.

“Get vaccinated, but act unvaccinated,” says Nichols. “That doesn’t mean you have to stay away from people altogether, but you should use common-sense measures to protect yourself including asking those around you, especially in your own household, to get the vaccination."

Nichols also stresses that early testing for patients who think they've been exposed or who have symptoms of COVID is crucial—especially if they end up with a positive result. "There are treatments that we can give to prevent serious infection," says Nichols "But they are only effective at the very early stages.”

What This Means For You

If you have blood cancer, it's important that you have a conversation about COVID-19 and your vaccine options with your oncologist. You can also talk to an LLS information specialist by calling 800-955-4572 or by reaching out to the organization online.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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  1. Greenberger LM, Saltzman LA, Senefeld JW, et al. Antibody response to SARS-CoV-2 vaccines in patients with hematologic malignancies. Cancer Cell. 2021;39(8):1031-1033. doi:10.1016/j.ccell.2021.07.012