NEWS Coronavirus News Experts: Blood Cancer Patients Should Receive a Booster COVID-19 Vaccine By Cyra-Lea Drummond, BSN, RN Cyra-Lea Drummond, BSN, RN Facebook LinkedIn Cyra-Lea Drummond, BSN, RN, is a writer and nurse specializing in heart health and cardiac care. Learn about our editorial process Published on September 30, 2021 Fact checked Verywell Health content is rigorously reviewed by a team of qualified and experienced fact checkers. Fact checkers review articles for factual accuracy, relevance, and timeliness. We rely on the most current and reputable sources, which are cited in the text and listed at the bottom of each article. Content is fact checked after it has been edited and before publication. Learn more. by Nick Blackmer Fact checked by Nick Blackmer LinkedIn Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years’ experience in consumer-oriented health and wellness content. Learn about our editorial process Share Tweet Email Print FatCamera/Getty Key Takeaways Certain blood cancer treatments may cause patients to have a dulled reaction to the COVID-19 vaccine.A booster dose of the COVID-19 vaccine may help blood cancer patients who had no response, or an inadequate response, to their initial dose of the vaccine.Blood cancer patients should not stop their treatment before getting a COVID-19 vaccine unless their doctor tells them to. The Leukemia & Lymphoma Society (LLS) is encouraging blood cancer patients who received either the Pfizer or Moderna mRNA COVID-19 vaccine to get a third dose. The LLS’s recommendation aligns with the Centers for Disease Control and Prevention’s (CDC) booster guidelines for people who are moderately-to-severely immunocompromised. Leukemia Types, Symptoms and Diagnosis Why Patients Need Boosters Data collected by the LLS showed that about one in four blood cancer patients will not form detectable antibodies to COVID-19 after receiving two doses of the Pfizer and Moderna vaccines. The reason for the dulled response is because the medications that are used to treat blood cancers often suppress the immune system, which in turn weakens its response to the vaccine. 5 Major Differences Between Leukemia and Lymphoma In a press release on September 13, Lee Greenberger PhD, chief scientific officer for the LLS, said that “antibodies tell us that a patient has responded to vaccination—and that is a positive finding, but vaccine experts are still working to determine exactly what antibody level is needed to protect against COVID-19 infection or its worst outcomes.” If You Got the J&J Vaccine The CDC’s recommendations only apply to people who received either the Pfizer or Moderna vaccines. Until more data is available, the LLS is asking patients to speak to their cancer care providers about a second dose of the Johnson & Johnson vaccine. LLS investigators published follow-up research in the journal Cancer Cell showing that 55% of the patients who had no response to the first two doses of the Pfizer or Moderna vaccines did develop antibodies after receiving a third dose. Furthermore, all of the patients that originally developed some antibodies against COVID-19 after receiving the first two vaccines had an even higher level of antibodies after the third dose. What Causes Lymphoma? However, Gwen Nichols, MD, the chief medical officer for LLS and one of the study’s authors, says that it is not yet known what level of antibodies provides full protection against COVID-19; still, any gain in antibodies is beneficial. B-Cells and Vaccine Response Non-Hodgkin lymphoma (NHL) and chronic lymphocytic leukemia (CLL) damage and deplete healthy B lymphocytes, which play a key role in helping the body develop antibodies against the COVID virus. The depletion of these cells is why patients with NHL and CLL are most likely to have an inadequate immune response to the COVID vaccine. Anti-CD20 and BTK Inhibitor Therapies The researchers discovered that two classifications of medications that are used in complement to blood cancer treatment (including to treat NHL and CLL) can diminish a person’s response to the COVID-19 vaccine. CD20 monoclonal antibodies, or anti-CD20 antibodies. These medications are designed to attack CD20, a unique protein on the surface of B lymphocyte cells. The most common anti-CD20 antibody is rituximab (Rituxan). In addition to NHL and CLL, rituximab can also treat rheumatoid arthritis (RA) and multiple sclerosis (MS). Bruton tyrosine kinase (BTK) inhibitors. BTK inhibitors stop an enzyme that signals B lymphocytes to reproduce (Bruton tyrosine kinase or BTK). Stopping reproduction of the B lymphocytes prevents them from proliferating, which in turn can slow the progression of NHL and CLL. Three BTK inhibitors are currently approved: ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa). Nichols highlights that neither class of medications selectively targets diseased B lymphocytes; both therapies have a broad effect on all B lymphocytes. Therefore, anyone taking these medications will have fewer healthy B lymphocytes than people who do not take them. What This Means For You If you’re taking any of these medications, you might wonder if you should stop taking them to help your body respond better to the COVID vaccine.Nichols emphasizes that patients should not stop their treatment without talking to their healthcare team. “Nothing in this paper suggests that you should stop your cancer therapy in order to get an antibody response to the vaccinations,” says Nichols. “If stop your medication and your lymphoma comes back, you’re in equally bad shape, so you should not stop it without talking to your doctor.” 6 Types of Lymphoma Treatment When to Get a Booster The CDC is advising that patients receive the third dose at least four weeks after getting their second dose of one of the mRNA COVID vaccines. Nichols says that patients who had COVID-19 antibody testing showing that they have developed immunity in response to the vaccine can wait until six to eight months after their second dose to get a booster shot. Take Precautions Even If You're Vaccinated LLS is urging all blood cancer patients to continue taking COVID precautions regardless of their vaccination status. Patients should keep wearing a face mask, practicing proper hand washing, social distancing, and avoiding poorly ventilated indoor spaces. “Not everybody knows whether they made antibodies, but I don’t think there’s any harm in getting it sooner,” says Nichols. “If you know that you had no antibodies please get it as soon as you can, but if you made antibodies, you should get it at six to eight months because it will last longer.” FDA Authorizes Pfizer Booster for Seniors and High Risk Groups. What's Next? Future Research The LLS Patient Registry has collected data on more than 11,000 blood cancer patients. Nichols acknowledges that this is "really a small number of patients" and that it is "a preliminary study," but it's still a good start. As more patients contribute to the registry, researchers will gain a better understanding of how blood cancer patients respond to vaccines and will be able to make recommendations that will improve care for all people with blood cancer. “The good news is, a lot of the patients are getting boosters and are giving us information about the boosters," says Nichols. "So we should have data on hundreds of more patients over the next few months.” New Registry Helps Blood Cancer Patients Manage Medical Records 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. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit 3 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Centers for Disease Control and Prevention (CDC). COVID-19 vaccines for moderately to severely immunocompromised people. Greenberger LM, Saltzman LA, Senefeld JW, Johnson PW, DeGennaro LJ, Nichols GL. 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 Greenberger LM, Saltzman LA, Senefeld JW, Johnson PW, DeGennaro LJ, Nichols GL. Anti-spike antibody response to SARS-CoV-2 booster vaccination in patients with B cell-derived hematologic malignancies. Cancer Cell. Published online September 7, 2021. doi:10.1016/j.ccell.2021.09.001.