Breaking News: New Study Shows That Most Blood Cancer Patients Benefit From Third COVID-19 Vaccine

This pandemic has been traumatic for all patients whose immune systems are compromised, including cancer patients. But perhaps no one group of cancer patients has been more concerned about or affected by Covid-19 than blood cancer patients. 

As I recently reported for Healthline, a study from the Leukemia and Lymphoma Society (LLS) found that 25 percent of blood cancer patients are not getting any antibodies from the Covid-19 vaccines. As a three-time survivor of non-Hodgkin's lymphoma, this news of course resonated with me and with my fellow lymphoma survivors. 

 

But there is some good news that we can now announce. 

In a new study published in the journal Cancer Cell, LLS researchers found that more than one in two patients with B-cell blood cancers produced antibodies after a third dose of COVID-19 vaccine despite having no detectable antibodies after the first two doses. 

The study also showed that patients who had detectable antibodies after the first two vaccine doses had increased levels after the third dose. 

In an exclusive interview, Dr. Gwen Nichols, Medical Director of LLS, told The Reno Dispatch, "Our findings are encouraging for patients with blood cancer, since the additional COVID-19 vaccine dose seems to improve immune response in many. But some blood cancer patients will still not mount a full response even with the extra dose, so our message remains the same."

She noted that If you have blood cancer, you are at increased risk of serious illness and death from COVID. "Get vaccinated and layer on additional precautions like masking and social distancing to stay safe," she said. 

LLS recommends that blood cancer patients who received two doses of either Moderna or Pfizer mRNA vaccine get an additional dose according to the Centers for Disease Control and Prevention (CDC) guidance for people who are moderately to severely immunocompromised. 

CDC has indicated that additional guidance will be coming soon for patients who received Johnson & Johnson’s Janssen COVID-19 vaccine. 

Until then, patients who received J&J or any other non-mRNA vaccine should consider an additional dose and talk to their healthcare provider. 

LLS also advises all blood cancer patients to continue to layer on additional precautions like masking and social distancing to avoid becoming infected. 

Based on pre-vaccine data, patients with blood cancer tend to have more prolonged and severe COVID-19 infections compared to their healthy counterparts, including having significantly higher rates of death.  

Dr. Lee Greenberg, LLS Chief Scientific Officer, explained to The Reno Dispatch that there can be multiple reasons why a patient with no antibodies will produce antibodies after booster vaccination.  

"One reason is that the B-cell suppressive effect of anti-CD20 Ab, which can last for months after the initial therapy, have dissipated," he said, adding that normal B-cell function can start to return in 6-9 months, but full recover could require more than 1 year.

"A second reason is that some patients have either discontinued the BTK inhibitor therapy or taken a reduced dose prior to booster vaccination," he said.

Another reason that this can happen is because the disease is under control and normal B-cell function has returned, he said.

And lastly, Greenberg explained, "Antibodies to SARS-CoV-2 are in the normal blood supply; those patients getting infusions of antibodies can acquire spike and nucleocapsid antibodies from the donor."

Treatment with the antibody Rituxan 6 to 12 months prior to vaccination was associated with a failure to produce detectable COVID-19 antibodies, even after a third dose of the mRNA vaccines. 

In addition, some patients being treated with Bruton tyrosine kinase (BTK) inhibitors also fail to make detectable COVID-19 antibodies, though individual results in BTK inhibitor patients were more variable. 

Current cancer treatment guidelines do not call for pausing these treatments or delaying COVID-19 vaccination in blood cancer patients. 

The best path forward is for blood cancer patients to consult with their health care team and to get vaccinated and to continue practicing other important infection prevention procedures recommended by the CDC, say LLS experts.

An earlier study of more than 1,400 blood cancer patients enrolled in the LLS National Patient Registry reported that about one in four fail to produce detectable antibodies after two doses of either Moderna or Pfizer mRNA COVID-19 vaccines. 

However, these rates vary by cancer type, with non-Hodgkin's Lymphoma (NHL) and chronic lymphocytic leukemia (CLL) patients less likely to have detectable antibodies. 

Patients with these forms of cancer have a diminished response to vaccination because NHL and CLL can deplete the body’s B-cells. The body needs healthy B cells to fight infections and also to mount an antibody response to the vaccines.

Among the 38 patients with B-cell derived malignancies (almost all had NHL or CLL) in this latest study who were seronegative after two vaccine doses, 21, or 55%, had detectable antibodies after the third dose while 17 patients (45%) remained seronegative. 

The 11 patients in the study who had measurable antibodies after the first two doses all had increased antibody levels after the third dose. Even in this difficult-to-immunize population, the study shows the majority (32 of 49, 65%) have detectable antibodies.

“Antibody levels in our study ranged from 2.2 to over 2,500,” said Greenberger.

"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.”

Greenberger and his colleagues, including Dr. Larry Saltzman, LLS Executive Research Director, are working on another study assessing blood cancer patients’ T-cell response to vaccines. 

The immune system’s T-cells are primed by vaccination to create “killer cells,” which are the first line of defense against infections like COVID-19. They are also analyzing antibody data from hundreds of additional patients who have received a third vaccine dose. 

T-cell results and an update to the current study are both expected later this year.

Based on the results of this and the earlier LLS study, the society estimates that at least 100,000 blood cancer patients in the U.S. will not have detectable antibodies following three doses of mRNA vaccines.