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Should Blood Cancer Patients Get a COVID Vaccine Booster?

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Published on August 11, 2021

Could a COVID Vaccine Booster Benefit Blood Cancer Patients?

Follow along as Dr. Gwen Nichols, MD, Chief Medical Officer of the Leukemia & Lymphoma Society, explains where we are with COVID immunity for patients with blood cancer. Dr. Nichols also shares her views on whether immunocompromised patients should get a vaccine booster.

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Transcript | Should Blood Cancer Patients Get a COVID Vaccine Booster?

Andrew Schorr: Hello and welcome to Patient Power. I'm Andrew Schorr joining you with Patient Power from California but joining us from the New York area is Dr. Gwen Nichols, who is the Chief Medical Officer of the Leukemia & Lymphoma Society. Dr. Nichols, welcome back to Patient Power.

Dr. Nichols: Thank you, Andrew. Great to be here.

Andrew Schorr: Dr. Nichols, you've been in the oncology world a long time, and the LLS has been publishing, having data published now, as you've studied patients like me across different blood cancers of what immunity we have or don't have to COVID-19. And we think about this a lot. So first of all, I understand, just to recap, what we know now is it's very variable among blood cancer patients, isn't it?

COVID-19 Vaccine Efficacy for Patients With Blood Cancer

Dr. Nichols: It absolutely is. And unfortunately, because the initial vaccination studies were done in healthy, older people and healthy, younger people, cancer patients were kind of left in the lurch about how well they responded and the safety of the vaccines for patients.

Andrew Schorr: And if I understand your study of myeloma patients and Hodgkin's patients and some others, they've done pretty well. But people in my category, chronic lymphocytic leukemia, maybe not so well.

Dr. Nichols: The lymphoid malignancies, pretty much across the board, fared worse than those that were myeloid. And we saw not only CLL, but a number of the non-Hodgkin's lymphomas not make antibodies at the same levels, even as other blood cancer patients. And this is obviously a concern because we saw early on, and this is actually what drove us to do this study, was the idea that we were seeing a higher rate of morbidity and mortality in patients who were infected with COVID and were also fighting blood cancer.

Andrew Schorr: Right, right. And also, people on certain medicines that may depress their immune system.

Dr. Nichols: Absolutely right. And so, this has implications far beyond just blood cancer patients. Because it does seem to be that suppressing the B lymphocytes, whether it is from the cancer itself or from the medicines that you may be taking, suppresses your ability to respond to vaccination.

Andrew Schorr: Wow, okay. I know you're continuing studies, not just of the spike protein antibody, but also another part of the immune system, T cells. And I'm in that study, so I'm hoping…

Dr. Nichols: Thank you.

Andrew Schorr: …there's another part of my immune system that will help, but we don't know yet.

Dr. Nichols: And I think that's a really, really important message, that the vaccination studies use antibody levels to judge immunity. And we know if you make antibodies, you have a good chance of being able to be safe. It doesn't mean you don't get COVID. You still can, but that you won't be hospitalized or get very ill. The problem is we don't know that that tells us the whole story, it's just what we have available to test. And so, I don't want people to get discouraged or to say, "Well, why should I even bother getting vaccinated?" You should get vaccinated unless your doctor tells you otherwise, because there are other parts of the immune system. Antibody making is just one arm of how we fight off viruses.

Andrew Schorr: So a couple of things going on. One is I know you're continuing to test over time, people related to antibody levels to see if they wane, I think is the word. Just like the flu shot, you need to get an annual flu shot. So, when does it sort of go down to a level where you need to boost it? And that brings up the whole question of boosters. And I know various government agencies are talking about that very currently. Does the LLS have a position about whether we should be trying to work with our doctor to see if we can get a booster? And as you know, some patients are even going to other regions, even lying about whether they've had a vaccine, to see if they can get a kicker, if you will.

Could a COVID Vaccine Booster Increase Immunity for Blood Cancer Patients?

Dr. Nichols: And I know that this is happening, and we're hearing from patients who were telling us that they feel that they should go and get another vaccination. I'm a scientist, and I'm a doctor. And I worry because we don't know that it's safe. And we don't know how effective it is. And we don't know which patients have the ability to respond and which patients do not. And so you're taking all the risk for none of the benefit. So, what we really believe is that this should be tested now, yesterday, days ago in the context of a clinical trial.

I have to say, I'm disappointed that there isn't a bigger effort to test immunosuppressed patients in clinical trials. This is happening in other countries. Boosters are being tested in cancer patients. And we ought to be doing that in the patient populations that we serve, so that we understand, is it safe and is it effective? We are learning, but we're learning by chance, by people who have done exactly as you said, are going out and saying, "I never got my vaccine," and CVS gives them a third vaccine. That's the wild west. That's not the right way to do science.

I don't criticize anyone for doing that. I understand that COVID has been hard on everyone, and it's been doubly hard on our blood cancer patients. So, I think we really are advocating. And that's why Larry Saltzman from LLS actually testified at the CDC meetings yesterday to try and encourage our funding, federally funding of clinical trials so we can understand this and try and get the answers patients need sooner rather than later.

Andrew Schorr: Well, I'm for that. And I've put in a written comment about the same thing, please do it and do it now. And I know that Israel is one country that are studying it, and we'll be watching that data, all of it. So. in the meantime, Dr. Nichols, you have sort of a slogan in what the LLS has put out called “Get Vaccinated and Act Unvaccinated.” Talk about that just for a second on how we should proceed.

How Should We Proceed in Terms of COVID-19 Precautions?

Dr. Nichols: Well, because we don't know how to boost the immune system. And I can't look at you and say, "I know you don't make antibodies." And I can't even look at your medicines as a doctor and say, "You don't make antibodies." So, I don't know which of the patients I'm talking to is actually well protected and which patients are at risk because they don't have enough antibodies to fight off COVID. And this is especially important now. And this is what drove us to kind of move the message forward, is that the Delta variant is even more communicable.

And so patients, and their people who care for them and care about them, need to continue to be cautious. That doesn't mean you have to be in a closet, but it does mean you should be extra careful about wearing a mask in public places, especially places you can't control the environment. I understand no one wants to hear this, but I think it's the safest path forward until we know what to do and more people are vaccinated.

Frankly, I still wear a mask in any situation where there are crowds, not because I am worried about myself, but because I am worried and want others to do the same thing. Because you don't know when the person standing next to you is immunocompromised, and that can be at the grocery store or the movie theater or wherever you are. And so, in my mind, we ought to still use many of the precautions that we used at the height of the pandemic.

Andrew Schorr: Right. Believe me, I am. One last question, Dr. Nichols. So, if a blood cancer patient loses their sense of taste or smell, let's say they've been vaccinated, because we have this breakthrough COVID happening, and I know some people where it's happened. It would seem like we need to tell our oncologist or hematologist fast. And there are things like Regeneron [Pharmaceuticals] monoclonal antibodies that may be used earlier, that can make a difference. Am I right?

Dr. Nichols: You are absolutely right. I would even say, don't wait about losing taste or smell. If you think you've been exposed, you find out that someone at the church you've gone to, or the wedding you went to, or your neighbor that you talk to at the grocery store is positive for COVID, you should tell your doctor that you've been exposed, get a COVID test, because the therapeutics that we have now can be effective, but they're only effective early on. And the sooner that you know that you're positive, the sooner you can get those treatments.

They're not available for prophylaxis. In other words, you can't just constantly get antibody to avoid maybe getting exposed. But if you have any hint that you've been exposed, I really, really urge all of your listeners to get to your doctor right away, because that's the time when these therapies are effective. And if you wait to see if you get a fever or see if you feel sick, it may be too late for the therapies to be maximally effective.

Andrew Schorr: Wow. Well, I just want to recap a couple of things. First of all, the LLS continues to marshal data in specific blood cancer situations about our immunity. Thank you so much for your leadership in doing that. Thank you, because it definitely fills an information gap that's so vital for us. Second of all, we want to push for boosters, but we need the data, so as you say, don't participate in the wild west, have it be based on science. And then lastly, if we have a suspicion that we've been exposed, work with our doctor to get early treatment. Am I right?

Dr. Nichols: Absolutely right. You got all the main points. Thank you so much.

Andrew Schorr: Thank you, Dr. Gwen Nichols, Chief Medical Officer with the Leukemia & Lymphoma Society. Thanks for your leadership, Gwen. I really appreciate you being with us today.

Dr. Nichols: We are very happy to be here. Thank you, Andrew, for the work that you do.

Andrew Schorr: Okay. Thank you. Andrew Schorr with Patient Power, reminding everyone that knowledge and really understanding this can be the best medicine of all.


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