• People over 50 and those who are immunocompromised are now eligible to get a second COVID-19 booster shot.
• The Leukemia & Lymphoma Society recently began recommending a second COVID-19 booster shot for people with blood cancer and most survivors.
• People with lymphoma should talk with their oncology teams about whether they should time any booster shots around cancer treatments.

The U.S. Centers for Disease Control and Prevention (CDC) is now recommending a second COVID-19 booster shot for individuals older than 50 and those with certain conditions that lead them to be immunocompromised. The American Cancer Society states, “Many expert medical groups recommend that most people with cancer or a history of cancer should get a COVID-19 vaccine.”

People living with lymphoma are typically considered immunocompromised, which can lead to an increased risk for severe disease and hospitalization from COVID-19. The new public health recommendations come after recent studies showed an immune response to the Moderna and Pfizer vaccines in many immunocompromised people, including individuals with blood cancer.

The New Recommendations

Health officials at the U.S. Food and Drug Administration (FDA) and CDC have authorized a second booster shot for people 50 and older and those with immunocompromising conditions. Although this recommendation affects a similar age group as initial recommendations for the first booster dose, there are several details to know before you get this fourth dose:

• This additional booster is for people who received their first booster shot or last COVID-19 vaccine shot at least four months ago.
• The fourth shot will be either the Moderna or Pfizer vaccine, not the Johnson & Johnson vaccine.
• Even if you were previously vaccinated with the Johnson & Johnson vaccine, it’s now recommended that this next dose be a Moderna or Pfizer vaccine only.
• For those who are immunocompromised and received a three-dose primary vaccination followed by an initial booster, this additional vaccine booster would count as your fifth shot.

How Booster Shots Can Protect People With Lymphoma

If you already had your first booster shot, you may be wondering what the research says about whether boosters are effective for people with lymphoma. Findings from the Leukemia & Lymphoma Society showed that, although about 25 percent of people with blood cancer did not generate antibodies after their initial two COVID-19 vaccine doses, 43 percent had an immune response after receiving a third shot, emphasizing the importance of boosters.

The Leukemia & Lymphoma Society recently began recommending a second COVID-19 booster shot for people with blood cancer and most survivors. The organization advises waiting at least four months after your previous booster dose of the COVID-19 vaccine. Speak with your oncologist if you’re unsure of your risk or the timing of your vaccines around treatments.

Response to the Moderna Vaccine

The CDC’s latest recommendations follow promising new results about the effectiveness of the vaccines in immunocompromised people. A recent study from Moffitt Cancer Center included people diagnosed with blood cancers, as well as individuals with solid tumors. Researchers tested levels of antibodies (the proteins the immune system makes) to help destroy a target. In this case, the antibodies were to the SARS-CoV-2 virus that causes COVID-19, made in response to the Moderna COVID-19 vaccine.

On average, antibodies against the coronavirus were identified after the second vaccine dose in about 90 percent of people in the study. About 85 percent of people with blood cancers showed an antibody response.

The lowest response — around 30 percent — was seen among people with B-cell non-Hodgkin lymphoma or chronic lymphocytic leukemia who were receiving immunosuppressive therapy. But their response was much higher — nearly 73 percent — when they were not receiving treatment at the time of vaccination.

People who had the following treatments generally had lower responses to the vaccine:

• Anti-CD20 monoclonal antibodies (including rituximab, sold as Rituxan) less than six months before vaccination
• Bruton tyrosine kinase inhibitors (such as ibrutinib, sold as Imbruvica) used to treat some types of lymphoma
• P13K inhibitors (such as idelalisib, sold as Zydelig) used to treat a variety of cancers, including some lymphomas
• Venetoclax (sold as Venclexta) used to treat certain types of lymphoma
• CD19 chimeric antigen receptor T-cell (CAR-T) therapy used to treat lymphoma, leukemia, and multiple myeloma

People who had the following treatments showed a stronger response to the vaccine:

• Autologous (self) stem cell transplants in the last year
• B-cell maturation antigen CAR-T therapies used to treat multiple myeloma
• Allogeneic (donor) stem cell transplants

Response to the Pfizer Vaccine

While this recent study only included people given the Moderna vaccine for COVID-19, other research has looked at the response of immunocompromised individuals to the Pfizer vaccine. These vaccines are based on the same technique, using a molecule called messenger RNA (mRNA) to teach cells how to make a protein that will trigger an immune system response and help prevent a SARS-CoV-2 infection.

In one study that included individuals with medical conditions that caused them to be immunocompromised (including lymphoma), immune system response was, on average, about 67 percent. However, individuals with non-Hodgkin lymphoma made antibodies after vaccination about 51 percent of the time, according to the study results.

Why These Results Matter

Additional doses of mRNA vaccines may be effective at increasing detectable antibodies in a similar way to the first and second doses. Other research indicates that antibody levels are likely to decrease over time, so getting booster doses at recommended intervals is necessary even for vaccinated people who made antibodies after their initial shots.

Simply making antibodies does not guarantee complete immunity from COVID-19 infection, but the findings from these studies are a good sign that the mRNA vaccines for COVID-19 can trigger strong responses — even from people with compromised immune systems. It’s evidence that vaccines can protect people at higher risk of severe infections.

According to the CDC, getting vaccinated is still the best way to protect yourself and slow the spread of the virus. In addition, the Leukemia & Lymphoma Society advises people with blood cancer to get vaccinated even if they’ve had COVID-19.

Find Your Team

MyLymphomaTeam is the online social support network for those with lymphoma, their caregivers, and their loved ones. Here, you can connect with other people who understand life with lymphoma. Members come together to ask questions, give advice, and share their stories with others who understand.

Are you planning to get another COVID-19 vaccine booster? Share your insights in the comments below, or start a conversation by posting on MyLymphomaTeam.