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Covid Vaccination and Lymphomas: Let's Be Clear

With the rapid progress of the vaccination campaign in our and other countries, there are now many lymphoma patients who have received the SARS-CoV-2 vaccine, but those who have not yet been vaccinated or have not completed the second dose may still have doubts and perplexity. I am undergoing chemotherapy, can I get vaccinated? Is the vaccine safe? Which vaccine is recommended? Will it work? When should i get vaccinated? These are the main questions of patients facing the SARS-CoV-2 pandemic and approaching vaccination.

SARS-CoV2 disease (COVID-19) unfortunately has higher mortality in patients suffering from onco-haematological diseases such as lymphomas or in those who have undergone stem cell transplantation .

Getting vaccinated is the best way to counteract the risk of infection, both because it significantly increases the probability of not getting sick and because, in case of contact with the virus and symptoms develop, these are generally less serious and not followed by further complications.

Vaccination against SARS-CoV2 is considered safe and strongly recommended for patients with blood diseases and for patients undergoing haematopoietic stem cell transplantation or other cell therapy (such as CAR-T ).

I HAVE LYMPHOMA, WHAT VACCINE CAN I GET?
The anti SARS-CoV-2 vaccines available to date are of two types: mRNA vaccines (Pfizer-BioNTech and Moderna) and vaccines with non-replicating viral vectors (currently available in Italy the Astra-Zeneca-Vaxzevria vaccine and the Johnson vaccine soon. & Johnson Janssen)

On the basis of the available data, in patients with lymphoma, as well as from other onco-haematological diseases, mRNA vaccines are to be considered first choice and to be preferred, if possible, to vaccines with non-replicating viral vectors, even if there are no contraindications. absolute certainties for this last formulation.

DO I HAVE TO UNDERGO CHEMOTHERAPY, WHEN CAN I GET VACCINATED?
In patients with lymphoma and with onco-haematological diseases in general, vaccination is recommended preferably at the onset of the disease, if possible by completing the vaccination course at least 2 weeks before the start of any immunosuppressive therapy or chemotherapy. Despite this, vaccination should not be a reason for delaying the initiation of therapy in cases of aggressive lymphomas, which require urgent treatment. In cases where the therapy for lymphoma cannot be postponed, vaccination can also be administered during chemotherapy, while trying to avoid the moments in which the lowering of the immune defenses is considered to be greater.

In patients who have undergone autologous or allogeneic stem cell transplantation or in patients who have received CAR-T therapy, vaccination is recommended starting 3 months after the procedure.

However, the most suitable time to carry out the vaccination must be assessed on a case-by-case basis and discussed with your reference oncohematologist.

I AM ALREADY DOING THE THERAPY, CAN THE VACCINE BE CONSIDERED SAFE AND WILL IT BE EFFECTIVE?
Vaccination is to be considered safe and therefore not contraindicated even in patients who are already being treated with chemotherapy and / or drugs with specific action against B lymphocytes (for example anti CD20 monoclonal antibodies such as rituximab). However, it is necessary to know that in the latter category of patients the effectiveness of the vaccine may be lower than in healthy subjects, due to a lower ability to produce antibodies and it would be advisable, if possible based on the clinical situation, to postpone it to 6 months after termination of immunochemotherapy treatment. Given the possibility of having a protective response in the face of very few side effects, the cost / benefit ratio of the vaccine is in any case considered favorable.

I HAVE ALREADY HAD COVID, DO I STILL HAVE TO GET VACCINATED?
Vaccination is also indicated in subjects who have already contracted COVID-19 in symptomatic or asymptomatic form, as vaccination seems to improve the immunization resulting from the previous infection and the available data show that vaccination carried out after the infection is not burdened by major side effects. In the patient with reduced immune defenses (immunocompromised), who has already had the infection, it is recommended to carry out a complete vaccination course, since the extent and duration of the immunological protection developed with the natural infection is not predictable.

DO MY FAMILY MEMBERS ALSO HAVE TO VACCINATE?
Vaccination is strongly recommended for all cohabitants of frail patients, especially those who, for various reasons, have not been vaccinated and those who have, but who may have a non-optimal vaccination response, such as lymphoma patients undergoing chemo-immunotherapy.

WILL WE BE ABLE TO DO WITHOUT THE MASK ONCE MY FAMILY IS VACCINATED?
Considering that the extent of the response to vaccination is not predictable in the immunocompromised patient, that vaccinated subjects could still contract an infection asymptomatically and the possible spread of variants, it is important to continue to respect the hygiene and social distancing rules aimed at prevention of contact with SARS-CoV-2.



Dr.ssa Alessia Castellino
Hematologist Physician
Editorial Committee FIL