VACCINES & BLOOD CANCER PODCAST - by DR SWAN & A/Prof. DR KATE BURBURY
Posted: Tue Aug 24, 2021 1:45 pm
Afternoon all... 
Firstly, I hope everyone is coping well in these difficult times, & managing to stay safe & happy as possible...
Before making this Post, I believe that it is incumbent upon me to state that how a vaccine affects one type of 'Blood cancer' patient, may be quite different to that of another, because not all of us are requiring the same treatment. Hence, there's a little bit to unpack through this Post & Podcast of from Dr Norman Swan & Dr Kate Burbury of the Peter MAC Cancer Foundation in Victoria.
It is therefore essential to realise that this talk & the subsequent findings are all premised upon the Lancet Report, (provided in the References below).
In Australia, much unlike other western nations, we tend to be the last ones to learn about the potential impacts of ramifications concerning 'Blood cancers', in my view...
Hopefully, this Post & report might aid some of you in our understandings of what it might be like to live in a Post COVID world w/ a blood cancer, that might be impacted by vaccines, and their likelihood of producing protective COVID anti-bodies or not...
PLEASE remember to discuss anything here first w/ your MPN specialist before making decisions concerning your health & well-being...
Please stay safe, happy & well...
Best wishes
Steve
KEY FINDINGS OF LANCET REPORT:
ABC Radio National PODCAST
(Link below)
https://www.abc.net.au/radionational/pr ... s/13441304
Protection against COVID for people with blood cancers
On Health Report with Dr Norman Swan
One of the commonest questions we get on Coronacast is from people with cancer who ask whether they should be vaccinated against COVID and how effective are the current vaccines?
While people with cancer generally respond well to Covid-19 vaccines and are able to produce protective antibodies, that may not be as true for people who have blood malignancies like leukaemia where the immune system itself is affected.
New research published in The Lancet Haematology has found that people with blood cancers, and in particular those on certain treatments, had lower antibody responses to the Pfizer vaccine.
So what does this mean for those affected and how can they stay safe in the pandemic?
Guest: Associate Professor Kate Burbury
Haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre
Host: Dr Norman Swan
Duration: 6min 26sec
Broadcast: Mon 12 Jul 2021, 5:40pm
Transcript
Norman Swan: One of the commonest questions we get on Coronacast, our sister podcast, is from people with cancer who ask whether they should be vaccinated against Covid and how effective are the current vaccines. Well, people with cancer generally respond well to COVID-19 vaccines and are able to produce protective antibodies. That may not be as true for people who have blood malignancies like leukaemia where the immune system itself is affected.
New research published in the Lancet Haematology has found that people with blood cancers and particularly those on certain treatments, had lower antibody responses to the Pfizer vaccine. So what does this mean for those affected, and how can they stay safe in the pandemic? Associate Professor Kate Burbury is a haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre. Welcome to the Health Report, Kate.
Kate Burbury: Thank you for having me, Norman.
Norman Swan: So the findings of this were not just about leukaemia, it was about the treatment that they were on.
Kate Burbury: Correct. This study, interestingly, is concordant with what we already know, that both patients with blood cancers either related to their underlying blood disorder, as you alluded to Norman, such as leukaemia, or the treatment they are receiving, can have a reduced or varied antibody response to vaccines, included COVID-19 vaccine. It's not unique to that one, it's across-the-board with vaccines. And I think importantly this is something that, as doctors looking after these patients, we are very familiar with. So for patients with blood cancers or indeed across-the-board with cancers, reaching out to your haematologist or oncologists or indeed your GP to ask about the appropriateness of any vaccine including COVID-19 is really important.
Norman Swan: How different is the results, though, compared to people who have got regular cancer? When I say 'regular cancer', I mean what they call solid tumours like colon cancer, lung cancer, breast cancer?
Kate Burbury: Understood, and I think largely it's due to their ability to mount an antibody response. So we know there are certain blood disorders such as leukaemia, sometimes in B cell disorders such as chronic lymphocytic leukaemia or myeloma, they are unable to mount antibody responses generally, as well as due to vaccines. So it is more problematic in patients with blood cancers.
Kate Burbury:
Kate Burbury:
So what I can say is that it's not the same for all patient populations, there are some people with underlying malignancies who aren't at an increased risk of a severe infection, but equally they are the people who are most likely to respond well to the vaccine as well. So, certainly for us I think the most important thing is some protection is…
Norman Swan: Yes, but why would an oncologist recommend to somebody with cancer not to have the vaccine at all?
Kate Burbury:
Kate Burbury:
As I said, I think reach out to your haematologist. This is something we are very familiar with and we have very good strategies to support our patients in terms of the decision-making, and equally with GPs. And many of us as haematologists and oncologists are working with the GPs in this space. I think telehealth has been transformative in this space, so we are doing telehealth consultations with the GPs and the patients to advise them around Covid vaccination.
Norman Swan: Kate, thanks for joining us on the Health Report.
Kate Burbury: Thank you for having me.
Norman Swan: Associate Professor Kate Burbury is a haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre in Melbourne.
REFERENCES
Maneikis et al, 2021. "Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study" https://doi.org/10.1016/S2352-3026(21)00169-1
https://www.thelancet.com/journals/lanh ... 1/fulltext
Firstly, I hope everyone is coping well in these difficult times, & managing to stay safe & happy as possible...
Before making this Post, I believe that it is incumbent upon me to state that how a vaccine affects one type of 'Blood cancer' patient, may be quite different to that of another, because not all of us are requiring the same treatment. Hence, there's a little bit to unpack through this Post & Podcast of from Dr Norman Swan & Dr Kate Burbury of the Peter MAC Cancer Foundation in Victoria.
It is therefore essential to realise that this talk & the subsequent findings are all premised upon the Lancet Report, (provided in the References below).
In Australia, much unlike other western nations, we tend to be the last ones to learn about the potential impacts of ramifications concerning 'Blood cancers', in my view...
Hopefully, this Post & report might aid some of you in our understandings of what it might be like to live in a Post COVID world w/ a blood cancer, that might be impacted by vaccines, and their likelihood of producing protective COVID anti-bodies or not...
PLEASE remember to discuss anything here first w/ your MPN specialist before making decisions concerning your health & well-being...
Please stay safe, happy & well...
Best wishes
Steve
KEY FINDINGS OF LANCET REPORT:
pp. e591In this study, there were severe breakthrough SARS-CoV-2 infections with a high viral load in fully vaccinated patients with haematological malignancies, three of which were fatal. The genotyping suggests that the infections were caused by the B.1.1.7 lineage, showing that fully vaccinated patients with haematological malignancies might develop severe COVID-19, even with strains not associated with substantial BNT162b2-induced immunity evasion. Although most of the infections happened in patients with low anti-S IgG antibody titres, severe COVID-19 was also seen in a patient with a reasonable antibody response to vaccination. The number of breakthrough infections we observed is too low to draw any conclusions about the protective antibody concentrations, which are currently unknown.
pp. e591-592Our findings suggest that in seronegative patients with haematological malignancies, the second dose of BNT162b2 should not be delayed. In previously seroconverted patients, the second dose is less urgent. Breakthrough severe SARS-CoV-2 infections in fully vaccinated patients with haematological malignancies emphasise the importance of ongoing strict adherence to non-pharmacological interventions, including personal protection, periodic pre-emptive testing, and household vaccination programmes, as well as novel pharmacological pre-emptive postexposure interventions when these become available. Prospective studies to develop optimal vaccination strategies in patients with haematological malignancies are warranted.
ABC Radio National PODCAST
(Link below)
https://www.abc.net.au/radionational/pr ... s/13441304
Protection against COVID for people with blood cancers
On Health Report with Dr Norman Swan
One of the commonest questions we get on Coronacast is from people with cancer who ask whether they should be vaccinated against COVID and how effective are the current vaccines?
While people with cancer generally respond well to Covid-19 vaccines and are able to produce protective antibodies, that may not be as true for people who have blood malignancies like leukaemia where the immune system itself is affected.
New research published in The Lancet Haematology has found that people with blood cancers, and in particular those on certain treatments, had lower antibody responses to the Pfizer vaccine.
So what does this mean for those affected and how can they stay safe in the pandemic?
Guest: Associate Professor Kate Burbury
Haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre
Host: Dr Norman Swan
Duration: 6min 26sec
Broadcast: Mon 12 Jul 2021, 5:40pm
Transcript
Norman Swan: One of the commonest questions we get on Coronacast, our sister podcast, is from people with cancer who ask whether they should be vaccinated against Covid and how effective are the current vaccines. Well, people with cancer generally respond well to COVID-19 vaccines and are able to produce protective antibodies. That may not be as true for people who have blood malignancies like leukaemia where the immune system itself is affected.
New research published in the Lancet Haematology has found that people with blood cancers and particularly those on certain treatments, had lower antibody responses to the Pfizer vaccine. So what does this mean for those affected, and how can they stay safe in the pandemic? Associate Professor Kate Burbury is a haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre. Welcome to the Health Report, Kate.
Kate Burbury: Thank you for having me, Norman.
Norman Swan: So the findings of this were not just about leukaemia, it was about the treatment that they were on.
Kate Burbury: Correct. This study, interestingly, is concordant with what we already know, that both patients with blood cancers either related to their underlying blood disorder, as you alluded to Norman, such as leukaemia, or the treatment they are receiving, can have a reduced or varied antibody response to vaccines, included COVID-19 vaccine. It's not unique to that one, it's across-the-board with vaccines. And I think importantly this is something that, as doctors looking after these patients, we are very familiar with. So for patients with blood cancers or indeed across-the-board with cancers, reaching out to your haematologist or oncologists or indeed your GP to ask about the appropriateness of any vaccine including COVID-19 is really important.
Norman Swan: How different is the results, though, compared to people who have got regular cancer? When I say 'regular cancer', I mean what they call solid tumours like colon cancer, lung cancer, breast cancer?
Kate Burbury: Understood, and I think largely it's due to their ability to mount an antibody response. So we know there are certain blood disorders such as leukaemia, sometimes in B cell disorders such as chronic lymphocytic leukaemia or myeloma, they are unable to mount antibody responses generally, as well as due to vaccines. So it is more problematic in patients with blood cancers.
Norman Swan: So they are protected by other people's immunisation. The French would give three doses of Pfizer to people like this. Why aren't we?But I liken it a little bit to how we use the annual flu vaccine. We know that being a vaccinated won't necessarily prevent an infection but we hope…the intent is to prevent but we [unclear] will reduce the likelihood of a severe infection and therefore further transmission as well. So in particular with patients that have a reduced immune system, some protection is better than none, and more importantly a widespread vaccination program throughout the community will hopefully achieve a reduced likelihood of transmission, particularly to those patients who are at risk.
Kate Burbury:
Norman Swan: What about organ transplant recipients?It's a good question and I think we don't know the answer to that, Norman, I think that's across-the-board with all the vaccines. And even if you look at this current study, they took index points before they were vaccinated, at the point of the first and then ten days post the second vaccine, and we don't know the durability of those vaccines. So giving further boosters doesn't necessarily mount a greater response. It may over time, but more importantly you can see the most discriminating factor was actually time since their last treatment. So actually revaccinating people during their lowest immune period might not necessarily be advantageous.
Kate Burbury:Many people with blood cancers have had a bone marrow transplant, and there is some disturbing evidence from other organ transplants that organ transplant recipients get almost no antibody response to vaccines.
Norman Swan: I mentioned Coronacast and the questions we get, I keep on getting questions from people saying their oncologist has advised…and I'm gobsmacked to hear it, that their oncologist has advised them not to have the vaccine at all. Why on earth would an oncologist recommend that to somebody with cancer when it seems to me that the imperative is actually to get vaccinated, even if the results are a bit poorer than the general population.So I think we need to separate solid versus stem cell transplants, and you can see even in this study, those that got donor stem cell transplants, so allogeneic, where they are basically being given a healthy donor stem cell that reconstitutes their immune system, they actually had very good antibody responses. And indeed those that had their own stem cells back also had very good antibody responses. So that's very different to someone who has had a solid organ transplant that then requires immunosuppression to prevent rejection of that organ transplant. I would put solid organ transplants in a similar position to those with suppressed immune systems due to their underlying disease and/or therapy.
Kate Burbury:
So what I can say is that it's not the same for all patient populations, there are some people with underlying malignancies who aren't at an increased risk of a severe infection, but equally they are the people who are most likely to respond well to the vaccine as well. So, certainly for us I think the most important thing is some protection is…
Norman Swan: Yes, but why would an oncologist recommend to somebody with cancer not to have the vaccine at all?
Kate Burbury:
Norman Swan: And finally, just advice for people with cancer, particularly haematological malignancies?I can't speak for individual oncologists but I know generally across-the-board most of us would be advocating some protection is better than none. And the only concern we would have is that they might not mount an adequate antibody response and therefore advocating that they continue to pursue the usual protective mechanisms such as keeping themselves safe and avoiding people that might have infective symptoms. But I would be surprised if oncologists and haematologists would be advising against it for the fear of safety issues and otherwise, except in the situation where we know there may be a risk of developing clots with a vaccine.
Kate Burbury:
As I said, I think reach out to your haematologist. This is something we are very familiar with and we have very good strategies to support our patients in terms of the decision-making, and equally with GPs. And many of us as haematologists and oncologists are working with the GPs in this space. I think telehealth has been transformative in this space, so we are doing telehealth consultations with the GPs and the patients to advise them around Covid vaccination.
Norman Swan: Kate, thanks for joining us on the Health Report.
Kate Burbury: Thank you for having me.
Norman Swan: Associate Professor Kate Burbury is a haematologist and Deputy Chief Medical Officer at the Peter MacCallum Cancer Centre in Melbourne.
REFERENCES
Maneikis et al, 2021. "Immunogenicity of the BNT162b2 COVID-19 mRNA vaccine and early clinical outcomes in patients with haematological malignancies in Lithuania: a national prospective cohort study" https://doi.org/10.1016/S2352-3026(21)00169-1
https://www.thelancet.com/journals/lanh ... 1/fulltext