COVID-19 Information Hub

Dear lymphoma community,

In an effort to protect our community and our staff from potential exposure to COVID-19 our office is closed until further notice.  All staff will be working remotely to provide our services in the areas of education, support, advocacy, and research.  We continue to respond to all inquiries via phone and email.  We are here to help as always, so please do not hesitate to contact us.

The worldwide battle against the COVID-19 virus continues.  Within Canada, our federal and provincial governments are responding with legislation and guidance to help protect Canadians as well as to provide regular updates on the impact of the virus in Canada.  Topics addressed include: vaccines, financial and economic support, travel, your health, limiting the spread, and other daily updates about COVID cases in the country.  This information is constantly evolving. Below we have provided links to the federal and provincial/territorial COVID-19 webpages and websites dealing with cancer patient-specific resources related to COVID-19.  We recommend that you consult these pages often and follow the guidance provided therein.

**IMPORTANT UPDATES**

The fourth COVID-19 vaccine

On March 31st, 2022, the National Advisory Committee on Immunization (NACI) reviewed emerging evidence on the duration of protection of the first booster dose and the vaccine effectiveness/safety of a second booster dose
of COVID-19 vaccines. NACI has made the following recommendation for rapid deployment of a second COVID-19 vaccine booster dose program (4th dose for immunocompetent individuals with a 2-dose primary series or 5th dose for moderately to severely immunocompromised individuals who have a 3-dose primary series):

• Adults 80 years of age and over living in the community (Strong NACI Recommendation)
• Residents of long-term care or other congregate living settings for seniors (Strong NACI Recommendation)
• While the greatest benefit is expected in adults 80 years of age and older, jurisdictions may also consider offering a second COVID-19 booster dose to adults 70-79 years of age living in the community. (Discretionary NACI Recommendation)

In general, jurisdictions should aim to provide a second booster dose 6 months after receipt of the previous booster dose, but the 6 month interval may need to be balanced with local and current epidemiology.

Please speak with your healthcare provider to determine if you are eligible to receive the second booster within your province. 

Lymphoma Canada will continue to monitor for any future guidelines released by the National Advisory Committee on Immunization (NACI) regarding the fourth vaccine for immunocompromised lymphoma patients. 

Treatments for COVID-19

Health Canada has approved several different treatments for COVID-19. Examples include drugs that reduce or stop the virus from multiplying in human cells and drugs that treat the symptoms of COVID-19. Currently approved treatments include:

• Remdesivir (Veklury)
• Bamlanivimab
• Casirivimab and imdevimab
• Sotrovimab
• Nirmatrelvir and ritonavir (Paxlovid™)
• Tixagevimab and cilgavimab (Evusheld™)

Evusheld is an option for people who are immunocompromised and whose immune system is unable to respond adequately to COVID‐19 vaccination as well as for people for whom vaccination is not recommended.

To learn more about these treatments, speak with your doctor.

Advocacy Efforts

The COVID-19 landscape in Canada is constantly changing with new information from the latest research. Because of the evolving nature of information surrounding COVID-19, different guidelines have been released by the provincial, territorial, and federal governments. Some guidelines take into account new research and provide specific guidance for cancer patients and their treatments, while many guidelines leave questions unanswered. To address challenges faced by the lymphoma community regarding COVID-19 and vaccine access, Lymphoma Canada continues to advocate on behalf of patients and caregivers.

1. With the support of many organizations including Lymphoma Canada, a letter was sent on February 1, of this year to the National Advisory Committee on Immunization (NACI), the Federal Minister of Health, Health Canada, and other provincial health bodies. This letter provided recommendations for dosing schedules to meet the required clinical trial timelines and advocated for the development of a pan-Canadian strategy for the collection and distribution of research and data on COVID-19 and the vaccine to guide decision-making.

Access Letter Here

2. Following these efforts, NACI continued with its 4-month dose delay schedule. With recent research published, addressing the safety and immune response in cancer patients, real evidence was provided to counter NACIs decision. Our Scientific Advisory Board felt strongly that continuing our advocacy efforts to address this issue was important. With this information, Scientific Advisors and clinicians affiliated with patient groups added their support. A second follow-up letter was sent on April 1, to Provincial/Territorial Health Ministers, Chief Medical Officers, Premiers, and Public Cancer Agencies, along with Health Canada and NACI about three important challenges facing the lymphoma and cancer community.

Access Letter Here

3. On April 7, NACI released a statement re-affirming their decision to continue with the 4-month dose delays. However, jurisdictions may choose to shorten the time between the first and second dose for specific populations. Certain provinces such as Ontario and Manitoba have adopted provincial guidelines to ensure normal dosing is scheduled for specific high-risk individuals. It is important to stay up-to-date with your province’s immunization plan as it could change to include your eligibility! After hearing from patients and caregivers about continued advocacy efforts, it was decided that a national awareness campaign was the next best step. Lymphoma Canada along with other patient organizations will be launching an article in the Globe & Mail that is addressed to the Prime Minister and Provincial/Territorial Health Bodies focused on the continued dose delays for cancer patients. This was published on April 28, 2021.

Access Article Here

4. Further advocacy efforts were taken in British Columbia, publishing a similar advocacy article in the Victoria Times Colonist on May 12, 2021, alongside in Quebec.

5. Lymphoma Canada, in collaboration with CLL Canada and the Lymphoma & Leukemia Society of Canada, have advocated to NACI on revising their definition of immunocompromised to be inclusive of lymphoma and CLL patients that are not on active treatment but are still immunosuppressed. Advocacy efforts began in February 2022 and will continue with NACI and across the provinces.

More advocacy work to come. We hear you; we support you!

Important Research Published on the COVID-19 Vaccine in Lymphoma and CLL Patients

The following are important scientific studies published on the safety and efficacy of the COVID-19 vaccines in lymphoma patients. As lymphoma patients were not included in the original vaccine clinical trials, research is currently underway to better understand the immune response in lymphoma subtypes. Few studies have been published thus far.

1.Research published on the efficacy and safety of a booster vaccination with Ad26.COV2.S DNA vector vaccine in haemato-oncological patients without antibody response after double-dose mRNA COVID-19 vaccine.

Reimann P. et al. (February 2022). Efficacy and safety of heterologous booster vaccination with Ad26.COV2.S after BNT162b2 mRNA COVID-19 vaccine in haemato-oncological patients with no antibody response. Br J Haematol, 196(3):577-584. Access article here.

2.Research published on the efficacy of a third mRNA vaccine in CLL patients who did not have a response after the standard 2-dose vaccination regimen.

Herishanu, Y., et al. (February 2022). Efficacy of a third BNT162b2 mRNA COVID-19 vaccine dose in patients with CLL who failed standard 2-dose vaccination. Blood, 139(5):678-685. Access article here.

3.Research published on the efficacy of the mRNA vaccine in immunocompromised individuals (untreated or treated lymphoma and CLL patients) compared to healthy controls.

Bergman, P. et al. (December 2021). Safety and efficacy of the mRNA BNT162b2 vaccine against SARS-CoV-2 in five groups of immunocompromised patients and healthy controls in a prospective open-label clinical trial. EBioMedicine, 74:103705. Access article here.

4.Research published on the efficacy of the third COVID-19 vaccine in hematology and solid cancer patients.

Fendler, A. et al. (December 2021). Immune responses following third COVID-19 vaccination are reduced in patients with hematological malignancies compared to patients with solid cancer. Cancer Cell. Access article here.

5. Research published showing reduced immune response to the COVID-19 mRNA vaccine in hematology patients receiving Rituximab therapy.

Peeters, M. et al. (Oct 2021). Reduced humoral immune response after BNT162b2 coronavirus disease 2019 messenger RNA vaccination in cancer patients under antineoplastic treatment. ESMO Open. 6(5):100274. Access article here.

6. Research published on the antibody response to the COVID-19 vaccine in hematology patients (different subtypes grouped together) and other solid tumour patients.

Benda, M. et al. (August 3, 2021). Serological SARS-Cov-2 antibody response, potential predictive markers and safety of BNT162b2 mRNA COVID-19 vaccine in haematological and oncological patients. Br J Haematol. Access article here.

7. Treatment with anti-CD20 treatment and active disease are negative predictors for a negative antibody response to the COVID-19 vaccine. Differences in CD20 treatments (obinituzumab vs rituximab) can play a role in response.

Gurion, R. et al. (July 29, 2021). Humoral serologic response to the BNT162b2 vaccine is abrogated in lymphoma patients within the first 12 months following treatment with anti-CD20 antibodies. Heamatologica. Access article here.

8. Research confirming that the first dose of both BNT162b2 and AZD1222 vaccine leads to lower production of antibodies against SARS-CoV-2 in patients with Waldenstrom Macroglobulinemia/Chronic Lymphocytic Leukemia/Non-Hodgkin Lymphoma compared to controls of similar age and gender and without malignant disease.

Gavriatopoulou, M. et al. (July 20, 2021). Low neutralizing antibody responses in WM, CLL and NHL patients after the first dose of the BNT162b2 and AZD1222 vaccine. Clin Exp Med., 1–5. Access article here.

9. Research on the antibody response to the COVID-19 vaccine in lymphoma subtypes. Importantly looks at timing of treatment and types of treatment received.

Herzog Tzarvfati, K. et al. (June 29, 2021). BNT162b2 COVID-19 vaccine is significantly less effective in patients with hematologic malignancies. AJH. Access article here.

10. Research showing that COVID-19 vaccine administration can cause vaccine-associated hypermetabolic lymphadenopathy (swelling of your lymph nodes) close to the vaccine site which can mimic progression of disease on PET imaging scans.

• Clinician’s should ask their patient when they received their vaccine(s) when interpreting the results of imaging scans.

Cohen, D., Krauthammer, S.H., Wolf, I. & Even-Sapir, E. (June 2021). Hypermetabolic lymphadenopathy following administration of BNT162b2 mRNA COVID-19 vaccine: incidence assessed by [18F]FDG PET-CT and relevance to study interpretation. Eur J Nucl Med Mol Imaging. Access article here.

11. Research determining the immune response to the COVID-19 vaccine in Chronic Lymphocytic Leukemia patients.

Herishanu, Y. et a. (April 16, 2021). Efficacy of the BNT162b2 mRNA COVID-19 vaccine in patients with chronic lymphocytic leukemia. Blood, 2021011568. Access article here.

12. Study that measured the antibody response to the COVID-19 mRNA vaccines in hematology patients.

Agha, M. et al. (April 7, 2021). Suboptimal response to COVID-19 mRNA vaccines in hematologic malignancies patients. MedRxiv. Access article here.

13. Interim research looking at the immune response to the COVID-19 vaccine in hematological patients.

Monin-Aldama, L. et al. (March 17, 2021). Interim results of the safety and immune-efficacy of 1 versus 2 doses of COVID-19 vaccine BNT162b2 for cancer patients in the context of the UK vaccine priority guidelines. MedRxiv. Access article here.

If you have any questions regarding these clinical studies, please contact us at info@lymphoma.ca.

Resources for Cancer Patients

We suggest you visit these COVID-19 Cancer Specific Resources:  Support for cancer patients – COVID-19 Cancer Patient Support Hub (covid19oncologyresources.ca)

This website is intended for people in Canada living with cancer, caregivers, their families, and anyone else affected by cancer.  It is regularly being updated as new developments, resources, services and assistance relating to COVID-19 and oncology change or become available.

If you are a patient with lymphoma or CLL, please do not hesitate to reach out to us for support at info@lymphoma.ca

Additional resources are available as follows:

World Health Organization: Coronavirus (who.int)

Canadian Pharmacists Association: CPhA – COVID-19: Information for Pharmacists – English

Lymphoma Canada’s COVID-19 Action Plan is sponsored by Merck.

Financial support has been provided by Gilead.