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New study shows blood cancer patients need at least 3 vaccinations to develop COVID-19 antibodies


A new study involving researchers at Leicester’s Hospitals and the University of Leicester has found that some people with cancer need at least three vaccinations in order to get any level of protection against COVID-19. 

People with a type of blood cancer called lymphoma often have a weakened immune system and are at high risk of severe COVID-19 disease, even if they have been vaccinated. 

The UK PROSECO study, which was set up by Dr Sean Lim at Southampton University and funded by Blood Cancer UK, analysed blood samples from patients with cancer before and after vaccination. The aim was to understand the extent to which their bodies created an immune response against COVID-19.

The study included 457 patients with blood cancer and who were undergoing active treatment for lymphoma. It used blood samples taken prior to vaccination and then following the first, second, and third vaccination to measure antibody levels and T-cell responses, both of which play important roles in the immune system. 

The researchers found that more than half (52 per cent) of all participants did not produce any antibodies after two COVID vaccinations. 

However, a third vaccine dose boosted antibodies in 92% of patients. Notably, patients on the study who were being treated with a certain kind of cancer treatment known as anti-CD20 treatment were significantly less likely to develop antibodies against COVID-19, with only 17% of patients on the study receiving this type of therapy going on to develop antibodies after a third vaccine.

Dr Matthew Ahearne, Clinical Lecturer at the University of Leicester and Consultant Haematologist at the University Hospitals of Leicester NHS Trust, co-authored the report. He said: 

“The global pandemic has been a challenge for everyone, but the incredible success of the vaccination programme now means society is returning to normal as COVID-19 restrictions are lifted. 

“However, there is significant uncertainty for people who are immunosuppressed, including those living with cancer, some of whom may not be protected by vaccinations and may remain vulnerable. 

“This study shows that regular antibody monitoring is vital to understand how many vaccine doses patients with cancer need to give adequate protection from serious illness due to COVID-19. There is also an urgent need to create revaccination strategies for people vaccinated whilst on active anti-cancer therapy: as this study shows, certain cancer treatments can dramatically reduce vaccine efficacy.”

Martin Huckerby from Sapcote in Leicestershire was diagnosed with lymphoma in December 2018. He was one of the 71 patients who agreed to take part in the trial in Leicester. 

He said: “Taking part in the study was a no-brainer: it gave me the opportunity to put something back. I am just so grateful to the NHS and its nurses for the fantastic care and treatment I’ve had over the past 3 years, so I was happy to help the researchers understand more about COVID and cancer. All I had to do was give some blood.”

Unfortunately Martin is one of the participants who did not develop a detectable immune response, despite receiving four vaccinations against COVID. 

He added, “I hope the researchers can find out why it hasn’t worked on my particular type of lymphoma. But life carries on – I will continue to wear a mask and protect myself as much as I can.” 

Leicester was among the top three sites for patient recruitment for the UK PROSECO study. This is a testament to the success of the clinical research team at the HOPE Cancer Trials Centre and the enthusiastic support of patients in Leicester.

Dr Ahearne added: “On behalf of the Hope Cancer Trials Centre team I’d like to thank all our patients like Martin who volunteered to be part of the study, without whom this important research could not have taken place.”

Cancer research experts are now keen to learn how antibody levels and T-cell responses can be used to predict risk of infection, hospitalisation and death from COVID-19. Further analysis into the clinical outcomes of patients in the UK PROSECO study will follow.

Findings from the UK PROSECO study suggest there is an urgent need for national antibody monitoring guidelines to be put in place that use evidence such as this to decide on the best timing and number of vaccine doses required for people with cancer, as well as a coherent revaccination strategy for people who were vaccinated whilst on active anti-cancer therapy.

The paper, 'Immune responses against SARS-CoV-2 variants after two and three doses of vaccine in B-cell malignancies: UK PROSECO study' in published in Nature Cancer.


Rachael Dowling, head of research communications, researchcomm@uhl-tr.nhs.uk