For some people, COVID-19 feels like no more than a minor cold. Unfortunately, this is not typical for people with blood cancers like lymphoma or leukemia. Most people with these conditions have risk factors that increase their chances of getting severe COVID-19, which may lead to hospital stays or even become a life-threatening situation.

To address these concerns, the Leukemia & Lymphoma Society (LLS) recently published a guide that provides multiple tips for protecting health, including advice about vaccination and other precautions for those living with blood cancer.

The best way to protect against serious consequences of COVID-19 is through vaccination. Vaccines can minimize your risk of severe disease, although you’ll need to get updated vaccines to stay protected against new COVID-19 variants.

The New Monovalent COVID-19 Vaccines

The U.S. Food and Drug Administration (FDA) has approved a new round of updated messenger RNA (mRNA) COVID-19 vaccines for adults and children ages 6 months and up. These new versions of the Moderna and Pfizer vaccines are recommended by the Centers for Disease Control and Prevention (CDC).

The previous round of mRNA vaccines were bivalent, meaning they contained blueprints of spike proteins found in two different versions of the SARS-CoV-2, the virus that causes COVID-19. These new vaccines are monovalent — they contain the blueprints of a single variant, called Omicron variant XBB.1.5 and nicknamed “Kraken.”

Health experts have identified XBB.1.5 as being highly transmissible and contagious. People who’ve received previous vaccinations or previously had COVID-19 have still been infected with this newer variant.

Who Should Get the New Vaccine?

All people ages 5 and up are eligible for one dose of the new vaccine as long as it’s been at least two months since their last vaccination. Children 6 months to 4 years old may receive more than one dose of the new vaccine, depending on their vaccination status.

People who are moderately or severely immunocompromised (have weakened immune systems) should also receive the new vaccine. The CDC cautions that these people are “at increased risk of severe COVID-19 illness and death.”

Are the New Vaccines Safe?

The FDA based its approval of the new mRNA vaccines on the safety and effectiveness of previous versions, which were manufactured in the same way as the new round. Per the CDC, millions of Americans have received COVID-19 vaccines “under the most intense safety monitoring program in U.S. history.”

The FDA noted that the benefits of receiving the vaccine outweigh any risks. Potential side effects — both common and rare but serious — are similar to those of previous versions of the vaccine. Common side effects are generally similar to flu symptoms, including temporary fever, chills, aches, and fatigue, along with irritation or soreness at the injection site.

Advice From LLS: Protecting Yourself Against COVID-19

COVID-19 vaccines work for people with leukemia. Some studies have found that people with leukemia are less likely to produce antibodies against the COVID-19 virus compared with those in the general population. However, other research has reported that people with blood cancers who get a third dose of the vaccine have higher antibody levels.

Do you have questions about your risk of COVID-19 or whether you should get further vaccination? Read on for some helpful tips outlined by the LLS.

1. Determine Your Immune Status

It’s important to know whether your immune system is compromised, for a couple of key reasons. First, you’re more likely to experience complications (additional medical problems) such as pneumonia, heart damage, or organ failure when you’re immunocompromised and get COVID-19. Second, getting a vaccine or booster will help reduce risk, but it might not offer as much protection as it would if you had stronger immunity.

How do you know if your immune system is suppressed? According to LLS, you may not have full immunity if you have a type of blood cancer that affects your B cells, such as diffuse large B-cell lymphoma, follicular lymphoma, marginal zone lymphoma, mantle cell lymphoma, Waldenström macroglobulinemia, or chronic lymphocytic leukemia.

Certain cancer treatments can also weaken your immune system. These include:

• Anti-CD20 monoclonal antibodies like rituximab (Rituxan) and obinutuzumab (Gazyva)
• Bruton tyrosine kinase inhibitors (TKIs) such as ibrutinib (Imbruvica), zanubrutinib (Brukinsa), acalabrutinib (Calquence), or pirtobrutinib (Jaypirca)
• Stem cell transplants
• Chimeric antigen receptor (CAR) T-cell treatments like lisocabtagene maraleucel or liso-cel (Breyanzi) or axicabtagene ciloleucel or axi-cel (Yescarta)

It’s a good idea to ask your doctor if you are immunosuppressed and whether you should take extra precautions against COVID-19.

2. Get Appropriate Vaccinations

To protect your health, it’s important to get vaccinated against infections. COVID-19 vaccines greatly decrease your chances of becoming infected with the virus that causes COVID-19. If you do develop an infection, having been vaccinated previously will likely mean you’ll experience milder symptoms and a reduced risk of severe COVID-19-related health problems.

Vaccination can be an important part of protecting your health. One study found that vaccinated people living with blood cancer were less likely to die from COVID-19 compared to those with blood cancer who developed COVID-19 before the vaccines were available.

The LLS recommends getting the initial COVID-19 vaccines plus a booster shot. The initial vaccination series for people with leukemia consists of three doses of an mRNA vaccine made by Moderna or Pfizer or at least one dose of a vaccine made by Novavax. The booster vaccine consists of a single dose of the updated 2023-2024 COVID-19 vaccine produced by either Moderna or Pfizer.

If your immune system isn’t as strong as it needs to be, you may need extra protection. Immunocompromised individuals may be able to receive extra doses of the 2023-2024 COVID-19 vaccine as a booster.

3. Think About Other Precautions

It’s possible to still get COVID-19 if you get vaccinated, although your risk will be reduced. So it’s a good idea to take extra steps to protect your health if you’re immunocompromised.

Public health experts list several steps to help prevent COVID-19, such as:

• Meeting up with others outdoors when possible, or air out an indoor space by opening a window
• Avoiding large crowds
• Keeping your distance from anyone who has COVID-19 or who has potential COVID-19 symptoms
• Wearing a clean, well-fitting mask that covers spans from your nose to your chin
• Washing your hands regularly and before touching your face

Ask your health care team to help you weigh the benefits and risks of protecting yourself from COVID-19 while still living a fulfilling life. For example, you may decide that you prefer avoiding indoor gatherings above a certain number of people.

4. Make a Plan in Case of Infection

If your immune system is weakened, it can’t properly fight off viruses and other germs. Even minor infections may quickly turn severe. Therefore, the LLS recommends having a plan to address infections so you can reduce your risk of complications.

First, the LLS suggests keeping COVID-19 tests on hand. Regularly check to make sure they’re not expired, and if they get too old, replace them with up-to-date tests. Check your infection status whenever you’re exposed to someone who tests positive or if you experience potential COVID-19 symptoms like fever, coughing, breathing difficulties, a stuffy or runny nose, body aches, nausea or vomiting, or diarrhea.

What happens if you test positive? Get in touch with your health care team right away. They can prescribe antiviral treatments that minimize symptoms or prevent your infection from getting worse.

While living with COVID-19, make sure to take care of yourself. Follow any recommendations from your doctor and use any medications as directed. Additionally, you can follow general advice for minimizing symptoms at home — get a lot of rest and drink plenty of fluids. You can also ask your doctor about taking over-the-counter pain medications.

Seek emergency medical care if, while living with COVID-19, you find yourself struggling to breathe, have ongoing chest pressure, feel confused, or can’t stay awake.

Learning More About Your Risk

The LLS guidelines address general concerns for people living with blood cancer. For more specific advice, get in touch with your health care team. Your doctor understands your health factors and can provide more personalized advice. Talk to your provider to better understand your current immune status and receive recommendations for getting a COVID-19 booster vaccine.

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 15,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Have you asked your doctor about getting a COVID-19 booster vaccine? Share your experiences in the comments below, or start a conversation by posting on your Activities page.