On 1 September, the JCVI announced that people who had a very weakened immune system at the time of their first and/or second vaccine doses will be given a third dose of a COVID-19 vaccine (known as a third primary dose).
The decision on who is eligible for a third dose of the vaccine and when will be made by their haematologist. The decision will be based on how well the person’s immune system was working at the time of vaccination.
The advice states that haematologists should take responsibility for providing clear advice to the patient’s GP about the need for a third primary dose of vaccine and the optimal timing.
Myeloma patients who received HDT-SCT or CAR-T cell treatment after their initial COVID-19 vaccination should still be re-vaccinated with the two-dose schedule around three to six months post-transplant. A third primary dose of vaccine should be administered at least 8 weeks after the second dose (in line with the advice above).
Anthony Nolan have produced a letter template for your transplant or haematology team to use to inform your GP of your need to be re-vaccinated after HDT-SCT. NHS England has approved the template. In some cases, your transplant team may be able to arrange your re-vaccination themselves, but they still should let your GP know.
Adults and children aged 12 years and over who are immunosuppressed, which includes myeloma patients, are included in the Stage 1 rollout.
The third dose is not the same as a booster.
If you had a very weakened immune system at the time of your first and/or second vaccine doses you should get a third dose of a COVID-19 vaccine and a booster. The booster should be given six months after the third primary dose.
The processes for organising and scheduling appointments for the third dose of COVID-19 vaccines vary across the UK. Therefore, there are some delays, and some patients will receive their third doses later than others.
Most patients will be contacted by letter or text to confirm eligibility. You will then be invited to book an appointment to receive your third dose as part of your primary care.
If you have not heard any information about your third dose you should contact your haematologist or clinical nurse specialist because they are primarily responsible for identifying people who are eligible for this third dose. They should be able to tell you if you are eligible for the third dose and give you more information about how the appointments for third doses are being arranged in your area. For patients managed through their GP you will need to organise your appointment through them.
If you are experiencing difficulties explaining your eligibility for a third COVID-19 vaccine to a healthcare professional, download this letter to inform your GP and/or haematology team about your need to receive a third vaccine and not a booster. You can also refer them to this Government and JCVI update or ask them to check COVID-19: the green book, chapter 14a for further information.
The JCVI specifically outlines patients under follow-up for myeloma and “other plasma cell dyscrasias”. Plasma cell dyscrasias include monoclonal gammopathy of undetermined significance (MGUS), smouldering myeloma, POEMS syndrome and AL amyloidosis.
We know many patients are experiencing difficulties in booking their third dose for the COVID-19 vaccine and this can be stressful.
At Myeloma UK we are working hard to make sure patients can access a third dose of the COVID-19 vaccine. We will continue to update advice when we receive further information.
The third dose of the COVID-19 vaccine is only for people with very weakened immune systems at the time of their first and/or second vaccination. This dose is being given to improve response rates and increase the level of protection against COVID-19.
Research has shown that people with weakened immune systems are less likely to produce a sufficient immune response after two vaccines doses. The third dose is now part of the standard vaccination schedule for people with weakened immune systems to increase their chance of producing an immune response.
A booster is given after someone has achieved a sufficient response to a vaccine. Boosters help maintain and extend the level of protection received from the initial vaccination schedule. Boosters are currently being offered to people aged 50 and over, as well as other groups as specified by the government.
The dose and ingredients in a third dose, or booster, of the Pfizer-BioNTech or Oxford-AstraZeneca COVID-19 vaccines are identical to the first two doses.
The ingredients in a third dose, or booster, of the Moderna vaccine are identical. However, the dose is different. It is offered as a full dose for a third dose and a half dose for the booster vaccine.
If you have received the Moderna vaccine as a booster and not as a third dose, and you are eligible for a third dose, please contact your healthcare team so they can advise you.
For the Pfizer-BioNTech or Oxford-AstraZeneca COVID-19 vaccines, the main concern is ensuring your name is on the list to receive a booster in Spring 2022. If you have received a Pfizer-BioNTech or Oxford-AstraZeneca as a booster already, contact the GP surgery, hospital or vaccination centre that administered the vaccine and ask them to amend your records. Your records need to state that you have received a third dose of a COVID-19 vaccine to make sure you are called back for a booster in the future.
If you have received the Moderna vaccine as a booster, contact your healthcare team and/or the facility that administered your vaccine to let them know that you have received a booster (a half dose) when you were eligible to receive a third dose (a full dose).
You can give the healthcare team our letter to inform them of your eligibility for a third dose. They will be able to advise you on any other steps that need to happen.
If you have been invited to receive a booster and have not yet attended it, try to contact the healthcare team to make sure they understand you are eligible for a third dose and amend your record before attendance.
You can refer the healthcare team to our letter to inform them about your eligibility for a third dose.
If you are struggling to contact the healthcare team before your appointment, consider emailing them a copy of our letter.
You could also print off the letter or save a copy on your phone to bring to your appointment. Give this information to the person administering the vaccine to help explain your eligibility for a third dose. This is to ensure that your vaccine record is being recorded correctly and, in the case of Moderna, ensure you receive the full dose.
Yes, if you received a third dose you should also get a booster.
When the booster programme is rolled out, people with weakened immune systems will be encouraged to have a booster at a minimum of six months after their third dose. We will continue to update advice from the JCVI when we have received further information.
Anyone living in the same household as a myeloma patient (or someone with a weakened immune system) is now eligible for a booster dose if it has been more than six months since their second dose.
Advice from the British Society of Blood and Marrow Transplantation and Cellular Therapy Vaccination Sub-Committee is that patients who have received a COVID-19 vaccine prior to HDT-SCT should be considered non-vaccinated after their HDT-SCT and therefore should be re-vaccinated against COVID-19.
Re-vaccination should be considered 2-6 months following HDT-SCT.
Patients who are concerned about their vaccines should talk to their clinical team when they get their vaccination letter. They will be able to tell you if the timing of the vaccine fits with your ongoing treatment.
Most people will receive the Moderna or Pfizer-BioNTech COVID-19 vaccines for the third dose, as recommended by the JCVI. Practical and operational reasons will determine which vaccine you are offered, and it may be different from the one you had before.
The AstraZeneca vaccine may be offered on a case-by-case basis following a decision by your healthcare team. For example, if there are problems with the supply of either the Moderna or Pfizer-BioNTech vaccines, the JCVI has recommended that adults over 18 who have already received the AstraZeneca vaccine can be offered this as an alternative.
Four vaccines have been approved for use in the UK by the Medicine and Healthcare Products Regulatory Agency (MHRA).
Vaccinations with the Pfizer-BioNTech vaccine, the Oxford-AstraZeneca vaccine and the Moderna vaccine are currently underway.
Plans and guidelines for the use of the Janssen-Johnson & Johnson vaccine will be released soon.
Vaccines work by causing your body to have an immune response against a specific infection without causing the infection itself. Your body remembers this response when it comes into contact with the infection, making it easier for your body to fight it off.
The vaccines currently available in the UK for COVID-19 work in different ways.
The Pfizer-BioNTech and Moderna vaccines – mRNA vaccines:
The Oxford-AstraZeneca vaccine and the Janssen-Johnson & Johnson – viral vector vaccines:
No. The vaccines don’t contain any ‘live’ COVID-19 virus, therefore, you can’t develop COVID-19 from the COVID-19 vaccines.
Like all other vaccines and medicines, the COVID-19 vaccine can cause side effects, although not everybody gets them.
Most side effects of the COVID-19 vaccine are mild and shouldn’t last longer than a week.
Common side effects include:
If you are concerned about any side effects, talk to your GP, haematologist or clinical nurse specialist.
Note: Patients on immunosuppressive treatment or recovering from high-dose therapy and stem cell transplantation (HDT-SCT) have a higher risk of infection (e.g. pneumonia). Some of the side effects caused by the COVID-19 vaccine are similar to signs of an underlying infection. Therefore, if you develop a high temperature and think it might be caused by an underlying infection you should contact your healthcare team.
The COVID-19 vaccines should give myeloma patients some protection against COVID-19.
However, we know that medications, immune function, and pre-existing health conditions can affect how some vaccines work. Therefore, the COVID-19 vaccine may not be fully effective in patients with weakened immune systems or people having treatment that weakens the immune system. Although the vaccine might not be fully effective in some myeloma patients, it is still important to be vaccinated as it will provide some protection against severe illness due to COVID-19.
Following vaccination, patients should continue to follow infection prevention measures, such as frequent hand washing and social distancing, unless told otherwise by their doctor.
You can learn more about the effectiveness of the COVID-19 vaccine in our video.
Research looking at how well COVID-19 vaccines work for myeloma patients is ongoing. So far, only data about how well myeloma patients respond to the first dose of COVID-19 vaccines have been published. The studies (the Royal Marsden/Institute of Cancer Research study and the PREPARE study) suggest that 60-70% of myeloma patients respond to the first dose of a COVID-19 vaccine. This tells us that most myeloma patients can and do respond well to COVID-19 vaccines.
However, more research is required to determine how well patients respond to both doses of the vaccine and the level of protection myeloma patients get from the vaccine. To help answer these questions Myeloma UK has joined the Blood Cancer UK Vaccine Research Collaborative.
You can learn more about the effectiveness of the COVID-19 vaccine in our video.
The Joint Committee for Vaccination and Immunisation (JCVI) does not advise a preference for either vaccine in any specific group of people. This is because there is insufficient data to directly compare the vaccines. The clinical trials have different designs (e.g. differences in who took part, where and when they were carried out and how effectiveness was measured) and there are no clinical trials directly comparing the Pfizer-BioNTech, Oxford-AstraZeneca and Moderna vaccines. All three vaccines give very high protection against severe illness due to COVID-19.
The dosing schedule was determined by the Joint Committee on Vaccination and Immunisation (JCVI). The JCVI analysed all the available data and concluded that 12 weeks is a reasonable dosing interval to achieve good longer-term protection. In their evidence statement supporting the widening of the dosing schedule to within 12 weeks of the first dose, the JCVI stated that they expected the vaccines to be as or more effective when delivered at an interval of 12 weeks from the first dose. Please be assured that this is something that Myeloma UK is monitoring.
You can read more about the dosing schedule in our COVID-19 blog.
Research looking at how vaccines impact transmission rates is ongoing.
In April, Public Health England released data about the impact one dose of a COVID-19 vaccine had on transmission rates. This data showed that those who became infected with COVID-19 three weeks after receiving one dose of the Pfizer-BioNTech or Oxford-AstraZeneca vaccine were between 38% and 49% less likely to pass the virus on to their household contacts than those who were unvaccinated.
This suggests that the vaccines do reduce the transmission of the virus and that vaccinating carers, family and friends helps further protect myeloma patients from COVID-19.