Maintaining our health and protecting our bodies from potential infection is paramount — perhaps now more than ever. There have been a ton of questions about the efficacy of vaccines (spoiler alert: they work). But if you have a diffuse large B-cell lymphoma diagnosis, you may be concerned about whether you should get certain vaccinations while you’re being treated for your condition.
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Oncologist Robert Dean, MD, explains why timing is everything when considering vaccinations after you’ve received a diagnosis.
Can people with lymphoma get vaccinated?
The quick answer is yes, you should get your standard vaccinations as soon as possible.
Your immune system is made of a gigantic network of cells that communicate with each other in order to build up its defenses and fight against incoming infections. When an infectious agent, like bacteria, viruses and parasites, is introduced, your body works to build up immunity against it. But certain types of cancer, like leukemia, lymphoma and multiple myeloma, affect your immune system directly.
“Your immune system is a really big, coordinated network with millions of cells communicating with one another,” explains Dr. Dean. “If you take a bunch of malignant versions of those cells and plop them into that network, they can disrupt the normal interactions between immune cells that they depend on in order to do their jobs properly.”
The standard treatment combination of chemotherapy and immunotherapy drugs affects your immune system, too, by temporarily wiping out some healthy immune cells. That can lower your immune system’s ability to create antibodies against new infections it hasn’t seen before.
For this reason, Dr. Dean recommends receiving vaccinations before your diagnosis, or receiving your vaccinations after diagnosis but before treatment to give your body enough time to build up its defenses before it loses that ability.
“It’s important to try to top off your immunity as much as possible before we get too far into treatment,” advises Dr. Dean. “It takes a long time for those reserve antibody-making cells to recover to normal levels again after people have finished their treatment.”
When it comes to vaccines, there are two main types to consider: live virus vaccines and non-live (or inactivated) virus vaccines.
Live virus vaccines
One way to get your immune system to generate a robust response against infection is to introduce a live virus to your immune system so it produces a mild infection and begins building antibodies against future attempts from that infection.
“Vaccines that work in this manner are some of the oldest vaccines that we have going back decades, and they can trigger very protective and long-lasting immunity without causing any serious illness in the vast majority of people who get them,” says Dr. Dean.
Some of these live virus vaccines include:
“They’re generally a weakened strain that won’t make you sick if you have a healthy functioning immune system, but they can cause illness if your immune system is weak,” says Dr. Dean. “Most guidelines recommend waiting three to six months after treatment before giving a live virus vaccine.”
Inactivated (non-live) vaccines
Another common form of vaccine is inactivated, meaning it’s composed of dead or inactivated viruses and bacteria. These don’t provide as much immunity as live virus vaccines, but they still do their job. Some common inactivated vaccines include:
There are other forms of non-live vaccines, and vaccination guidelines are updated often as new research becomes available. If you’re considering a vaccine, you should speak with your doctor about which recommended vaccines are appropriate for you.
The COVID-19 vaccine
The currently recommended COVID-19 vaccines are so-called “messenger RNA” (or mRNA) vaccines, and Dr. Dean strongly recommends everyone get at least two doses of one before they begin treatment for diffuse large B-cell lymphoma.
“The COVID vaccines are much more effective at protecting people from COVID if they get them before they’re treated,” says Dr. Dean. “If you give the COVID vaccines after treatment, it hamstrings the ability of your immune system to generate antibodies.”
This means your weakened immune system during treatment may not be strong enough to fight off a COVID-19 infection effectively. But if you can get the vaccine before beginning treatment, your body can build its immunity up to sustain protection while you’re in treatment.
Along with COVID-19 vaccines, you could consider receiving monoclonal antibodies — laboratory-made antibodies — for additional protection.
“These are authorized for use as a preventive measure if someone is in a high-risk medical situation,” explains Dr. Dean. “We can give you these synthetic antibodies to provide an extra layer of protection and keep you out of trouble in case you get exposed.”
Can a vaccine have negative effects on treatments for lymphoma?
Vaccines themselves don’t have negative effects on treatment for lymphoma. Instead, the effectiveness of vaccines decreases by as much as 50% while you’re receiving treatment and for at least six months afterward, depending on how you measure it.
“We realize that people may worry about whether certain vaccines are safe for them. It’s important for people to understand that we worry about whether the vaccines will be as effective as we want them to be, but we don’t have a reason for concern about the safety of the vaccines, with the exception of the live weakened strains of virus,” assures Dr. Dean.
Can people in remission from lymphoma safely get vaccines?
Vaccines made without live viruses can be given safely at any time, but you should hold off from getting live virus vaccines for at least three months after your treatment ends to avoid potential illness.
At the end of the day, vaccines produce the most protective effect when they’re given before treatment is started or at least six months after treatment ends.
“I strongly recommend to my patients that they get vaccinated right away if they haven’t already,” says Dr. Dean. “The more immune protection people can carry into their treatment, the better off they’re going to be.”