We asked Dr. Jasmine Zain, cutaneous lymphoma specialist and member of the Cutaneous Lymphoma Foundation’s Medical Advisory Council, to respond to COVID-related questions of interest to the cutaneous lymphoma community:

With a new study that vitamin D deficiency contributes to the risk factors for COVID-19, should I increase my vitamin D supplements?

This is one study but it is suggestive that adequate vitamin D levels may be associated with improved outcomes after a COVID-19 infection. However, outcomes from serious infection are influenced by many factors including vaccination status, underlying health conditions etc. If your vitamin D levels are low than it is a good idea to supplement with vitamin D with the advice of your doctor.

Does sunscreen block vitamin D from the sun? 

Sunscreen prevents sunburn by blocking UVB light. Theoretically, that means sunscreen use lowers vitamin D levels.

What is the difference between an epidemic, a pandemic and endemic?

An epidemic means an outbreak of infection or sudden increase in cases of an infection in a certain area. A pandemic is an infection that is present world-wide. An endemic means that the infection or condition is regularly found among particular people or in a certain area.

If I just had COVID, am I protected against getting a severe course of COVID in the future? 

The data on this is not clear. You can still get an infection especially as new variants emerge.

Is there any information about a fourth shot for immunocompromised? 

The CDC recommends a booster dose for moderate to severely immunocompromised patients. This is only for Moderna and Pfizer at least five months after the 3rd dose. In these patients, the course of 3 vaccines is the primary dose and the 4th is considered a booster.

Is the COVID-19 vaccine just as safe for people with cancer as they are for cancer-free individuals?

An article was recently published in JNCCN (Journal of the National Comprehensive Cancer Network), and they have reported on the largest published peer-reviewed study examining short-term adverse effects of mRNA COVID-19 vaccination in patients with cancer - finding they experienced no more, and no different, side effects. These vaccines are safe for use in cancer patients. However, it is  recommended that before any vaccination, patients should consult with their treating doctors. Certain conditions like bone marrow transplant and certain chemotherapies may interfere with your ability to mount an immune response.

Members of the cutaneous lymphoma community have been reaching out with their questions related to COVID-19, the Delta variant, and the CDC’s new guidelines for a third dose of the vaccine as well as a booster shot. Drs. Michi Shinohara and Jasmine Zain, both cutaneous lymphoma specialists and members of the Cutaneous Lymphoma Foundation’s Medical Advisory Council, generously addressed these questions below:

What information can you share with cutaneous lymphoma patients about the third COVID-19 vaccine shot?

(See CDC’s definition for third dose vaccine vs booster vaccine provided beneath the Q&A) 

Given the range of cutaneous lymphoma diagnoses and the sub variants, it’s hard to broadly categorize all patients as immunocompromised. However, many patients with cutaneous lymphoma may be considered to be immunocompromised. Also important, individual-immunosuppressive medicines (i.e., methotrexate, cyclosporine, chemotherapy, etc.), not just a diagnosis, can be a factor in a person being immunocompromised and/or affect the recommendation for the timing of a third dose.

It should be noted that currently, the third dose of the vaccine is for people who are immunocompromised and only for those individuals who received the Moderna or Pfizer vaccines. The guidelines also state an immunocompromised person should wait 28 days after their second dose to receive the third, and the third dose should ideally be the same brand as the first two.

Regarding booster vaccines, they are being recommended for all individuals who received either the Moderna or Pfizer vaccines. The booster should be given 8 months after the second dose and should ideally be the same brand as the first two. 

In summary, broadly speaking, cutaneous lymphoma patients, whether they are being actively treated or not, are recommended to receive the third dose. However, patients should always refer to their prescribing doctor regarding a more personal recommendation.

Should people who received the Johnson & Johnson or the AstraZeneca vaccines be concerned that there is no recommendation for them to receive a booster shot?

Both the Moderna and Pfizer vaccines are mRNA vaccines while the Johnson & Johnson and AstraZeneca are not. The recommendation for a both a third dose and a booster comes from the current information showing the protection from the mRNA vaccines may wane faster than that of the others. It’s likely that we will hear more about booster shots across all vaccines soon.

Are there studies being done specifically about cutaneous lymphoma patients and the effects of COVID and/or the vaccines on them?

Although there may be individual studies being done at institutions, we are not aware of anything being published so far that is specific to cutaneous lymphomas. However, there are studies being done from other broader perspectives (i.e., transplant, oncology patients, etc.), which may include people affected by cutaneous lymphomas.

What is the difference between immunosuppression and compromised immunity?

The terms immunosuppressed, immunocompromised and compromised immune system are interchangeable and indicate that part of the immune system is not fully working. 

Are there new concerns or precautions that cutaneous lymphoma patients should take into consideration with the Delta variant?

Based on the research so far, it appears the Delta variant is even more infectious and contagious than what we experienced last year, meaning it is spreading faster and easier. Therefore, it is still very important for people to follow the recommendations of masking, social distancing, and hand-washing even if they have been fully vaccinated. 

For patients under active treatment, as we’ve explained, some treatments can affect the effectiveness of the vaccines. Therefore, given the potential immune system issues along with the impact of treatments, we recommend that even after receiving the vaccine doses, people should still mask, distance and wash hands frequently or use a hand sanitizer.

Should patients with cutaneous lymphoma avoid traveling?

The vaccines were not designed to protect against infection, but rather against severe infection and hospitalization. Meaning, you can still get infected after vaccination. The safest thing is to avoid travel during the pandemic. Travel has the potential to increase your exposure to other people who may or may not be vaccinated. The mode of traveling (i.e., plane, train or personal car) would factor into the overall potential risk. So, we recommend that you discuss the risk with your physician before making any travel plans. Regardless, when making these choices it’s important for people to consider that, even vaccinated, your immune system may not have generated a strong enough response against viruses that are getting more infectious.

What can you tell us about post-exposure prophylaxis?

There are some antiviral medications including monoclonal antibodies that can be taken. If you’ve recently been in a high-risk exposure you should contact your physician to discuss a possible prophylaxis. Unfortunately, with the challenges around limited access these are not always available but worth inquiring about in high risk situations.

Both Drs. Michi Shinohara and Jasmine Zain concluded with "the information we have is constantly evolving and unfortunately there are questions that have no answers yet. We still don’t know about the long-term effects this virus will leave and information might change. It is important for people to keep updated with the CDC guidelines, take your advice from experts, and follow those instructions to the best of your abilities."

Information taken from the CDC’s website: What’s the difference between a booster dose and an additional dose?

Sometimes people who are moderately to severely immunocompromised do not build enough (or any) protection when they first get a vaccination. When this happens, getting another dose of the vaccine can sometimes help them build more protection against the disease. This appears to be the case for some immunocompromised people and COVID-19 vaccines. CDC recommends moderately to severely immunocompromised people consider receiving an additional (third) dose of an mRNA COVID-19 vaccine (Pfizer-BioNTech or Moderna) at least 28 days after the completion of the initial 2-dose mRNA COVID-19 vaccine series.

In contrast, a “booster dose” refers to another dose of a vaccine that is given to someone who built enough protection after vaccination, but then that protection decreased over time (this is called waning immunity). HHS has developed a plan to begin offering COVID-19 booster shots to people this fall. Implementation of the plan is subject to FDA’s authorization and ACIP’s recommendation.

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World Health Organization (WHO) - advice for the public at large
Coronavirus Disease

United States Centers for Disease Control and Prevention (CDC) - information about and ways to protect yourself against the coronavirus
Coronavirus (COVID-19)
What to Do if You Are Sick

Federal Emergency Management Agency (FEMA)
Coronavirus Rumor Control

Friends of Cancer Research (FCR)
Evidence Accelerator Leverages Real-World Evidence in FDA’s Response to Global Pandemic

Blood Cancer / Chronic Health Conditions

American Society of Clinical Oncology (ASCO)
This post is no longer reviewed or updated. It was first published on March 3, 2020.
Coronavirus 2019: What People With Cancer Need To Know - ASCO

Mental Health & Well-Being

Collaborative event to help support the mental health and well-being of the lymphoma community during COVID pandemic: the Cutaneous Lymphoma Foundation, Lymphoma Research Foundation, and International Waldenstrom’s Macroglobulinemia Foundation
Coping With a Lymphoma Diagnosis During the COVID-19 Pandemic