In patients with hematologic malignancies, uptake of COVID-19 vaccines is high for the first 2 doses but declines with each subsequent dose, according to study results published in the European Journal of Cancer.

The study also showed that vaccine uptake varied by cancer type and level of social deprivation.

The study included data from the QResearch database, which encompassed more than 12 million individuals in England who were eligible for COVID-19 vaccination. A total of 97,707 patients had a hematologic malignancy.

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For the first dose of a COVID-19 vaccine, uptake was high among patients with hematologic malignancies and among people from the general population — 92.2% and 79.8%, respectively. 

However, vaccine uptake declined with each subsequent dose for both groups. In the general population, uptake declined from 75.3% for the second dose to 58.0% for the third dose and 3.4% for the fourth. 

Among patients with a hematologic malignancy, vaccine uptake decreased from 90.9% for the second dose to 82.3% for the third dose and 31.3% for the fourth dose. 

Vaccine uptake varied by cancer type. In a multivariable analysis, higher vaccine uptake for all doses was seen in patients with indolent B-cell non-Hodgkin lymphoma (first vaccine hazard ratio [HR], 1.06; 95% CI 1.04-1.09) and those with chronic lymphocytic leukemia (first vaccine HR, 1.07; 95% CI, 1.05-1.10), compared with patients who had monoclonal gammopathy of undetermined significance. 

On the other hand, vaccine uptake for all doses was significantly lower among patients with Hodgkin lymphoma (first vaccine HR, 0.96; 95% CI 0.93-0.99) and those with myeloproliferative neoplasms (first vaccine HR, 0.89; 95% Cl 0.87-0.91).

Vaccination was associated with social deprivation as well. The proportion of patients who had received 4 vaccine doses was 15.3% in the most deprived quintile and 40.4% in the most affluent quintile. In an adjusted analysis, uptake of the first vaccine dose was significantly lower in all quintiles of deprivation compared with the most affluent quintile (HR, 0.72; 95% CI, 0.70-0.74).

“This population-based study shows that there is a reduction in COVID-19 vaccine uptake over time and there are inequalities in uptake affecting those with the greatest clinical need,” the researchers concluded. “Current policies, communication on, and delivery of COVID-19 vaccines to people with blood cancers should be improved to ensure equitable uptake.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Hirst J, Mi E, Copland E, Patone M, Coupland C, Hippisley-Cox J. Uptake of COVID-19 vaccination in people with blood cancer: Population-level cohort study of 12 million patients in England. Eur J Cancer. Published online February 9, 2023. doi:10.1016/j.ejca.2023.02.001

This article originally appeared on Cancer Therapy Advisor