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It’s a Tough Jab (But Somebody’s Got to Do It)

November 11, 2021

COVID-19 and Vaccination

Natasha Szuber, MSc, MD
Natasha Szuber, MSc, MD

Dr. Natasha Szuber (@NatashaSzuber) is a hematologist-oncologist at Maisonneuve-Rosemont Hospital, University of Montreal in Quebec, Canada, specializing in myeloid disorders, particularly myeloproliferative neoplasms, and has further interests in clonal hematopoiesis and iron metabolism. She received her MSc at McGill University in Montreal, her MD at University of Montreal, and did her Advanced Hematology Myeloid Fellowship at Mayo Clinic in Rochester, Minnesota. Dr. Szuber remarked that she was “born, raised, and currently still residing in Montreal…It's a beautiful, vibrant city if you can look past the orange construction cones and innumerable potholes!” 

While Dr. Szuber is “relatively new” to the ASH family, she is looking forward to collaborating further in coming years and was just selected to participate in the ASH Clinical Research Training Institute this year. Fun fact: Dr. Szuber enjoyed a “past life as an aspiring rock n' roll star, recorded three albums, and toured with my band across Canada before finally surrendering to the call to med school.” 

Natasha Szuber, MSc, MDLet’s talk numbers: 244 million. That’s how many people have contracted the COVID-19 virus worldwide thus far; 4.9 million have died from it. If these staggering figures seem challenging to fathom, consider the vaccination effort. Now we’re in the billions — 6.7 to be specific That is the sum total of COVID-19 vaccine doses that have been jabbed into the arms of more than 3.8 billion people across the globe. Not too shabby, considering mass vaccine rollout began less than a full year ago. As our collective focus shifts away from sourdough bread baking and quarantine TikToks (disclaimer: I actually don’t know what these are, but I’ve sure heard a lot about them), a new spotlight is fixated on what many are designating an injection of hope — the COVID-19 vaccine. While remaining the most significant means to limit the spread of the infection and halt the pandemic, the emergence of novel strains, vaccine production setbacks, inconsistent rollout, and public reticence to receive the shot have contributed to making the COVID-19 vaccination endeavor a tough job indeed. 

To say that a herculean effort has been put forth by the ASH research community to tease out the details concerning COVID-19 vaccination and populations with hematologic diseases would be as much of an understatement as calling the COVID-19 pandemic a trifling disease outbreak. This, too, has been a tough job (involving, in fact, many tough jabs), but one that our scientific leaders have confronted with great diligence and drive. This fervent commitment has provided a dramatic shot in the arm (idiom intended) to research on COVID-19 and vaccination, as evidenced by the sheer volume of high-quality abstracts and sessions presented at this year’s annual meeting (382 yielded when searching for “COVID-19” and 157 for “vaccine,” to be precise). Emerging themes include the complex interplay between blood disorders, disease-directed therapies, and the efficacy of immune response to vaccination, as well as the rationale and indications for booster doses. As the obligate broadening of our job descriptions to include “would-be immunologist” has undoubtedly made a tough task even tougher, the selected sessions detailed in this article will assuredly serve as guideposts to navigate the core evidence surrounding COVID-19 and vaccination. 

The session Acute Myeloid Leukemia: Clinical and Epidemiological: COVID and Beyond scheduled for Saturday, December 11, at 2:00 p.m. Eastern time (ET) features two oral presentations addressing vaccination. The first, “Responses to Sars-Cov-2 Vaccines in Patients with Myelodysplastic Syndrome and Acute Myeloid Leukemia” presented by Dr. Akriti G. Jain is the largest study to date reporting serial serologic data following vaccination in patients with acute myeloid leukemia and myelodysplastic syndromes. The second, “Antibody Response to Vaccination with BNT162b2, mRNA-1273, and ChADOx1 in Patients with Myeloid and Lymphoid Neoplasms” presented by Dr. Jil Rotterdam details the variable disease-specific immune responses after the second COVID vaccine dose in a large subset of patients with both malignant and nonmalignant hematologic conditions. 

The Scientific Symposia on COVID-19 Vaccination in Immunocompromised Patients - Live Q&A taking place on Sunday, December 12 at 9:30 a.m. ET will be co-chaired by Drs. Amit Verma and Sabine Eichinger. As Dr. Verma summarized, “In this session you will hear about the latest research on the efficacy of COVID-19 vaccine boosters, the biomarkers for vulnerable patient populations, and future measures to protect them from COVID-19.” The symposia specifically include a session on “Booster Vaccinations to Protect Against COVID-19 Vaccination in Patients with Hematologic Malignancies” given by Dr. Sean H. Lim, reporting outcomes from two large prospective studies. Dr. Lim elaborated: “PROSECO [is] an observational study evaluating COVID-19 vaccine responses in patients with lymphoma, and OCTAVE-DUO [is] a randomized phase III study evaluating immune responses to booster.” Though Dr. Lim is still awaiting the most up-to-date results, she expressed she was looking forward to discussing “the key factors determining immune responses to two doses of vaccine and who might benefit most from the third dose.” As the symposia involve a live Q&A, it also marks a valuable opportunity to stand up, speak out (or simply stay put and unmute yourself), and ask those everything-you-always-wanted-to-know-about questions relating to COVID-19 and vaccination but were either too afraid or didn’t know who to ask. 

The session ASH Advances COVID Research 2021, scheduled for Monday, December 13 at 12:15 p.m. consists of three sessions, including one led by Dr. Jeffery Auletta on “Immunology and Immune Response in COVID-19 Vaccines.” In his preview comments, Dr. Auletta reminded us that while we are beginning to understand the immune response to the virus in immunocompetent hosts, “our level of understanding for the immune response to SARS-CoV-2 in immunocompromised patients … remains largely undefined.” He emphasized that “defining why and how reduced immunogenicity occurs in specific immunocompromised populations will result in ways to augment immune response to vaccine” in these patients. Finally, Dr. Auletta projected that “defining immune response to SARS-CoV-2 may in fact reveal novel ways to modulate immune response in general, and even enhance immune recovery in immunocompromised patients,” a decidedly exciting prospect. 

Finally, as we prepare to explore this new intersection of the Hematology-Immunology Venn diagram inspired by COVID-19 vaccine research, we would be remiss not to appreciate the critical tour de force that has been accomplished. The truth is, it has been, and will continue to be a tough job, but if the outstanding sessions programmed for this year’s ASH meeting have proven anything, it is that we are up to the task.   

Dr. Szuber indicated no relevant conflicts of interest. 


Related Annual Meeting Sessions

The COVID Crash: Lessons Learned from a World on Pause - Live Q&A

Time: Saturday, December 11, 9:30-10:15 a.m. Eastern time
Place: Virtual and in-person at the Georgia World Congress Center, Hall C2-C3 The COVID-19 pandemic has caused immense morbidity and mortality and, despite unprecedented public health measures, continues to rage across the United States and the world. This education session will explore the pathophysiology of COVID-19 associated coagulopathy and thrombosis and evidence supporting best practices in management including anticoagulation strategies depending on disease severity and clinical setting. The session will also discuss the role of passive immune therapies including convalescent plasma and monoclonal antibodies in COVID-19.
Immune Response to Old and New Enemies - Live Q&A

Time: Saturday, December 11, 2:00 p.m.-2:45 p.m.
Place: Virtual and in-person at the Georgia World Congress Center, Georgia Ballroom 1-3
A successful immune response to a viral pathogen is an intricately choreographed affair, involving coordination between the innate, adaptive, and memory immune response. This session will highlight recent findings identifying critical areas of coordinated anti-viral response and the mechanisms by which SARS-CoV-2 subverts them. Understanding the nature of the immune response that leads to recovery over severe disease is key to developing effective treatments for COVID-19.
Blood Therapeutics in Pandemics - Live Q&A

Time: Saturday, December 11, 4:00-4:45 p.m.
Place: Virtual and in-person at the Georgia World Congress Center, Hall C1
Using SARS-CoV-2 as a prototype, this session will address scientific approaches to ensure a safe and available blood supply during a pandemic and highlight recent cutting-edge research on the mechanisms by which passive immunotherapies (such as convalescent plasma) may reduce infections or their complications. The role of ABO glycoproteins in influencing infectious pathophysiology will also be discussed. Findings from this session will be applicable to other potential emerging infectious agents that could impact the health of patients with hematology and transfusion globally.
Viral and Bacterial Infections: Basic Insights Into Vascular Biology and Coagulation – Live Q&A

Time: Monday, December 13, 10:30-11:15 a.m.
Place: Virtual and in-person at the Georgia World Congress Center, Thomas Murphy Ballroom 1-2
Infections are often associated with coagulation disorders. All aspects of the coagulation cascade (i.e., primary hemostasis, coagulation, and fibrinolysis) can be affected. Consequently, thrombosis and disseminated intravascular coagulation, hemorrhage, or both, can occur. This session will present cutting-edge research on pathways by which viruses and bacteria influence the vascular endothelium, coagulation, and the immune system.

For more COVID-19–related content, including oral and poster presentations, search the annual meeting program.
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