There’re only a few documented cases worldwide, but anti-vaccine activists will tell you this is evidence that the mRNA vaccine causes cancer.
Last year, I wrote a controversial article about five unique situations representing statistical outliers when the Covid-19 vaccine may be unsafe. One such situation is certain types of cancer.
Now that a year has passed, more evidence has documented the uncanny link between the mRNA vaccine and lymphoma, a cancer of the lymphatic system. But it should be noted that such evidence is still preliminary and doesn’t outweigh the benefits of vaccines in cancer patients who are often immunocompromised and, thus, are at high risk of severe Covid-19.
Despite that, understanding the nuanced intricacies in certain outlier situations will help us better understand vaccine safety and the underappreciated significance of vaccine safety transparency.
A physician-scientist honesty
Writing for The Atlantic, Roxanne Khamsi, a science journalist and editor did a brilliant job telling the story of Michel Goldman, MD, Ph.D., a professor specializing in internal medicine and immunology, known for being one of Europe’s most competent researchers.
As Goldman was diagnosed with lymphoma, a lymphatic system cancer, he was eager to get the mRNA vaccine booster shot on 22 September 2021. He knew he would soon get immunocompromised from chemotherapy, so he wanted to ensure he got adequate protection against Covid-19. Plus, Goldman was 67 years old, an age category at high risk of severe Covid-19.
But Goldman’s cancer symptoms — night sweats, fatigue, and swollen lymph nodes — got worse within a few days of getting boosted. He then took another computed tomography (CT) scan. And the results were horrific.
“The pictures showed a brand-new barrage of cancer lesions — so many spots that it looked like someone had set off fireworks inside [Goldman’s] body,” Khamsi described. “More than that, the lesions were now prominent on both sides of the body, with new clusters blooming in [Goldman’s] right armpit in particular, and along the right side of his neck.”
Such cancer progression within three weeks is uncanny given what we know about the natural course of lymphoma, and Goldman needed steroids as soon as possible. Goldman began to suspect that the booster shot had somehow worsened his lymphoma, making his chance of survival for more than five years at only 30%.
Before getting boosted, the lymphoma was only limited to Goldman’s left armpit and neck. Coincidentally, Goldman received his first and second mRNA vaccine dose on the left arm. But Goldman received the booster on the right arm, and the lymphoma began appearing therein.
Besides that, there were other theoretical bases linking mRNA vaccines to lymphoma in Goldman’s case.
For one, while lymphoma has many distinct types, Goldman’s case is angioimmunoblastic T-cell lymphoma, which affects follicular helper T-cells in the lymph nodes. And the mRNA vaccine is particularly effective at inducing follicular helper T-cell responses compared to other vaccine types, which scientists argue is what makes mRNA vaccines so effective.
“Perhaps the shots gave such a jolt to his helper T cells that they went berserk,” Khamsi wrote. “If they were prone to forming tumors, or if they were already cancerous, then overstimulation could have made the problem even worse.”
When I freelanced for a physician professor last year, the professor shared with me his experience with seven patients with stage IV cancers that were well-controlled for over five years, only to experience a sudden cancer progression right after getting the Covid-19 vaccine. He theorized that vaccination, or any other immune stimulant for that matter, disturbed the delicate balance in the immune surveillance of cancer cells.
Second, lymphadenopathy (swollen lymph nodes) is a common adverse event associated with mRNA vaccines. A nationwide surveillance study from Israel found that the mRNA vaccine (Pfizer-BioNTech) is associated with a 2.4-times increased risk of lymphadenopathy compared to no vaccine, with an excess of 78 cases per 100,000 vaccines.
A meta-analysis of nine studies examining changes in 18F-FDG PET/CT scans after Covid-19 (mainly mRNA) vaccination revealed that 37% of vaccinees developed axillary lymphadenopathy on the same side as the shot due to vaccine-related immune responses. Since such vaccine-related axillary lymphadenopathy is similar to certain cancers, so they may get misdiagnosed as cancer. Patients at risk of cancer spread to axillary lymph nodes — e.g., breast cancer, melanoma, and lymphomas —are thus advised to get vaccinated in the arm opposite to the cancer side.
*Note: 18F-FDG PET/CT is a more sensitive type of imaging that can detect numerous types of diseases. Axillary means the armpit region.
Third, certain mutations within the lymphomas might make them more sensitive to mRNA vaccines. A 2018 study showed that mice with RHOA G17V and TET2 mutations — which were also present in Goldman’s lymphoma — developed lymphoma upon immunization with sheep red blood cells. And it was the RNA present in the sheep's red blood cells that was responsible for the immunization. And mRNA is a type of RNA.
Of course, being the prudent scientist he is, Goldman also considered the alternative hypothesis that his lymphoma progression would have happened regardless of vaccination. But given the temporal (time between booster shot and unprecedented cancer progression), spatial (vaccine injection and cancer sites), and theoretical (mechanisms) bases, it’s also unscientific to dismiss the case as a mere coincidence.
As a firm advocate of vaccine safety, including the mRNA vaccine, in academia and the public, Goldman was conflicted. He was unsure if he should report his rare but life-threatening vaccine-related adverse event.
On the one hand, such incidents might be underreported due to their extreme rarity. On the other hand, people might begin to fear mRNA vaccines; plus, anti-vaccine activists will surely exploit such information.
But in the end, Goldman believed being transparent is the right thing to do. Perhaps people with lymphoma might be and feel safer if they opt for non-mRNA vaccines instead, although Goldman still stands by the fact the benefits of the mRNA vaccine far outweigh its associated risks.
As a result of Goldman going public, he received a few anecdotes of similar cases. At least two people have contacted Goldman about their close kin developing lymphomas shortly after getting the Covid-19 vaccine. “Again, these could be coincidences,” Khamsi wrote. “Or maybe they are the second and third data points in a growing set.”
And Goldman’s lymphoma is under control now with chemotherapy and other medications, although Goldman still needs to watch out for cancer recurrence.
The literature on mRNA vaccine and lymphoma
Goldman and colleagues published his case report in Frontiers of Medicine, titled “Rapid Progression of Angioimmunoblastic T Cell Lymphoma Following BNT162b2 mRNA Vaccine Booster Shot: A Case Report,” conveying their findings to academia.
Herein, we can see Goldman’s 18F-FDG PET/CT scan before and after getting the mRNA vaccine booster shot, where the black spots (except the brain) represent lymphadenopathies indicative of cancer spread.
In the paper, Goldman et al. further cautioned that
“At this time, extrapolation of the findings of this case to other patients with AITL [AngioImmunoblastic T cell Lymphoma] or other peripheral T cell lymphoma involving TFH [T follicular helper] cells is premature. AITL patients are rare and their mutation profile is heterogeneous…Prospective studies involving systematic PET/CT imaging after SARS-CoV-2 vaccination in AITL patients with specified mutation profiles might eventually be needed. Whatever the result of such studies, it should not affect the overall favorable benefit-risk ratio of these much-needed vaccines.”
Digging into the literature myself, a lot of papers have been published on Covid-19 vaccine effectiveness in cancer patients whose immune system is often compromised, finding lower vaccine effectiveness compared to the general population. But most studies did not examine vaccine safety.
Notably, in the latest meta-analysis of 15 studies investigating how patients with hematological (blood-related) cancers— including lymphomas — react to Covid-19 vaccination, no significant differences in rates of adverse events between cancer and non-cancer patients were noted.
However, the total sample size of cancer patients from those 15 studies was only about 2000 patients, which is very low if we are looking for rare adverse events. To expound on that, if a rare adverse event occurs at the rate of 1 in 10,000 people, detecting it at the significance level of P < .05 requires a sample size of at least 30,000 people.
There are also published case reports documenting similar lymphoma progression, diagnosis, or recurrence in patients who recently got vaccinated against Covid-19. Coupled with several anecdotes or unpublished cases, lymphoma progression might very well be a rare adverse event associated with the mRNA Covid-19 vaccine.
However, the novelty of this issue is also a testament to how rare this adverse event is. Whereas other rare Covid-19 vaccine-related adverse events, such as vaccine-induced thrombotic thrombocytopenia (VITT) and myocarditis, were discovered much earlier when vaccine roll-out began.
Also, given the immunocompromised state of lymphoma patients, the vaccine benefits in protecting against Covid-19 could not be more vital. But these patients may consider opting for non-mRNA Covid-19 vaccines if they have a similar lymphoma condition as Goldman’s, although other experts may disagree with this advice, given how rare and novel mRNA vaccine-associated lymphoma progression is.
And the transparency surrounding this matter is commendable. It shows that vaccine-related adverse events — even when there are only a few cases in the world — are taken seriously, despite the unfortunate yet anticipated incidents of anti-vaccine activists using Goldman’s case to convince people that the mRNA vaccine is cancerous.
In the end, no drug is risk-free. It’s all about weighing the risks and benefits of a given situation.