Anon writes:
Hello TWIV:

My father was recently diagnosed with plasmablastic lymphoma. He received his first dose of the Moderna COVID vaccine three weeks before his diagnosis.  I know that some people have had a lymphatic response due to the vaccine.  My father’s hematologist doesn’t think the vaccine caused the lymphoma but mentioned it may have caused it to increase the lymphoma’s fast growth. I have a couple of questions:

1. How likely do you think my father’s hematologist is correct in his belief that the Moderna vaccine may have sped along the progression of his plasmablastic lymphoma?

2. My father didn’t get the second Moderna vaccine. He is immunocompromised because he had a kidney transplant.  He also has diabetes. How much protection from covid will he likely have from the one Moderna shot? I don’t think it is much. 

3. Given what the hematologist said, we weren’t planning on getting my father the second Moderna vaccine.  What do you think of this plan?  I mean I hate it but I don’t know what else to do. 

4. Is there another covid vaccine you can recommend for my father? If he gets covid, he is in the high risk category on many fronts and we really want to get him vaccinated, but we are very concerned it will make the lymphoma worse or if he ends up in remission it may cause it to come back. 

Also, I should note that my father will likely go to a rehab facility in between chemo treatments because he needs PT and OT. 

Here is some other information: my father recently finished his second round of dose adjusted EPOCH chemo and just completed four rounds of retuxin.  

Please let me know if you need more Information to answer some of these questions.  

Thank you very much. 

Barry writes:

Hello Daniel,

I’d really like to hear your views on the role of budesonide and other inhaled corticosteroids in mild COVID-19. 

The three or so articles I have reviewed seem to reflect a favourable trend. Many of my colleagues in ambulatory and emergency medicine are prescribed budesonide. I’m uncharacteristically supportive as well, even though I generally stay well back from the sharp, cutting edge of clinical medicine.

Thanks for making me look so smart throughout the pandemic! All I have to do is  listen to your weekly TWIV podcast and I look and sound oh so clever!!! 


Barry Nathanson,
Barry N. Nathanson BA, MD, MHCM, FRCPC, FACP
Medical Director, Critical Care Services
Department of Medicine
Southlake Regional Health Centre
Newmarket, Ontario

Chief of Staff
Stevenson Memorial Hospital
Alliston, Ontario

Faculty of Medicine
Departments of General Internal Medicine and Critical Care Medicine
University of Toronto
Toronto, Ontario

‘We cannot stop COVID-19 without protecting our health workers.’
-Tedros Ghebreyesus, Director General, WHO 

Stav writes:

Hello Daniel and Vincent,

First, I’m glad for the opportunity to thank you and all your TWIV colleagues for enlightening a dark period for me. Knowledge is blessing. 

My question: my 52 year old boyfriend has hay fever these days, because of the spring pollen. He takes daily antihistamines. He got an opportunity to vaccinate and of course, following your #1 rule, received a Moderna dose. I advised him to stop taking the antihistamines, to let his immune system be at its best for the making of the anti SARS antibodies, but after one day he felt so bad with the spring hay fever that he continued with the medication. 

Was I right? Do antihistamines interfere with the efficiency of the body’s immune system to produce antibodies to the mRNA vaccine? 

Thank you so much for your incredible show,


Pablo writes:

Good morning 

Thanks for the weekly updates. 

1.  Patient at high risk (cerebral palsy, tracheostomy, non verbal) whose parents are COVID + but he was not. Admitted for bacterial tracheitis. According to EUA rules I cannot use monoclonal because he is COVID neg but once he becomes + he is going to be inpatient and likely hypoxic…..Suggestions. 

2. Patient on Rituximab for autoimmune encephalitis got severe Covid pneumonia 1 month after 2nd dose of Moderna. After Remdesivir went home and came back few days later. Ct value 27. No spike IgG present. Is he a candidate for preventive monoclonal (does EUA would allow it? 


Dr. Laufer