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Patients with cancer are at high risk of COVID-19-associated complications and, accordingly, the preliminary recommendations issued by the National Comprehensive Cancer Network (NCCN) COVID-19 Vaccination Advisory Committee state that all cancer patients should be prioritized for COVID-19 vaccination, and caregivers and household/close contacts should also be considered for early immunization.1
Due to limited prospective data on vaccination in patients with active malignancies, the preliminary recommendations summarized here are based on expert opinion from the NCCN COVID-19 Vaccination Advisory Committee. The guidance will be updated regularly when new data becomes available.
Local guidelines should be used to decide when to vaccinate cancer patients, alongside guidelines laid out by the US National Academies of Sciences, Engineering, and Medicine (NASEM) Framework for Equitable Allocation of COVID-19 Vaccine. The key principles are as follows:
Recommendations for vaccination timing for patients with hematologic malignancies according to treatment type are laid out in Table 1.
Table 1. A summary of the recommendations for vaccine timing for patients with hematologic malignancies, including those receiving cellular therapies1
Treatment type |
Timing* |
---|---|
Allo-HCT |
At least 3 months post-HCT/cellular therapy** |
Auto-HCT |
|
Cellular therapy |
|
Intensive cytotoxic chemotherapy |
Delay until absolute neutrophil count recovery |
Marrow failure from disease and/or therapy expected to have limited or no recovery |
When vaccine available |
Long-term maintenance therapy |
When vaccine available |
allo-HCT, allogeneic hematopoietic cell transplantation; auto-HCT, autologous hematopoietic cell transplantation. *Due to the lack of data on dual vaccination, COVID-19 vaccines should be prioritized over other needed vaccines, with a 14-day delay between vaccines. **Graft-versus-host disease (GvHD) and immunosuppressive GvHD treatment regimens could hinder the COVID-19 vaccine response. Therefore, vaccine administration should be delayed until there is evidence of T-cell and B-cell immunity from immune phenotyping and/or there is a reduction in immunosuppressive therapy. |
In the case of limited availability of COVID-19 vaccines, prioritization among cancer patients should be evidence- and values-based. The following criteria may help with the development of local guidance on vaccine prioritization:
Current vaccines are considered safe and effective in the general population. However, due to the lack of data for immunocompromised patients, cancer patients should be made aware of the importance of following current prevention guidance, postvaccination.
This article summarizes the guidance for COVID-19 vaccination for patients with cancer, including those with hematologic malignancies. Patients with cancer should be prioritized for vaccination, and those of older age, with underlying health conditions, and undergoing treatment should be given further priority. Vaccine timing should be considered in the context of treatment regime. Due to limited postvaccination information, cancer patients and their close contacts should continue to follow the recommendations for COVID-19 prevention, even after receiving the vaccine.
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