All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit the Lymphoma Coalition.

The Lymphoma Hub uses cookies on this website. They help us give you the best online experience. By continuing to use our website without changing your cookie settings, you agree to our use of cookies in accordance with our updated Cookie Policy

Introducing

Now you can personalise
your Lymphoma Hub experience!

Bookmark content to read later

Select your specific areas of interest

View content recommended for you

Find out more
  TRANSLATE

The Lymphoma Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the Lymphoma Hub cannot guarantee the accuracy of translated content. The Lymphoma Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.

Steering CommitteeAbout UsNewsletterContact
LOADING
You're logged in! Click here any time to manage your account or log out.
LOADING
You're logged in! Click here any time to manage your account or log out.
2021-03-16T11:35:48.000Z

NCCN COVID-19 vaccination recommendations for patients with hematologic malignancies

Mar 16, 2021
Share:

Bookmark this article

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.

Key points

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:

  • Cancer patients are at high risk of COVID-19 complications and therefore treatment centers should take measures to control the spread of infection
  • The vaccination process should be simple and rapid
  • Equity of vaccine distribution should be ensured, inclusive of socially underrepresented groups such as patients with disabilities, ethnic minorities, and non-English-speaking patients
  • Carers and close contacts should be considered for early vaccination as they can be a potential source of transmission
  • There are no known safety concerns linked to COVID-19 vaccines in patients being treated for cancer

Vaccine timing

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.

Priority criteria

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:

  1. All cancer patients undergoing active treatment, scheduled to start treatment, and <6 months posttreatment should be given priority (excluding those receiving only hormonal therapy)
  2. Additional risk factors for COVID-19 complications that should be considered for patient prioritization include:
    1. Advanced age, i.e., ≥65 years
    2. Comorbidities, such as chronic pulmonary, cardiovascular, or renal disease
    3. Social and demographic factors, such as poverty, limited access to healthcare, and underrepresented ethnic groups

Efficacy and safety

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.

Summary

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.

  1. National Comprehensive Cancer Network. Preliminary recommendations of the NCCN COVID-19 Vaccination Advisory Committee. https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf. Published Jan 22, 2021. Accessed Mar 2, 2021.

Understanding your specialty helps us to deliver the most relevant and engaging content.

Please spare a moment to share yours.

Please select or type your specialty

  Thank you

Newsletter

Subscribe to get the best content related to lymphoma & CLL delivered to your inbox