COVID-19 Vaccine for Patients With Cancer: NCCN Guidance

The National Comprehensive Cancer Network (NCCN) today released guidance for COVID-19 vaccinations in patients with cancer. The NCCN created a committee of hematology and oncology experts who specialized in infectious disease, vaccine development and delivers, medical ethics, and health information technology to come up with the recommendations.

All patients in active cancer treatment should get the vaccine, taking timing into special consideration regarding immunosuppression, the committee determined. The NCCN recommends that patients:

• With hematopoietic cell transplantation or cellular therapy (such as CAR T-cell therapy) wait at least 3 months after hematopoietic cell transplantation/cellular therapy for COVID-19 vaccination
• With hematologic malignancies receiving intensive cytotoxic chemotherapy delay vaccination until their neutrophil count recovers
• With hematologic malignances with marrow failure from disease and/or therapy and are expected to have limited recovery; or on long-term maintenance receive the vaccine when available
• With solid tumors receiving cytotoxic chemotherapy, targeted therapy, immunotherapy, or radiation receive the vaccine when available
• With solid tumors undergoing major surgery separate date of surgery from vaccination by at least a few days

“One of our primary goals is reducing morbidity and mortality,” said Sirisha Narayana, MD,

Associate Professor of Medicine, Chair of the UCSF Ethics Committee, UCSF Health. “We also have to take social determinants of health into account and make special efforts for people in high-risk communities.”

Currently, patients with cancer are prioritized for the vaccination in the high-risk category (CDC group 1b/c). The NCCN states that caregivers and household members for those with cancer should also receive the vaccine when available, too.

“Our number one goal is helping to get the vaccine to as many people as we can. That means following existing national and regional directions for prioritizing people who are more likely to face death or severe illness from COVID-19. The evidence we have, shows that people receiving active cancer treatment are at greater risk for worse outcomes from COVID-19, particularly if they are older and have additional comorbidities, like immunosuppression,” said Steve Pergam, MD, MPH, Associate Professor, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center and Infection Prevention Director at Seattle Cancer Care Alliance, co-leader of the NCCN COVID-19 Vaccine Committee.

Pegram also explained that the guidelines were crafted with the limited data that is available for patients with cancer receiving the available COVID-19 vaccines and this will likely be an evolving document.

“The medical community is rising to one of the biggest challenges we have ever faced,” said Robert W. Carlson, MD, Chief Executive Officer, NCCN. “The COVID-19 vaccines exemplify the heights of scientific achievement. Now we have to distribute them quickly, equitably, safely and, efficiently, using clearly defined and transparent principles.”

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