COVID-19 vaccination in cancer patients: Who should be vaccinated and when?

When should cancer patients receive a COVID-19 vaccine? The National Comprehensive Cancer Network (NCCN) has issued recommendations to provide guidance on the topic.

Guideline author Steven Pergam, MD, of Fred Hutchinson Cancer Research Center, Seattle, explains NCCN’s recommendations to host David H. Henry, MD, in this episode.

Prioritization

• Prioritization for COVID-19 vaccination should be given to cancer patients currently receiving chemotherapy, those who just finished active treatment, or those about to receive treatment.
• Additional factors that should be taken into consideration include age, comorbidities, and sociodemographic characteristics.

Transplant and cellular therapy

• Patients who undergo allogeneic or autologous transplant or those who receive cellular therapy should be vaccinated at least 3 months after this treatment.
• This recommendation is based on best practices used for other vaccines, as there are insufficient data on COVID-19 vaccination in these patients, Dr. Pergam noted.

Hematologic malignancies

• For patients with hematologic malignancies receiving intensive cytotoxic chemotherapy, vaccination should be delayed until absolute neutrophil count recovery.
• Patients with marrow failure from disease, those receiving therapy expected to have limited or no recovery, and those on long-term maintenance therapy should get vaccinated when a vaccine is available to them.

Antibody response

• There are no current data to support checking antibodies prior to vaccination, as one will lose antibodies over time, Dr. Pergam noted.
• Likewise, there are no data to support testing for antibodies after vaccination.

Solid tumor malignancies

• Patients with solid tumor malignancies who are receiving cytotoxic chemotherapy, targeted therapy, radiation, or checkpoint inhibitors or other immunotherapies should be vaccinated when a vaccine is available to them.
• For patients undergoing surgery, there should be adequate time between receiving a vaccine and the surgical date, as side effects from the vaccine, such as fever, can delay surgery.

These guidelines are available for download from the NCCN website: https://www.nccn.org/covid-19/.

Show notes written by Malika Gill, MD, a resident at Pennsylvania Hospital, Philadelphia.

Disclosures

Dr. Pergam and Dr. Henry have no relevant disclosures.

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