NCCN Issues Updated Guidelines Regarding Third COVID-19 Vaccine Booster for Those With Cancer


Updates to the National Comprehensive Cancer Network guidelines on the COVID-19 vaccine for patients with cancer indicate that this group should be prioritized for a third dose.

The National Comprehensive Cancer Network (NCCN) has announced a significant update to the guidelines for COVID-19 vaccine administration, including a third dose, in patients with cancer, according to a press release issued by the organization.1

The recommendation indicated that several groups of individuals should be eligible for a third dose of the COVID-19 vaccine, including those with new or recurring solid tumors within 1 year of their initial vaccine dose regardless of therapy, as well as those with active hematologic malignancies. Patients who have received a stem cell transplant (SCT) or engineered cellular therapy such as CAR T-cell therapy within the past 2 years should also eligible, as well as those who are recipients of SCT on immunosuppressive therapy or with a history of graft-versus-host disease regardless of when the transplant took place.

“COVID-19 can be very dangerous, especially for people living with cancer, which is why we’re so grateful for safe and effective vaccines that are saving lives,” Robert W. Carlson, MD, chief executive officer of the NCCN, said in a press release. “Our organization exists to improve the lives of people with cancer; we have a long track record for making recommendations that improve quality and length of life. We want our patients to live the longest and best lives possible, which means following the science on vaccination and mask-wearing.”

The NCCN COVID-19 Vaccine Advisory Committee consists of multidisciplinary physicians across the NCCN’s Member Institutions. In particular, the committee includes experts in infectious diseases, vaccine development and delivery, cancer management, and medical ethics. The recommendations, which are based on available evidence and expert consensus, have been utilized globally to aid in making management decisions over the course of the COVID-19 pandemic.

“When it comes to people’s safety, we have to take every precaution,” Steve Pergam, MD,

MPH, associate professor of the Vaccine and Infectious Disease Division at Fred Hutchinson

Cancer Research Center and infection prevention director at Seattle Cancer Care Alliance, as well as the co-leader of the NCCN COVID-19 Vaccination Advisory Committee, said in a press release. “That means even after a third dose of vaccine, we still recommend immunocompromised people—such as those undergoing cancer treatment—continue to be cautious, wear masks, and avoid large group gatherings, particularly around those who are unvaccinated. All of us should do our part to reduce the spread of COVID-19 and get vaccinated to protect those around us from preventable suffering.”

Additional recommendations from the updated guidelines suggest that all eligible caregivers and close contacts of those with cancer should be immunized whenever possible.2 The use of all vaccines with FDA approval or emergency use authorization—including the Pfizer/BioNTech BNT162b2 mRNA vaccine (Comirnaty), the Moderna mRNA-1273 SARS-CoV-2 vaccine, and the Janssen Ad26.COV2.S Adenovirus vector vaccine—is recommended in eligible patients by the committee.

Those who are receiving allogeneic or autologous SCT or CAR T-cell therapy will need to wait at least 3 months post-therapy before receiving the vaccine. Patients with hematologic malignancies, including those receiving cytotoxic chemotherapy such as cytarabine and anthracycline-based induction regimens for acute myeloid leukemia, need to delay inoculation until absolute neutrophil count recovery. Those who are experiencing marrow failure from their disease and/or are expected to have limited or no recovery from their therapy as well as those who are receiving long-term maintenance are able to receive the vaccine once it is available.

In solid tumors, the vaccine may be received once available for those who are undergoing treatment with cytotoxic chemotherapy, targeted therapy, checkpoint inhibitors, and other immunotherapy or radiation therapy. Those who are undergoing major surgery need to wait a few days following their surgical procedure before getting the vaccines.

The Center for Disease Control (CDC) currently recommends a third dose of the mRNA COVID-19 vaccines for individuals who are moderately to severely immunocompromised. This includes:

  1. Active cancer treatment for malignancies of the blood or tumors.
  2. Those who have received an organ transplant and are taking immunosuppressive drugs.
  3. Individuals who have received a SCT within the last 2 years or are taking immunosuppressive medications.
  4. Moderate or severe primary immunodeficiency, including diseases such as s DiGeorge syndrome or Wiskott-Aldrich syndrome.
  5. Advanced or untreated infection with the human immunodeficiency virus.
  6. Active treatment with high-dose corticosteroids or other treatments that may result in a suppressed immune response.

The CDC recommends that a third dose of the mRNA COVID-19 vaccine should be given at a minimum of 4 weeks following the second dose of either the Moderna or Pfizer vaccines. Notably, although preliminary data indicate that a third dose could augment antibody titers in an immunocompromised population of patients, those who have been diagnosed with cancer continue to be at a higher risk for infection with COVID-19 and COVID-19–related complications. Even with the additional dose, infection is still possible meaning that precautions such as avoiding crowds and wearing a mask are recommended.


  1. Information on third mRNA COVID-19 vaccine dose added to NCCN guidance for people with cancer. News release. National Comprehensive Cancer Network. August 30, 2021. Accessed August 30, 2021.
  2. NCCN. Recommendations of the National Comprehensive Cancer Network® (NCCN®) COVID-19 vaccination advisory committee. COVID-19, version 8.2021. Accessed August 30, 2021.
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