Vaccination of Adults with Cancer

Patient Guideline

Publication Date: March 17, 2024
Last Updated: March 19, 2024

Objective:

Objective:

  • This patient guideline summarizes key takeaways from the American Society of Clinical Oncology (ASCO) guideline for the vaccination of adults with cancer.
  • The purpose of this guideline is to provide new evidence-based recommendations on the topic.

Overview:

Overview:

  • People with cancer often have a compromised immune system due to the disease itself or the treatment. Therefore, people with cancer are at higher risk of infection.
  • The collaboration between the oncologist and the primary care provider is important to obtain an updated vaccine history and discuss the need for other vaccines.
  • The purpose of vaccination is to protect from infection and to reduce the severity of disease when infection cannot be fully prevented.
  • Live vaccines (vaccines that contain weakened but replicating live viruses or bacteria) are generally not used in people with severely compromised immune systems.
  • On the other hand, non-live vaccines (vaccines that contain inactivated or killed viruses or bacteria) are generally considered safe.

Vaccination recommendation:

Vaccination recommendation:

  • Clinicians should assess the vaccination status and ensure that adults newly diagnosed with cancer and about to start treatment are up to date on:
    • seasonal vaccines
    • age-based vaccines
    • risk-based vaccines

  • Ideally vaccination should precede any planned cancer treatment by 2-4 weeks. However, non-live vaccines can be given during or after chemotherapy or immunotherapy, hormonal treatment, radiation, or surgery.

  • After hematopoietic stem cell transplant:
    • Complete revaccination starting 6-12 months after hematopoietic stem cell transplant.
    • Live and live attenuated vaccines should be delayed for at least 2 years and given only in the absence of active graft-versus-host disease or immunosuppression.
    • COVID-19, influenza, and pneumococcal vaccines can be administered as early as 3 months after transplant.

  • For adults with blood cancers such as lymphoma or myeloma who are receiving CAR-T therapy that targets certain proteins on B-cells (a type of immune cell) called CD19 or BCMA:
    • Influenza and COVID-19 vaccine no sooner than three months after the completion of therapy.
    • Non-live vaccines no sooner than 6 months after completion of therapy.

  • For adults who receive B-cell-depleting therapy:
    • Revaccination for COVID-19 only, no sooner than 6 months after completion of treatment.

  • For long-term survivors of hematologic malignancy with or without active disease or those who have longstanding B-cell dysfunction or hypogammaglobulinemia from therapy or B-cell lineage malignancies:
    • The recommended non-live vaccines even though the response may be attenuated.

  • For adults with solid and hematologic cancers traveling to an area of risk:
    • To follow the CDC standard recommendations for the destination.
    • Note. Hepatitis A, intramuscular typhoid vaccine, inactivated polio, hepatitis B, rabies, meningococcal, and Japanese encephalitis vaccines are safe.

  • For household members and close contacts, it is recommended, where feasible, to be up to date on vaccinations.

TABLE 1. Recommended Immunizations for Adults with Cancera

Having trouble viewing table?
Vaccine Recommended Age Schedule
Influenzab All ages Annually
RSV 60 years and older Once
COVID-19 All ages As per the latest CDC schedule for immunocompromised1
Tetanus, Diphtheria, and Pertussis (Tdap) or Tdc 19 years and older 1 dose of Tdap, followed by Td or Tdap booster every 10 years
Hepatitis B 19-59 years: eligible
60 years and older: immunize those with other risk factorsd
For adults aged ≥ 20 years, use high antigen (40µg) and administer as a 3-dose Recombivax HB series (0,1,6 mos.) or 4-dose Engerix-B series (0,1,2,6 mos.)2
Recombinant zoster vaccine 19 years and older 2 doses at least 4 weeks apart
Pneumococcal vaccine 19 years and older 1 dose PCV15 followed by PPSV23 eight weeks later
OR
1 dose PCV20e
Human Papillomavirus (HPV) 19-26 years: eligible
27-45 years: shared decision-making
3 doses, 0, 1–2, 6-months
Abbreviations: CDC, Centers for Disease Control and Prevention; COVID-19, coronavirus disease of 2019; HPV, human papillomavirus; PCV, pneumococcal conjugate vaccine; PPSV-23, 23 valent Pneumococcal polysaccharide vaccine; RSV, respiratory syncytial virus; Tdap, tetanus, diphtheria, and acellular pertussis
a Adapted from CDC Adult Immunization Schedule By Medical Condition and Other Indication.3 Information linking US trade names for each vaccine is available and routinely updated at the CDC's website on vaccines.4 Co-administration of two or more of the recommended non-live vaccines is acceptable per CDC guidelines. When given on separate days, there is no recommended waiting period. Note, PCV-15 and PPSV-23 should be separated by at least 8 weeks as noted in the table.
b Live attenuated influenza vaccine which is administered as a nasal spray cannot be given to people with cancer
c Tdap has lower amounts of diphtheria and pertussis toxoid and is only used for those 7 years of age and older. DTaP, the pediatric vaccine for prevention of tetanus, diphtheria and pertussis is only for children < 7 years of age
d HIV, chronic liver diseases, intravenous drug use, sexual risk factors, incarcerated individuals
e Patients who have previously received PCV13 only can receive one dose of PCV 20 at an interval of one year

Additional readings:

Additional readings:

  1. Centers for Disease Control and Prevention: Use of COVID-19 Vaccines in the United States. Interim Clinical Considerations. https://www.cdc.gov/vaccines/covid-19/clinical-considerations/covid-19-vaccines-us.html,
  2. Weng MK, Doshani M, Khan MA, et al: Universal Hepatitis B Vaccination in Adults Aged 19-59 Years: Updated Recommendations of the Advisory Committee on Immunization Practices - United States, 2022. MMWR Morb Mortal Wkly Rep 71:477-483, 2022
  3. Centers for Disease Control and Prevention: Adult Immunization Schedule by Medical Condition and Other Indication. Recommendations for Ages 19 Years or Older, United States, 2024. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html
  4. Centers for Disease Control and Prevention: Vaccines and Other Immunizing Agents in the Adult Immunization Schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/adult-schedule-vaccines.html

Source Citation

Kamboj M, Bohlke K, Baptiste DM, et al. Vaccination of Adults with Cancer: ASCO Guideline. J Clin Oncol. 2024 March 18. doi: 10.1200/JCO.24.00032