National Comprehensive Cancer Network Adds Guidance on COVID-19 mRNA Booster Shots


The guidance noted it is preferable for immunocompromised patients to receive their third dose in a health care delivery setting rather than a pharmacy or public vaccination clinic.

The National Comprehensive Cancer Network (NCCN) has made significant updates to its guidance on COVID-19 vaccines for patients with cancer, including which patients should be considered eligible for a third dose of messenger RNA (mRNA) vaccines.

The new updates are the fourth version of NCCN’s COVID-19 vaccination guide and incorporate the newest data in addition to recent FDA and CDC approvals regarding the third mRNA vaccine dose for immunocompromised individuals. The recommendations have been used by cancer care providers to make important management decisions for their patients during the COVID-19 pandemic, according to a press release.

“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,” said Robert W. Carlson, MD, chief executive officer at NCCN, in the 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.”

According to the press release, patients that should be considered eligible for a third dose of mRNA COVID-19 vaccines include those with solid tumors who are receiving treatment within one year of their initial vaccine dose, regardless of the type of therapy; those with active hematologic malignancies regardless of whether they are currently receiving therapy; any recipient of a stem cell transplant or engineered cellular therapy, especially within the last 2 years; recipients of allogeneic stem cell transplants or immunosuppressive therapy or with a history of graft-versus-host disease; and those with additional immunosuppressive conditions or being treated with immunosuppressive agents unrelated to their cancer therapy.

These recommendations all align with CDC guidance, which advises patients to wait at least 4 weeks between their second and third doses. Individuals who develop COVID-19 despite initial vaccination should wait until they have documented clearance of the virus before receiving their third dose.

Individuals living in the same household as immunocompromised patients should also receive a third dose once they are eligible, according to the press release. Furthermore, the press release said it is best to receive the same type of vaccine for the third dose as patients received for the first 2 doses, although a different mRNA vaccine is acceptable if necessary. The guidance also said it is preferable for immunocompromised patients to receive their third dose in a health care delivery setting rather than a pharmacy or public vaccination clinic to limit their risk of exposure to the general public.

“When it comes to people’s safety, we have to take every precaution,” said Steve Pergam, MD, MPH, infection prevention director at Seattle Cancer Care Alliance and co-leader of the NCCN COVID-19 Vaccination Advisory Committee, in the press release. “That means even after a third dose of the 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.”


Information on Third mRNA COVID-19 Vaccine Dose Added to NCCN Guidance for People with Cancer. News release. NCCN; August 30, 2021. Accessed September 1, 2021.

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