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Updated Guidance for COVID-19 Vaccination from NCCN Recommends Fifth mRNA Shot (Second Booster Dose) for Immunocompromised People

National Comprehensive Cancer Network Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis provides expert consensus to help guide cancer care providers on latest research, available at

PLYMOUTH MEETING, PA [April 27, 2022] — Today, the National Comprehensive Cancer Network® (NCCN®)—an alliance of leading cancer centers—released the latest recommendations from the NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis. The frequently-updated guidance, along with other important information on COVID-19 and cancer, is available for free at

“This guidance is intended to let cancer care providers know not only what they can do, but also what they should do, according to experts across the United States,” said Brahm Segal, MD, Roswell Park Comprehensive Cancer Center, Co-Leader of the NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis.

The NCCN Advisory Committee on COVID-19 Vaccination and Pre-exposure Prophylaxis is comprised of leading multidisciplinary physicians from across NCCN’s Member Institutions, with particular expertise in infectious diseases, vaccine development and delivery, cancer management, and medical ethics. The group first published guidance on vaccinating people with cancer against COVID-19 in January of 2021 and has published numerous updates since then. The recommendations reflect the policies that have already been put in place in many of the country’s top academic cancer centers.

The latest update includes:

  • Clarification that the primary mRNA vaccination series for immunocompromised people is considered three shots—this essentially includes most patients with active cancer or a recent history of cancer. The primary series remains two shots for people who are not immunocompromised.
  • Recommendations for two booster doses for people who are immunocompromised (meaning three primary mRNA doses plus two booster doses).
  • Detailed information on how the primary series and booster definition and number differs for people who initially received the JNJ-78436735 vaccine.
  • Updated dosing recommendations for pre-exposure prevention with tixagevimab plus cligavimab (also referred to as monoclonal antibodies or MABs) for people with cancer; this treatment should not be viewed as a substitution for vaccination.
  • Updated data on mixing mRNA vaccine types, which is now considered to have similar effectiveness compared to using the same vaccine type.

The committee continues to recommend that household members and other close contacts of people with cancer should get vaccinated according their CDC-determined eligibility.

“Bottom line, we want to share COVID-19 recommendations that are simple and useful,” said committee co-leader Lindsey R. Baden, MD, Professor of Medicine, Harvard Medical School and an Infectious Diseases specialist at Brigham and Women’s Hospital and Dana-Farber Cancer Institute. “We know a lot more about COVID-19 and the vaccines now, and we can use that knowledge to minimize the confusion and enhance the protection we can offer to our immunocompromised patients.”

All of NCCN’s recommendations for cancer care during the pandemic can be found at A patient and caregiver guide to vaccinations is also available at

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About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit for more information and follow NCCN on Facebook @NCCNorg, Instagram @NCCNorg, and Twitter @NCCN.