Patients with active cancer (cancer on treatment, those planning to start treatment, and those immediately post-treatment) consider getting the COVID-19 vaccine, like the other vulnerable populations, to reduce the severe risk of SARS-CoV-2 infection. We suggest patients with cancer should be vaccinated with a non-lived COVID-19 vaccine. Specific consideration belongs to the type of cancer, current treatment, phase of disease along the cancer continuum, and optimal timing for vaccination; they should talk to their hematologist-medical oncologist. Vaccination with the live-attenuated and replicating-vector vaccine is strongly discouraged in patients with active cancer receiving chemotherapy and during other immunocompromising therapies. For patients those receiving intensive chemotherapy (e.g., induction or consolidation therapy in acute leukemia), anti-B-cell antibodies, hematopoietic stem cell transplantation (HSCT), and other immunocompromised conditions, we suggest postponing SARS-CoV-2 vaccination until reaching stable lymphocyte counts due to the risk of vaccine infectivity. Cancer survivors are considered to have the same risk as other persons with matched aged and other risk factors. They also should be vaccinated as early as possible. There are various other risk factors for cancer patients which must consider related to complications of COVID-19, such as age, other comorbid diseases, demographic and social factors. All of these factors should be judged as a comprehensive evaluation of an individual patient. The use of masks, physical distancing, hygienic activities such as washing hands with soap and hand sanitizers are still needed during this pandemic. Caregivers and households should certainly be included in the vaccination strategies.

WHO. The current COVID-19 situation [Internet]. World Health Organization. 2020. Available from: https://www.who.int/countries/idn/

WHO. Draft landscape and tracker of COVID-19 candidate vaccines [Internet]. World Health Organization. 2021. Available from: https://www.who.int/publications/m/item/draft-landscape-of-covid-19-candidate-vaccines

Gallagher J. Coronavirus: When will the outbreak end and life get back to normal? [Internet]. British Broadcasting Corporation. 2020. Available from: https://www.bbc.com/news/health-51963486

BPOM. Penerbitan Persetujuan Penggunaan Dalam Kondisi Darurat Atau Emergency Use Authorization (EUA) Pertama Untuk Vaksin COVID-19 [Internet]. Badan Pengawas Obat dan Makanan (BPOM) - Republik Indonesia. 2021. Available from: https://www.pom.go.id/new/browse/more/pers/28-01-2020/28-01-2021/1

Dai M, Liu D, Liu M, Zhou F, Li G, Chen Z, et al. Patients with cancer appear more vulnerable to SARS-COV-2: a multi-center study during the COVID-19 outbreak. Cancer Discov. 2020;10(6):783–91.

Ribas A, Sengupta R, Locke T, Zaidi SK, Campbell KM, Carethers JM, et al. Priority COVID-19 Vaccination for Patients with Cancer while Vaccine Supply Is Limited. Cancer Discov. 2021;11(2):233–6.

Desai A, Sachdeva S, Parekh T, Desai R. COVID-19 and Cancer: Lessons From a Pooled Meta-Analysis. JCO Glob Oncol. 2020;(6):557–9.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708–20.

Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature. 2020;584(7821):430–6.

Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, et al. Case Fatality Rate of Cancer Patients with COVID-19 in a New York Hospital System. Cancer Discov. 2020;10(7):935–41.

Garassino M, Giesen N, Grivas P, Jordan K, Francesca L, Mir O, et al. ESMO Statements for Vaccination Against COVID-19 in Patients with Cancer [Internet]. European Society for Medical Oncology. 2020. Available from: https://www.esmo.org/covid-19-and-cancer/covid-19-vaccination

Shah MK, Kamboj M. Immunizing Cancer Patients: Which Patients? Which Vaccines? When to Give? Oncology (Williston Park). 2018;32(5):254–8, C3.

Brydak LB, Guzy J, Starzyk J, Machała M, Góźdź SS. Humoral immune response after vaccination against influenza in patients with breast cancer. Support Care Cancer. 2001;9(1):65–8.

Meisel R, Kuypers L, Dirksen U, Schubert R, Gruhn B, Strauss G, et al. Pneumococcal conjugate vaccine provides early protective antibody responses in children after related and unrelated allogeneic hematopoietic stem cell transplantation. Blood. 2007;109(6):2322–6.

Bitterman R, Eliakim-Raz N, Vinograd I, Zalmanovici Trestioreanu A, Leibovici L, Paul M. Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database Syst Rev. 2018;2018(2):CD008983.

Doshi P. Covid-19 vaccine trial protocols released. BMJ. 2020;371:m4058.

Dooling K, Marin M, Wallace M, McClung N, Chamberland M, Lee GM, et al. The Advisory Committee on Immunization Practices' Updated Interim Recommendation for Allocation of COVID-19 Vaccine. 2020;

Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3).

Rieger CT, Liss B, Mellinghoff S, Buchheidt D, Cornely OA, Egerer G, et al. Anti-infective vaccination strategies in patients with hematologic malignancies or solid tumors—Guideline of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Oncol. 2018;29(6):1354–65.

Committee for Medicinal Products for Human Use (CHMP). COVID-19 mRNA vaccine (nucleoside-modified) – assessment report [Internet]. European Medicine Agency Science Medicines Health. Amsterda; 2020. Available from: https://www.ema.europa.eu/en/documents/assessment-report/comirnaty-epar-public-assessment-report_en.pdf

Harsono FH. Menkes Budi Gunadi Tetapkan 7 Jenis Vaksin COVID-19 untuk Vaksinasi [Internet]. 2021. Available from: https://www.liputan6.com/health/read/4446237/menkes-budi-gunadi-tetapkan-7-jenis-vaksin-covid-19-untuk-vaksinasi

Auletta J, Chemaly R, Khawaja F, Papanicolaou G, Hill J, Kanter J, et al. ASH-ASTCT COVID-19 and Vaccines: Frequently Asked Questions [Internet]. American Society of Hematology. 2020. Available from: https://www.hematology.org/covid-19/ash-astct-covid-19-and-vaccines

Zhang Y, Zeng G, Pan H, Li C, Hu Y, Chu K, et al. Safety, tolerability, and immunogenicity of an inactivated SARS-CoV-2 vaccine in healthy adults aged 18–59 years: a randomised, double-blind, placebo-controlled, phase 1/2 clinical trial. Lancet Infect Dis. 2021;21(2):181–92.

Xia S, Zhang Y, Wang Y, Wang H, Yang Y, Gao GF, et al. Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBIBP-CorV: a randomised, double-blind, placebo-controlled, phase 1/2 trial. Lancet Infect Dis. 2021;21(1):39–51.

Folegatti PM, Ewer KJ, Aley PK, Angus B, Becker S, Belij-Rammerstorfer S, et al. Safety and immunogenicity of the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2: a preliminary report of a phase 1/2, single-blind, randomised controlled trial. Lancet. 2020;396(10249):467–78.

Ramasamy MN, Minassian AM, Ewer KJ, Flaxman AL, Folegatti PM, Owens DR, et al. Safety and immunogenicity of ChAdOx1 nCoV-19 vaccine administered in a prime-boost regimen in young and old adults (COV002): a single-blind, randomised, controlled, phase 2/3 trial. Lancet. 2020;396(10267):1979–93.

Voysey M, Clemens SAC, Madhi SA, Weckx LY, Folegatti PM, Aley PK, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021;397(10269):99–111.

Keech C, Albert G, Cho I, Robertson A, Reed P, Neal S, et al. Phase 1–2 Trial of a SARS-CoV-2 Recombinant Spike Protein Nanoparticle Vaccine. N Engl J Med. 2020;383(24):2320–32.

Anderson EJ, Rouphael NG, Widge AT, Jackson LA, Roberts PC, Makhene M, et al. Safety and Immunogenicity of SARS-CoV-2 mRNA-1273 Vaccine in Older Adults. N Engl J Med. 2020;383(25):2427–38.

Jackson LA, Anderson EJ, Rouphael NG, Roberts PC, Makhene M, Coler RN, et al. An mRNA Vaccine against SARS-CoV-2 — Preliminary Report. N Engl J Med. 2020;383(20):1920–31.

Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403–16.

Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603–15.

Sandherr M, Hentrich M, von Lilienfeld-Toal M, Massenkeil G, Neumann S, Penack O, et al. Antiviral prophylaxis in patients with solid tumours and haematological malignancies—update of the Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Medical Oncology (DGHO). Ann Hematol. 2015;94(9):1441–50.

Hidayat MB. Petunjuk Teknis Pelaksanaan Vaksinasi Dalam Rangka Penanggulangan Pandemi Corona Virus Disease 2019 (COVID-19) [Internet]. Jakarta, Indonesia; 2021. Available from: https://covid19.go.id/storage/app/media/Regulasi/2021/Januari/Final SK Dirjen Juknis Vaksinasi COVID-19 02022021.pdf

PAPDI. Rekomendasi PAPDI tentang Pemberian Vaksinasi covlD-19 (CoronaVac) pada Pasien dengan Penyakit Penyerta/ Komorbid (Revisi 9 Februari 2021) [Internet]. Pengurus Besar Perhimpunan Ahli Penyakit Dalam Indonesia (PAPDI). 2021. Available from: https://www.papdi.or.id/berita/info-papdi/1009-rekomendasi-papdi-tentang-pemberian-vaksinasi-covid-19

Pergam S, Baden L, Abel G, Bunnell C, Cinar P, Hamdan A, et al. Preliminary Recommendations of the NCCN COVID-19 Vaccination Advisory Committee [Internet]. National Comprehensive Cancer Network (NCCN). Montgomery; 2021. Available from: https://www.nccn.org/covid-19/pdf/COVID-19_Vaccination_Guidance_V1.0.pdf

Callaway E. The race for coronavirus vaccines: a graphical guide. Nature. 2020;580(7805):576–7.

Corti C, Curigliano G. Commentary: SARS-CoV-2 vaccines and cancer patients. Ann Oncol. 2021;S0923-7534.

Marra A, Generali DG, Zagami P, Gandini S, Cervoni V, Venturini S, et al. LBA77 Anti-SARS-CoV-2 antibody response in patients with cancer and oncology healthcare workers: A multicenter, prospective study. Ann Oncol. 2020;31:S1206.

Kamboj M, Hohl T, Vardhana S, Knorr D, Lesokhin A, Papanicolaou Z, et al. MSK COVID-19 Vaccine Interim Guidelines for Cancer Patients [Internet]. Vol. 4. New York; 2021. Available from: https://www.asco.org/sites/new-www.asco.org/files/content-files/2021-MSK_COVID19_VACCINE_GUIDELINES_final_V.2.pdf

Sun L, Surya S, Le AN, Desai H, Doucette A, Gabriel P, et al. Rates of COVID-19–Related Outcomes in Cancer Compared With Noncancer Patients. JNCI Cancer Spectr. 2021;5(1).

Howard J, Snowden J, Ashcroft J. COVID-19 Vaccine in patients with haematological disorders British Society for Haematology [Internet]. British Society of Haematology. United Kingdom; 2020. Available from: https://b-s-h.org.uk/media/19195/haematology-covid-19-v10-vaccination-statement-231220.pdf

Recommendations for anti-Covid-19 vaccination in patients with multiple myeloma (MM) and related conditions, AL amyloidosis and other monoclonal gammopathies of clinical significance [Internet]. 2020. Available from: http://cms.cws.net/content/beta.myelomasociety.org/files/PM COVID vaccination in MM guidelines The Final.pdf

DeMarco C. COVID-19 and stem cell transplants: What you should know [Internet]. MD Anderson Cancer Center. 2020. Available from: https://www.mdanderson.org/cancerwise/covid-19-and-stem-cell-transplants-what-you-should-know.h00-159380367.html

Ullmann AJ, Schmidt-Hieber M, Bertz H, Heinz WJ, Kiehl M, Krüger W, et al. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol. 2016;95(9):1435–55.

Cordonnier C, Einarsdottir S, Cesaro S, Di Blasi R, Mikulska M, Rieger C, et al. Vaccination of haemopoietic stem cell transplant recipients: guidelines of the 2017 European Conference on Infections in Leukaemia (ECIL 7). Lancet Infect Dis. 2019;19(6):e200–12.

Carpenter PA, Englund JA. How I vaccinate blood and marrow transplant recipients. Blood. 2016;127(23):2824–32.

Kuderer NM, Choueiri TK, Shah DP, Shyr Y, Rubinstein SM, Rivera DR, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395(10241):1907–18.

Robilotti E V., Babady NE, Mead PA, Rolling T, Perez-Johnston R, Bernardes M, et al. Determinants of COVID-19 disease severity in patients with cancer. Nat Med. 2020;26(8):1218–23.

Garassino MC, Whisenant JG, Huang L-C, Trama A, Torri V, Agustoni F, et al. COVID-19 in patients with thoracic malignancies (TERAVOLT): first results of an international, registry-based, cohort study. Lancet Oncol. 2020;21(7):914–22.

Lee GM. Preventing infections in children and adults with asplenia. Hematology. 2020;2020(1):328–35.