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Blood cancer patients, especially those undergoing chemotherapy, are more likely to get infections because of their weakened immune systems. Find tips for preventing infections, avoiding illness and injury, hygiene and personal care, and food safety.
Many types of blood cancer can reduce the ability to fight infections. Because people with blood cancer are at an increased risk from respiratory illnesses like influenza, COVID-19, and RSV, it is important that they take steps to avoid them, including by getting vaccinated.
Blood Cancer United follows the science on vaccines.
We encourage people with blood cancer to talk with their oncology or other healthcare teams about the vaccines they may need and the best time to get them. We also encourage blood cancer patients with weakened immune systems to take additional precautions, like masking and avoiding crowds.
It is important for people with blood cancer to talk to their healthcare team about the vaccines they need.
As we move into the fall and winter, the risk of contracting respiratory viruses increases. Vaccines that protect against these seasonal viruses include:
- COVID-19 vaccination, which is available to people with cancer (and others with high-risk conditions) starting at age 6 months and for everyone aged 65 years and older.
- Influenza vaccination aka flu vaccine (inactivated vaccine only, aka “injectable”), which is available to everyone 6 months and older. People with blood cancer should not get the nasal mist form of the vaccine.
- RSV vaccination, which is available to people with cancer starting at age 50 years and everyone aged 75 years and older.
- The fall is also a good time to check on pneumococcal vaccine status.
People who have received transplants need additional vaccinations. The National Marrow Donor Program Vaccinations webpage provides a guide for which vaccines transplant patients need and when.
Children get many more vaccines compared to adults, so it is important to talk with their healthcare team about which vaccines they need and when. Childhood vaccines are timed very carefully to provide protection when children are most vulnerable or at times when they are highest risk of encountering an infection.
Recommendations for COVID-19 Vaccination in Adults and Children with Compromised Immunity
This information is adapted from Infectious Diseases Society of America (IDSA) 2025 guidelines. IDSA is a global community of over 13,000 physicians, scientists, and public health experts who specialize in infectious diseases.
- An FDA-approved 2025-2026 COVID-19 vaccine dose should be given as soon as possible.
- A second dose of COVID-19 vaccination is likely to extend protection.
- Household members and close contacts of immunocompromised patients should keep up to date with COVID-19 vaccination.
- It is appropriate for patients to receive COVID-19, influenza, and RSV vaccines at the same time.
Yes, people with suppressed immune systems should not get live, attenuated vaccines. Except for the nasal spray flu vaccine, most other live, attenuated vaccines are given during childhood as a one-time series. Live, attenuated vaccines include:
- Measles, mumps, rubella (MMR)
- Chickenpox
- Nasal spray flu vaccine (the shot is fine)
- Oral polio vaccine (the shot is fine)
- Rotavirus
Blood cancer and its treatments can make the body less able to fight illness—referred to as having a weakened immune system. This leaves patients more likely to get infections, be hospitalized, develop a long-term disability, or even die.
People whose blood cancer or its treatment has weakened their immune system may not get the full benefits from vaccines that people who do not have cancer get. This doesn’t mean people with cancer should skip vaccines—any protection is better than no protection. Even if the vaccine does not completely prevent infection it can help keep illness milder and keep people with cancer out of the hospital.
There are certain forms of blood cancer that are more likely to weaken the immune system before, during, and sometimes after treatment:
- Chronic lymphocytic leukemia
- Diffuse large B-cell lymphoma
- Follicular lymphoma
- Mantle cell lymphoma
- Marginal zone lymphoma
- Waldenstrom’s macroglobulinemia
Treatments that target cancerous B cells (a type of immune cell) in the blood can increase the risk of infection. These treatments are essential to control cancers, but they also can impact the ability of healthy B cells to fight infections. They include:
- BTK inhibitors, such as ibrutinib (Imbruvica), acalabrutinib (Calquence), and zanubrutinib (Brukinsa)
- Anti-CD20 antibodies, such as rituximab (Rituxan) and obinutuzumab (Gazyva)
- CAR T-cell treatments, ide-cel (Abecma), obe-cel (Aucatzyl), liso-cel (Breyanzi), (clita-cel) Carvykti, tisagenlecleucel (Kymriah), brexu-cel (Tecartus), and axi-cel (Yescarta)
- Autologous and allogeneic stem cell transplants
Vaccines work by helping the immune system learn to fight off certain illnesses. Vaccines help the body develop immunity without having to get sick (“natural immunity”). Some people say the “natural immunity” is better than immunity from vaccines. This is not true, and you risk getting severely sick from infections like COVID, influenza, RSV, and others that vaccines can either prevent or help to keep from becoming severe.
Household members and close contacts of immunocompromised patients should keep up to date with vaccinations. People who share a home with people with blood cancer who are immune compromised should not receive oral polio vaccine (there is an inactivated polio vaccine they can receive). Household contacts of patients who recently received a stem cell transplant or who have graft-vs-host-disease (GVHD) should also avoid the live flu vaccine (nasal mist form) and get a flu shot instead.
Vaccines have become widely available at retail pharmacies like CVS, Walgreens, Walmart, and Kroger. When you know which vaccines your healthcare team recommends you can visit your local pharmacy to get them. Vaccines may also be available in doctor’s offices or through public health departments.
Blood Cancer United is monitoring federal vaccine policy for changes that will impact vaccine availability.
Blood Cancer United has one aim: to help patients with blood cancer and their families live their best and healthiest lives. Vaccines are an important part of that and are one of the safest medical interventions available.
Blood Cancer United strongly urges people with blood cancer to talk to their oncology healthcare team about what’s right for them.
So far, CDC has not changed recommendations about which vaccines cancer patients should receive. This means that state recommendations and CDC recommendations for cancer patients are not different—for now.
Blood Cancer United is closely monitoring changes in federal vaccine policy.
Most insurance plans cover vaccines without patients needing to pay anything.
Blood Cancer United is keeping an eye on any changes in federal vaccine policy that could change this. For now, COVID-19, influenza, and RSV, plus pneumococcal disease vaccines, are covered.
Tips for preventing flu and respiratory infections
Take the following precautions to help prevent the flu and other respiratory infections, both for you and the people around you:
- Contact your primary care doctor and oncologist to see if an antiviral drug is recommended for you.
- Avoid contact with people who have the flu or other respiratory infections, which are spread mainly through person-to-person contact. In most cases, the CDC recommends that people who are coughing and sneezing stay home from work or school and limit contact with others to keep from spreading illness.
- Follow general public health advice about avoiding crowds.
- Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue away right after you use it.
- Wash your hands often with soap and water, especially after you cough or sneeze. If you don't have access to soap and water, use alcohol-based hand sanitizers.
- Reduce the spread of germs by avoiding touching your eyes, nose, or mouth
- As a precaution, store a supply of food, medicines, alcohol-based hand sanitizer, and other essential supplies.
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Cancer and vaccines
American Society of Clinical Oncology. Vaccination of Adults with Cancer: ASCO Guideline. At: https://ascopubs.org/doi/10.1200/JCO.24.00032.
American Society of Hematology. ASH Comments to Advisory Cmte on Immunization Practices re: the Importance of Vaccines for Hematologic Disorders. At: https://www.hematology.org/advocacy/testimony-and-correspondence/ash-co….
National Marrow Donor Program (NMDP). Vaccinations. At: https://network.nmdp.org/services-support/hematology-oncology/post-tran….
Vaccine schedules
American Academy of Family Physicians (for healthy adults & elderly people). Immunization Schedules. At: https://www.aafp.org/news/media-center/statements/aafp-announces-fall-i….
American Academy of Pediatrics. AAP Immunization Schedule (for children and adolescents). At: https://publications.aap.org/redbook/resources/15585/AAP-Immunization-S….
American College of Obstetricians & Gynecologists (for pregnant women). ACOG Releases Updated Maternal Immunization Guidance for COVID-19, Influenza, and RSV. At: https://www.acog.org/news/news-releases/2025/08/acog-releases-updated-m….
Infectious Diseases Society of America. IDSA 2025 Guidelines on the Use of Vaccines for the Prevention of Seasonal COVID-19, Influenza, and RSV Infections in Immunocompromised Patients. Published October 17, 2025. At: https://www.idsociety.org/practice-guideline/idsa-2025-guidelines-on-th….
Vaccine coverage
AHIP. AHIP Statement on Vaccine Coverage. At: https://www.ahip.org/news/press-releases/ahip-statement-on-vaccine-cove…;
Blood Cancer United resources
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