Instructions for the vaccination of oncology patients with the vaccine against the SARS-CoV-2 virus, are given by the Professors of the Therapeutic Clinic of the Medical School of the National and Kapodistrian University of Athens, Efstathios Kastritis, Evangelos Terpos (EPAPOS) Terpos
In order to facilitate the vaccination process, oncology patients should pay attention to the following:
1. Activate the intangible prescription. Detailed instructions can be found at https://www.gov.gr/ipiresies/ugeia-kai-pronoia/phakelos-ugeias/aule-suntagographese. This will make it easier for you to plan your vaccination as you will be automatically notified by SMS or email about your appointment date and the vaccination center.
2. Some antineoplastic therapies may affect the body's ability to develop immunity after vaccination. You should contact your doctor to schedule treatment in relation to the date of vaccination.
3. For patients receiving first-time antineoplastic therapy, an effort should be made to vaccinate prior to initiating treatment.
4. For patients already receiving chemotherapy there is no clear instruction on the day of vaccination in relation to the infusion of chemotherapy. However, vaccines should be given one week after chemotherapy and, if possible, 10 days before the next chemotherapy.
Where possible, corticosteroids should be discontinued for the period from the first vaccination to the second and for at least 7 days after the second vaccination.
6. You should consult your doctor so that you do not have a low white blood cell count when you get the vaccine, aiming for the best therapeutic effect.
7. Radiation and hormone treatments do not appear to affect the safety and efficacy of the vaccine.
8. M-RNA technology vaccines do not contain attenuated virus and are therefore considered safe for administration to immunocompromised patients.
9. Patients in clinical trials should be vaccinated like other oncology patients.
10. Patients who will undergo autologous transplantation should ideally be vaccinated 3 months before mobilization-collection of hematopoietic stem cells and 3 months after autologous hematopoietic stem cell transplantation.
11. Administration of anti-CD20 therapy (Rituximab, ofatumumab, obinutuzumab) may reduce the immune response to vaccines. Ideally, if the underlying disease condition allows, they should be discontinued at least 6 months before the vaccine is given and in any case should be discussed with the treating physician.
12. Treatment with anti-CD38 monoclonal antibodies (daratumumab, isatuximab) may not affect the immune response to vaccines, but data are limited.
13. Patients receiving immunotherapy should not be excluded from the vaccination program even if they are in clinical trials. From relevant vaccine data for seasonal influenza, there do not appear to be any problems with vaccine efficacy.
14. Tyrosine kinase inhibitors (TKIs) such as sorafenib and sunitinib do not appear to affect the immune response to vaccines.
15. Bruton tyrosine kinase inhibitors (ibrutinib) appear to affect the body's ability to develop an adequate immune response after vaccination.
16. For treatment with drugs such as proteasome inhibitors (bortezomib, Ixazomib, carfilzomib) there is no clear guideline and the general rules apply for the time interval between the last treatment, the vaccination and the next treatment.
17. Immunomodulatory drugs such as lenalidomide, pomalidomide do not appear to affect the effectiveness of vaccinations, but the general rules apply.
18. Depending on the instructions of the Health Authorities, in the second phase, the vaccination may include the caregivers of the immunocompromised patients, as they will act as a shield for the people who cannot develop sufficient immunity with the vaccination.
19. At this stage there is no preference for vaccination technology for oncology patients as no significant safety issues have arisen.
20. Personal precautionary measures and social isolation should continue to be applied after vaccination for as long as necessary (mask, hand hygiene, distances)
Vaccine side effects (Tozinameran, BNT162b2)
Side effects occur within 7 days of the vaccine, especially after the 2nd dose. Particularly:
1) Local reactions (at the injection site) (pain, redness, swelling)
2) Fatigue
3) Headache
4) Myalgias
5) Chills
6) Joint pains
7) Fever.
Contraindications to vaccination
1) An absolute contraindication to vaccination is any severe hypersensitivity to the described active ingredients of the vaccine, as well as a previous history of anaphylaxis in a vaccine for COVID-19 disease. The doctor at the vaccination center should be informed of any history of allergic reaction prior to administration of the vaccine.
2) Known allergy to polyethylene glycol (PEG). It is a component of certain vaccines such as pneumococcus, laxative clean prep (used before colonoscopy), chemotherapy such as Caelyx, supportive treatment such as Neulasta and medicines such as dexamethasone and prednisone in syrup.
3) For people with a history of allergic reactions to previous vaccinations, mast cell activation syndrome, idiopathic anaphylaxis, certain brands or doses of the same drugs (and therefore not the active substance) require increased vigilance and contact with an allergist. Patients with a history of severe allergic reactions should be evaluated by the treating physician on a case-by-case basis and by the vaccinating physician.
4) Immediate allergic reaction of any severity to polysorbate (due to possible cross-hypersensitivity to the PEG component of the vaccine).
5) There are not enough clinical data for pregnant women and therefore it is not currently appropriate to vaccinate them with the COVID-19 vaccine. For the same reason, vaccination of adolescents and children under 16 years of age is not yet appropriate.
6) Vaccination should be postponed in patients with acute severe febrile illness.
7) Clinical studies have shown that severe allergic-anaphylactic reactions to COVID-19 vaccine are rare (<1%) (15 / 1,000,000 doses).
