Skip to main content

COVID-19 vaccine for stem cell transplant patients

We have produced resources to help you arrange COVID-19 vaccinations for your stem cell transplant patients. These resources can be used by transplant teams and GPs.

COVID-19 vaccine third primary doses and boosters

The JCVI has recommended that patients who are severely immunocompromised receive a third primary dose of a COVID-19 vaccine. High-risk individuals are also being offered a booster vaccine. This is separate from the third primary doses.

The below table summarises the current JCVI advice as it relates to stem cell transplant patients aged 12 and above.

 Third primary doseBooster dose
 Patients within 24 months of receiving an autologous or allogeneic stem cell transplant at the time of their first or second dose.

Patients at any time after transplant who had ongoing immunosuppression or graft versus host disease (GVHD) at the time of their first or second dose. 

Full JCVI third primary dose guidance  
Patients over 24 months of receiving an autologous or allogeneic stem cell transplant AND who did not have immunosuppression or graft versus host disease (GVHD) at the time of their first or second dose.  

Full JCVI booster guidance  
TimingIdeally, at least 8 weeks after the second dose. Third dose timing to be decided by specialist involved in care of patient.At least 6 months after the primary course of vaccine is completed.
Choice of vaccineFor over 18’s mRNA vaccines Pfizer BioNTech (Comirnaty®) or Moderna (Spikevax®) are preferred. 

For 12-17 year olds Pfizer BioNTech (Comirnaty®) is preferred.  

AstraZeneca (Vaxzevria®) is an option for individuals who have received this vaccine previously where this would help to improve implementation. In exceptional circumstances, persons aged 40 or over who received a mRNA COVID-19 vaccine previously may be offered a third dose of AstraZeneca (Vaxzevria®) vaccine. Reviewed on a case-by-case basis.  
Pfizer-BioNTech vaccine is preferred as a booster dose irrespective of the vaccine used for the primary course. As an alternative, individuals may be offered a half dose (50µg) of the Moderna COVID-19 vaccine. The latter appears to give very good immune responses and is expected to be less reactogenic than a full dose (Choi et al, 2021).  

Where mRNA vaccines are not suitable, vaccination with AstraZeneca vaccine may be considered in those who were primed with the same vaccine.  
Identification and bookingSpecialists are responsible for identifying and contacting patients in their care who should receive a third dose.  

For those based in England refer to this guidance on the identification and booking process.  
Individuals will be invited to book their booster vaccination by the National Booking System or via their local practice.  

For those based in England refer to this guidance on the identification and booking process.  

Please note that the JCVI has not yet made a recommendation for the timing of a booster (4th) dose for individuals with severe immunosuppression. We will update this guidance once a recommendation has been made.

Links to guidance

COVID-19 vaccine: re-vaccination after transplant

Patients who receive their COVID-19 vaccination before their stem cell transplant or CAR-T therapy should be re-vaccinated with all three primary doses, as per JCVI advice.

You can use this template to arrange re-vaccination for your patient after their transplant or CAR-T treatment.

The letter has been developed with NHSE England. Clinicians based in Scotland, Wales or Northern Ireland may need to adapt it for use locally.

The timing of re-vaccination should be in line with BSBMTCT recommendations i.e. 2-6 months after transplant or 3-6 months after CAR-T.