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COVID-19 vaccines 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 primary and booster doses

The JCVI has recommended that patients who are severely immunocompromised, including certain stem cell transplant recipients, receive three primary doses of a COVID-19 vaccine followed by two further booster doses. Stem cell transplant patients who do not fall within the severely immunocompromised category should receive two primary doses followed by a single booster dose of a COVID-19 vaccine.

The below table summarises the current JCVI advice as it relates to stem cell transplant patients aged 12 and above. Children aged 5-11 who are at-risk or who live with an at-risk person, should receive two paediatric doses. Further information can be found here.

 Three primary doses and two booster dosesTwo primary doses and one booster dose
 Patient groupPatients within 24 months of receiving an autologous or allogeneic stem cell transplant at the time of their primary dose.

Patients at any time after transplant who had ongoing immunosuppression or graft versus host disease (GVHD) at the time of their primary dose.
Patients who have received CAR-T therapy in the past 24 months are likely to fit the criteria in the Green Book for a third primary dose.
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. 
TimingThird primary dose ideally at least 8 weeks after the second dose. Third dose timing to be decided by specialist involved in care of patient.

Initial booster (4th) dose no sooner than 3 months after the third primary dose. ‘Spring booster’ (5th) dose no sooner than 3 months after the previous booster dose.
Booster dose at least 3 months after the second primary dose.
Choice of vaccine: third primary doseFor those aged 18+ 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.
N/A
Choice of vaccine: booster dosePfizer-BioNTech (Comirnaty®) vaccine is preferred irrespective of the vaccine used for the primary course. As an alternative, individuals may be offered a half dose (50µg) of Moderna (Spikevax®).

Where mRNA vaccines are not suitable, vaccination with AstraZeneca (Vaxzevria®) may be considered in those who were primed with the same vaccine.

This does not apply for 12-17 year olds who should receive Pfizer BioNTech (Comirnaty®) for all doses.
Pfizer-BioNTech (Comirnaty®) vaccine is preferred irrespective of the vaccine used for the primary course. As an alternative, individuals may be offered a half dose (50µg) of Moderna (Spikevax®).

Where mRNA vaccines are not suitable, vaccination with AstraZeneca (Vaxzevria®) may be considered in those who were primed with the same vaccine.

This does not apply for 12-17 year olds who should receive Pfizer BioNTech (Comirnaty®) for all doses.
Identification and bookingSpecialists are responsible for identifying and contacting patients in their care who should receive these additional doses and the majority are being administered through hospital consultants and GPs.

Adult patients in England with a clinical referral letter from their doctor can also either book an appointment via the NHS national booking system, or use the NHS online COVID vaccine walk-in finder to find walk-in appointments. 
Individuals will be invited to book their booster vaccination by the National Booking System or via their local practice.

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 primary doses and booster doses they are eligible for, as per JCVI advice.

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

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 NHS England. Clinicians based in Scotland, Wales or Northern Ireland may need to adapt it for use locally.