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The ongoing coronavirus pandemic is an understandable concern for all of us and people with a weakened immune system are at a higher risk of experiencing more serious complications from it.
As the UK government continues to update its COVID-19 related restrictions we are updating our advice for people who have received or waiting to receive a stem cell transplant. We are working alongside other cancer charities, medical experts and the NHS to make sure this advice is updated as the situation develops.
At this time, you probably have lots of questions, so we have tried to answer some of the most common and pressing concerns here:
You can contact the Anthony Nolan Patient Services helpline on 0303 303 0303 or patientinfo@anthonynolan.org
The COVID-19 vaccines approved for use in the UK have been tested on healthy volunteers of various ages. They have not yet been tested in patients with compromised immune systems, such as stem cell transplant recipients. This means we do not yet know for certain how effective they will be.
We are continuing to gather more information from stem cell transplant experts and will share it with you here.
Key points:
We answer more questions on COVID-19 vaccines here
Everyone in the UK must now follow their national restrictions. These are summarised below and in this BBC News website article. In England clinically extremely vulnerable people have now been advised to shield again after a new national lockdown was announced on 4th January.
As an adult you are at very high risk of severe illness from coronavirus (COVID-19) if you:
If your child had a stem cell transplant, their medical team will advise you whether they are at very high risk of severe illness from coronavirus. Further guidance for parents is available here.
If you fall into this 'clinically extremely vulnerable' category, you were previously advised to follow rigorous ‘shielding’ measures by remaining indoors in order to keep yourself safe. This includes staying at home, limiting those who visit your home to people providing essential support, making sure all visitors wash their hands regularly and maintaining safe distancing measures whenever possible. Everyone is now advised to work from home and to follow similar measures during lockdown.
Each government will write to everyone who is clinically extremely vulnerable with detailed advice for you on the current restrictions in your area. In England the letter will look like this. These letters are due to be sent out in January. If you do not receive a letter and feel you should be added to the list of clinically extremely vulnerable patients, contact your GP.
Each government has also published extra advice for anyone clinically extremely vulnerable in:
After talking to transplant centre consultants, we recommend that you discuss your situation with your medical team before making any changes to the precautions you follow. Your medical team has the fullest understanding of your own medical history and the potential impact COVID-19 could have on your health.
If you have any concerns about returning to school, college or university, either as a stem cell transplant recipient or as the parent of a patient, we recommend you discuss the specifics of your situation with the school, college or university. They have a responsibility to ensure you or your child can study safely.
If you think you have developed any symptoms of coronavirus such as a new, continuous cough or fever, seek clinical advice using the NHS 111 online coronavirus service or call NHS 111. Do this as soon as you get symptoms.
Everyone is advised to work from home if it is possible to do so.
If working from home is not an option, people who are clinically vulnerable are advised to not go to work and we are currently seeking clarity from the government that these people are eligible for the furlough scheme.
It is your employer’s responsibility to make sure you can work safely.
If you are unable to work, you may be eligible for:
Citizens Advice and turn2us have further information on benefits you may be entitled to.
Our Going back to work after your stem cell transplant and Work and stem cell transplant guides for patients and employers provide further information to make sure you get the support you are entitled to.
If you have any concerns about any of this, you can also contact your medical team who will be able to advise on the most suitable course of action for you.
The sharp increase in the number of coronavirus cases in many areas across the UK has led to the re-introduction of restrictions to help control the rate of infection. Each of the UK’s devolved nations currently have their own set of restrictions in place:
If you have any concerns about any of this, please contact your medical team who will be able to advise on the most suitable course of action for you.
Most government support for people shielding ended when shielding was paused in August, but local groups and organisations are still providing some support. You can find more information about the support in your area using the following links:
We realise this guidance may be challenging to follow and its impact could cause stress and anxiety for some of our patients. Your healthcare team will be able to help answer any specific questions you have around this.
You can also call our helpline on 0303 303 0303 or email us: patientinfo@anthonynolan.org
During these periods of nation lockdowns and local restrictions, everybody not considered to be clinically vulnerable should be avoiding all unnecessary contact with other people and always maintain safe social distancing. You should also work from home if it is possible to do so and limit travelling on public transport whenever possible.
Public Health England has published guidance on how households can cope with a possible coronavirus infection. We advise you follow this guidance no matter where you live in the UK.
Keep in touch with your medical team too as they may want to change the way they offer their follow-up appointments. This will be to limit the number of times you have to physically attend the hospital and so you can minimise your travel, particularly on public transport.
If you have any specific questions about how coronavirus could affect your own situation, please contact someone from your medical team. They will be happy to talk to you about any concerns you may have.
To help prevent the spread of coronavirus the advice to everyone, to protect yourself and others, is to:
Your transplant team are likely to change how they manage your medical appointments. Some consultations will be carried out either over the phone or by video. This will limit the amount of face-to-face contact needed and reduce your need to travel on public transport.
If you do need to attend in person, steps will be put in place to reduce the time spent in waiting rooms. Everyone will be asked to attend appointments without family members or carers if possible.
Where possible you should also try to avoid picking up your prescriptions in person. This can be done by ordering through online home delivery services, asking for help from family and friends or NHS volunteer services.
The stem cell transplant process significantly weakens the immune system, making patients more vulnerable to contracting infections including coronavirus. During the first peak of the coronavirus outbreak, some stem cell transplants were delayed to help protect patients and enable vital NHS resources to be directed to where they were most needed. Most autologous transplants and allogeneic transplants where the situation was deemed non-urgent were affected.
Despite the current wave of infections, hospitals are currently able to cope with the demands of treating patients. Some non-essential treatments have been temporarily suspended but this is not currently affecting cancer treatment such as stem cell transplants. We keep in regular contact with all the UK’s transplant centres and continuously monitor the situation.
At Anthony Nolan, we are working closely with every transplant centre in the UK and our suppliers to minimise the disruption coronavirus may cause. This includes any potential disruption as countries restrict travel to and from the UK to limit the spread of the new coronavirus variant.
Where possible, we are searching for multiple potential stem cell donors, including those from umbilical cord stem cells, and making sure we can still import donated cells from across the world. This will allow us to continue our life-saving work.
If you have any specific concerns, please contact your transplant centre. They will be in the best position to advise based on your medical condition, where your stem cells are coming from and the impact of coronavirus on local hospitals.
More information about coronavirus and how to reduce the risk of infection is available from the NHS website.
The Anthony Nolan Patient Services team is working hard to ensure we can still provide support to patients and families throughout the coronavirus pandemic:
The range of vaccines currently in development to protect us against COVID-19 will hopefully provide a much-needed long term solution to the current global pandemic. Although recent progress is promising, we understand there are still many unanswered questions for our patients. We have answered some of your most pressing concerns with the most up to date knowledge.
As always, we are working alongside other cancer charities, medical experts, and the NHS to make sure this advice is updated as the situation develops. On 6th January 2021 we co-hosted a Facebook Live Q&A event with Blood Cancer UK, when an expert panel answered further questions on Covid vaccines - you can watch it here.
Vaccines from the three most high-profile clinical trials (Pfizer, Moderna and AstraZeneca - aka the Oxford vaccine) use different approaches to achieve COVID-19 protection. Once injected, these vaccines stimulate our cells to make proteins found only in the strain of coronavirus that causes COVID-19. This does not mean we get COVID-19, but it does trigger our immune system to react to the new protein and develop immunity. So, if we then get infected, our body will recognise the virus and be able to destroy it, without us getting ill.
There is currently no evidence to suggest that either type of vaccine will give a better level of immunity than the other for stem cell transplant patients, either vaccine will be suitable for you.
Now all three vaccines have been approved, decisions will be made about which vaccine will be given to which groups of people, but it is likely to depend on many factors including availability, cost and effectiveness. However, we do know that all three vaccines will be given as two injections, a number of weeks apart from each other.
The vaccines will be given at specially set up vaccination centres, at hospitals, as well as local GPs and pharmacies. The government have also announced 50 hospital hubs that will co-ordinate the vaccination programme.
Any adult who has received a stem cell transplant to treat their blood cancer or blood disorder will be prioritised for a Covid vaccine:
You will be in Priority Group 4 (for 'clinically extremely vulnerable' patients) if:
You will be in Priority Group 6 (for people with serious underlying health conditions) if:
If you feel you have not been appropriately prioritised for a Covid vaccine, your GP will be able to address this on your behalf. We recommend you discuss this with your GP as soon as possible.
Children who have had a stem cell transplant will be considered for vaccination on an individual basis by their medical team. Specific information regarding how children will be prioritised for the vaccine is regularly updated on the CCLG website.
More information and the complete list of priority groups is available on the BBC website.
In general, the vaccine should be suitable for both pre and post-transplant patients. However, the vaccine is more likely to be effective if you have a functioning immune system.
This means that patients who have just had their transplant may need to wait a few months before they can be vaccinated:
Your individual situation will be assessed in detail by your medical team to make sure you are vaccinated at the most suitable time.
Anyone who is experiencing GvHD (Graft versus Host Disease) after their transplant may have their vaccination temporarily deferred to enable the strongest response from your immune system. This will be assessed on an individual basis for every patient.
Early reports from the first round of vaccinations suggest it may cause some side effects in a few people with allergies to the components of the vaccine. Although these people made full recoveries, if you have concerns that your own allergies may affect your reaction to the vaccine you should talk to the medical team about it before hand. Providing a list of the medications you are currently taking would also be helpful.
For the vaccine to work effectively, your body needs a functioning immune system so that it can react to the vaccine and provide immunity. Treatments such as systemic steroids and immunosuppressant drugs (such as Ciclosporin and ECP), usually given to prevent or treat graft-versus-host disease (GvHD), are all designed to suppress your immune system. This means they could potentially reduce your body’s response to the vaccine.
As post-transplant patients start to receive COVID-19 vaccines over the next few months, it will be important to understand how well they respond to the different types of vaccine, to inform future recommendations. As soon as we have a better understanding from the experts we work with, we will update this information.
Even if your current situation suggests you may not have a strong response to the vaccine, it is still important for you to have it because even some protection is better than none.
When you have had your vaccine, you should still remain careful and maintain the measures you have been following to protect yourself during the pandemic. This includes wearing a face mask, maintaining social distancing and regularly washing your hands. After vaccination, it can take several weeks to develop an immune response to prevent COVID-19. Furthermore, we need to understand more about how effective these vaccines are in immunosuppressed and post-transplant patients.
We are also working hard to make sure all NHS transplant staff as well as the people you live with are prioritised for vaccination too. This will help prevent the spread of the virus and reduce the risk of you picking it up from someone you are in close contact with. When we have more information on this situation will update this page.