UPDATED 20 October 2021
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 COVID-19.
As the UK government continues to relax its COVID-19 restrictions, we are working with other cancer charities, medical experts, researchers and the NHS to update our advice for people who have received or are waiting to receive a stem cell transplant.
You can contact the Anthony Nolan Patient Services helpline on 0303 303 0303 or firstname.lastname@example.org
- Will the COVID-19 vaccines be suitable for me?
- Will the vaccines protect me from COVID-19?
- What are the different types of vaccine?
- How will the vaccines be given?
- Will I be prioritised for a vaccine?
- Will the timing of my second dose change how effective it is?
- Will my other medications or treatments impact how effective the vaccine is?
- Will I need to be vaccinated again after my transplant?
- What else can I do to stay protected?
- How can I support research into vaccines for stem cell transplant patients?
Four vaccines - Pfizer’s vaccine, the AstraZeneca vaccine (aka the Oxford vaccine), the Moderna vaccine and the Janssen single-dose vaccine - have been approved for use in the UK by the Medicines and Health Regulatory Agency (MHRA). The Janssen single-dose vaccine is due to be used in the UK later in 2021. A further Novavax vaccine is awaiting MHRA approval.
None of the approved COVID-19 vaccines are ‘live’ vaccines. This means they all should be suitable for people who have had a stem cell transplant or who are waiting to have a stem cell transplant.
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:
- It has been recommended that anyone who has an autologous transplant (auto) receives the vaccine at least two months after their transplant.
- Anyone who has an allogeneic transplant (allo) is recommended to receive the vaccine 3-6 months after their transplant.
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.
After receiving the COVID-19 vaccine it may feel sore where the needle went into your arm, or you may feel tired or sick, have a headache or body aches. These common side effects usually wear off within 48 hours. If you experience any other side effects, or they last longer than 48 hours, we recommend you discuss them with your GP or hospital team.
The COVID-19 vaccines could cause side effects in a few people with allergies to the components of the vaccine. If you have concerns that your own allergies may affect your reaction to the vaccine, you should talk to the medical team about it beforehand. Providing a list of the medications you are currently taking would also be helpful.
Will the vaccines protect me from COVID-19?
The COVID-19 vaccines approved for use in the UK have been tested on healthy volunteers of various ages. They were not initially 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.
A great deal of research is taking place into this, and Anthony Nolan is part of Blood Cancer UK’s Vaccine Task Force which is tracking all research in this area.
Early findings suggest that COVID-19 vaccines may be less effective among patients who are undergoing cancer treatment, and that it may take longer for them to develop immunity.
One study has suggested that roughly three quarters of stem cell transplant patients can produce detectable antibodies following their vaccine. The first published results from the OCTAVE clinical trial, which we are supporting through the IMPACT partnership, showed similar findings. When looking at the responses of the first 42 transplant recipients, they generally produced fewer antibodies than the general population, although their T-cell responses were similar. However, we don’t yet know whether transplant recipients can make enough antibodies to give suitable protection from COVID-19. The early findings from the OCTAVE study have been summarised by Blood Cancer UK
There is also hope that antibody treatments may be able to reduce the risk of COVID-19 among patients who the vaccines do not work for. We will continue to share findings with you as research develops.
If you are concerned about the level of protection a COVID-19 vaccine has given you, we recommend you discuss this with your healthcare team. They will be able to advise you on further steps you can take to protect yourself.
What are the different types of vaccine?
The four approved vaccines (from Pfizer, Moderna, AstraZeneca and Janssen) 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 will be able to destroy it, without us getting ill.
There is currently no evidence to suggest that any specific COVID-19 vaccine gives a better level of immunity for stem cell transplant patients. All the COVID-19 vaccines should be suitable for you.
How will the vaccines be given?
The Pfizer, Moderna and AstraZeneca vaccines are given as two injections, a number of weeks apart from each other. You will be offered your 2nd vaccine dose within 8 weeks of your first dose.
Anyone whose immune system was severely suppressed at the time they were vaccinated may also be offered a 3rd dose of COVID-19 vaccine. This includes anyone who had a stem cell transplant within the past 2 years.
Your hospital team or GP will invite you for a 3rd dose if you are eligible for one. You will be offered your 3rd vaccine dose at least 8 weeks after your 2nd dose. Anyone aged 12 or above who is immunocompromised will be considered for a 3rd dose. All eligible patients were due to be invited for a 3rd dose by 11th October, so if you have not yet been offered a 3rd dose and feel you are eligible for one, we recommend you contact your hospital team or GP as soon as possible.
If you were not severely immunosuppressed at the time of your first two vaccines, you may still be offered a booster vaccine dose. Everyone who is clinically extremely vulnerable or in an at-risk group (see below) will be offered a booster vaccine dose, unless they have already been invited for a 3rd dose. Adults living with someone who is immunosuppressed will also be eligible for a booster dose.
Note: a Janssen COVID-19 vaccine is approved for use in the UK, although it is not currently being used here. When it is used, the Janssen vaccine will be given in one injection as a single dose, in contrast to the other COVID-19 vaccines.
Will I be prioritised for a vaccine?
Any adult who has received a stem cell transplant to treat their blood cancer or blood disorder will be prioritised for a COVID-19 vaccine.
You will be in Priority Group four (for 'clinically extremely vulnerable' patients) if:
- you are currently being treated for a blood cancer
- you had a stem cell transplant within the last six months
- your conditioning therapy is due to begin in two weeks' time or longer
- you are taking medication to suppress your immune system, including treatment for graft vs host disease (GvHD), or
- you have been classed as 'clinically extremely vulnerable' for any other reason.
You will be in Priority Group six (for people with serious underlying health conditions) if:
- you had a stem cell transplant more than six months ago, or
- you are over 16 and live with someone who has a weakened immune system in England or Wales, e.g. if they have blood cancer or are undergoing chemotherapy. Further details are here. In Wales household contacts can use this self referral form to request vaccination.
The NHS will contact you to arrange your COVID-19 vaccination. Anyone who is in Priority Group four (for clinically extremely vulnerable patients) can request a COVID-19 vaccination appointment online here.
You will be recommended to have a COVID-19 vaccine after your transplant, along with other post-transplant vaccinations, regardless of whether or not you were vaccinated against COVID-19 before your transplant.
If you feel you, or anyone in your household, have not been appropriately prioritised for a vaccine, your GP or hospital team will be able to address this on your behalf.
You may find the following official statements useful when having your discussion:
- BSBMTCT (British Society of Blood & Marrow Transplantation & Cellular Therapy) COVID-19 Vaccination Statement
- British Society for Immunology statement on COVID-19 vaccines for patients who are immunocompromised or immunosuppressed
More information and the complete list of priority groups is available on the BBC website.
Children over the age of 12 who are at high risk of developing severe COVID-19 will be offered the Pfizer vaccine. This includes children diagnosed with blood cancer or sickle cell disease and children who have had a stem cell transplant. Specific information regarding how children will be prioritised for the vaccine is regularly updated on the CCLG website.
Over 12s will also be offered the COVID-19 vaccine if they live with someone who has a compromised immune system. Blood Cancer UK has further information on how each UK nation is making vaccination available to children here.
All 16 and 17-year-olds in the UK will be offered their first dose of the Pfizer vaccine from August. The UK government has published further details here.
Will the timing of my second dose change how effective it is?
The Pfizer, Moderna and AstraZeneca vaccines are delivered as two injections, a number of weeks apart.
Research is ongoing into whether the timing of your second dose could affect the level of protection from COVID-19. Anthony Nolan is part of Blood Cancer UK’s Vaccine Task Force which is tracking the research in this area.
Early findings from two studies suggest that patients undergoing cancer treatment may be less protected against COVID-19 than other people and it may take longer for them to develop immunity.
While these studies are in their early stages, the Blood Cancer Alliance (of which Anthony Nolan is a member) is urging the Joint Committee on Vaccination and Immunisation (JCVI) to assess whether a shorter time between doses of the Pfizer vaccine provides better protection for people with blood cancer.
In the meantime we strongly encourage patients to take the COVID-19 vaccine that is offered to them, at the earliest opportunity. After receiving each dose of the vaccine you should continue to follow safety measures to protect yourself during the pandemic - including wearing a face mask, maintaining social distancing and regularly washing your hands.
If you are concerned about the timing of your second dose, we recommend you discuss this with your GP or hospital team. In your discussion you may find it useful to refer to this statement by the BSBMTCT (British Society of Blood & Marrow Transplantation & Cellular Therapy).
Will my other medications or treatments impact how effective the vaccine is?
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 continue to receive COVID-19 vaccines, 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.
Will I need to be vaccinated again after my transplant?
Yes. During your transplant your immune system is replaced, so if you received a COVID-19 vaccine before your transplant it is recommended that you are vaccinated again after your transplant. This is known as 're-vaccination'.
Your transplant team will help to arrange this for you. They will assess your individual situation to make sure you are re-vaccinated at the most suitable time for you.
Your transplant team should use this letter template (PDF, 163KB) to inform your GP of your need to be re-vaccinated after your transplant. This template has been approved by NHS England.
In some cases your transplant team may be able to arrange your re-vaccination themselves, but they still should let your GP know.
All doses of COVID-19 vaccine, delivered a number of weeks apart, will be required to give you maximum protection.
This official recommendation for patients to be re-vaccinated after stem cell transplant is in the Public Health England guidance for healthcare professionals known as the Green Book. The reference to re-vaccination is in Chapter 14 on page 20 here - you may find this link useful when discussing re-vaccination with your transplant team.
What else can I do to stay protected?
Even if your current situation suggests you may not have a strong response to the vaccine, it is still important for you to have the vaccine because even some protection is better than none.
After vaccination it can take some time to develop an immune response to COVID-19, and the level of protection for stem cell transplant recipients is not yet fully understood. So 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.
This is particularly important if you live in an area where COVID-19 cases are high.
Vaccine Research Appeal
Donate to our Vaccine Research Appeal to help protect vulnerable blood cancer patients who urgently need a vaccine that works for them.
- Should I still be shielding?
- What if I'm not in the high risk group?
- What further steps should I be taking?
As an adult you are at very high risk of severe illness from coronavirus (COVID-19) if you:
- are currently being treated for a blood cancer or blood disorder
- had a stem cell transplant within the last six months
- are taking medication to suppress your immune system, including treatment for graft vs host disease (GvHD).
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' (CEV) category, you were previously advised to follow rigorous ‘shielding’ measures to keep yourself safe from COVID-19. Shielding advice included:
- staying at home
- limiting those who visit your home to people providing essential support
- ensuring all visitors wash their hands regularly
- maintaining safe distancing measures whenever possible.
Shielding advice has now been withdrawn. Instead, anyone clinically extremely vulnerable is advised to discuss the precautions you follow with your own medical team. Your medical team has the fullest understanding of your own medical history and the potential impact COVID-19 could have on your health.
Each government has published advice for anyone clinically extremely vulnerable in:
Summaries of the remaining restrictions for each home nation are available in this BBC News website article.
A number of other changes have also taken place now shielding has ended:
- CEV children are advised to return to school.
- CEV people who cannot work from home are no longer able to access Employment Support Allowance (ESA) or Statutory Sick Pay on the basis of needing to shield. You will require a sick note from your doctor to access that support.
- Access to supermarket delivery priority slots is still available in Wales.
In response to continuing high levels of COVID-19 in the community, Anthony Nolan is urging the UK governments to continue to support CEV people who were previously asked to shield.
If you have any concerns about returning to work, school or further education, either as a stem cell transplant recipient or as the parent or guardian of a patient, we recommend you discuss the specifics of your situation with your employer or educational support staff. They have a responsibility to ensure you or your child can study safely. Further information can be found in the work section below.
Although the legal requirements of social distancing and wearing facemasks has now ended in most parts of the UK it's still important to protect both yourself and people who are clinically extremely vulnerable to COVID-19. We recommend people still wear facemasks in crowded indoor spaces, including public transport, and maintain safe social distancing where 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, to protect yourself and others, everyone is advised to:
- Regularly wash your hands thoroughly (for 20 seconds) with soap and water.
- Wash your hands when you get home or arrive at work.
- Wear a face covering in shops and other public indoor spaces as well as on public transport.
- Cover your mouth and nose with a tissue when you cough or sneeze.
- Put used tissues in the bin straight away and wash your hands afterwards.
- Avoid close contact with people who are unwell.
- Avoid touching your face if your hands aren’t clean.
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.
What are the current restrictions where I live?
Across the UK, COVID-19 restrictions are being lifted in stages, subject to various factors including case numbers and COVID-19 vaccination levels within the community.
Each of the UK’s devolved nations currently has its own set of restrictions in place. These are summarised below and in this BBC News website article.
We recommend that you discuss your situation with your own medical team before making any changes to the precautions you follow. Your team has the fullest understanding of your own medical history and the potential impact COVID-19 could have on your health.
- England – Most legal restrictions have now been removed. There's no limit on the number of people you can meet, either indoors or outdoors, and all hospitality venues have reopened. Social distancing and wearing a face covering is no longer a legal requirement but some shops and travel operators still require face coverings to be worn. Current restrictions are outlined here.
We recommend that you continue to wear face coverings in crowded indoor areas, such as shops and when on public transport, to protect yourself and reduce the spread of COVID-19.
The government has published further guidance for clinically extremely vulnerable people in England here. This recommends socialising outside, continuing to practice social distancing 'if that feels right for you and your friends', and asking friends and family to take a lateral flow test before visiting you, among other recommendations.
- Wales – Most legal restrictions have now been removed. There is no limit on how many people can meet, either indoors or outdoors, but it is still a legal requirement to wear a face covering on public transport and in most public places indoors except bars, pubs and restaurants. To enter nightclubs and many indoor or outdoor events, you must prove you've been vaccinated by showing the NHS COVID Pass or a negative lateral flow test. Wales is at Alert Level 0 which is explained in full here.
- Scotland – Most legal restrictions have now been removed. There is no limit on the number of people you can meet, either indoors or outdoors, and social distancing is no longer required. However you are still legally required to wear a face covering indoors in public places and on public transport. To enter nightclubs and large events, you must prove you've been vaccinated by showing a COVID Vaccination Certificate. Further details are available here.
- Northern Ireland – Up to 15 people from four households can meet in private homes. There is no limit on the number of people you can meet outdoors. However you are still legally required to wear a face covering on public transport, in shops and some other settings. Social distancing is still required in shops, restaurants and for many indoor activities. Current restrictions are outlined here.
If you are a stem cell transplant recipient and you have any concerns about your child returning to school, we recommend you discuss this with their school. They have a responsibility to ensure your child can study safely and that you are not put at risk by their return to school.
If you have any other concerns, please contact your medical team who will be able to advise on the most suitable course of action for you.
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.
Despite the current level of COVID-19 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 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.
Can I return to work?
It is your employer’s responsibility to make sure you can work safely during the COVID-19 pandemic.
If you cannot work from home, talk to your employer to ensure suitable measures have been taken to protect you from COVID-19 at your workplace. If you have a union representative, they will be able to raise any concerns on your behalf.
Anthony Nolan has joined a group of charities calling on employers to put protective measures in place for staff vulnerable to COVID-19. These #SafeAtWork measures are explained in a letter which you can share with your employer.
- UK government guidance on working safely during the coronavirus pandemic can be found here.
- In Wales if you have been asked self-isolate via the NHS COVID-19 app and you cannot work from home, you may be eligible for a £500 payment. Further details are here.
- The Scottish Government has updated its workplace advice for anyone clinically extremely vulnerable. It has also developed a workplace risk assessment tool.
- More information on how coronavirus could impact your work is available on the ACAS website.
If you are unable to work, you may also be eligible for:
Note: since 1 April 2021 anyone clinically extremely vulnerable who cannot work from home will require a sick note from your doctor to be eligible for SSP or ESA.
Our Going back to work after your stem cell transplant and Work & stem cell transplant: Information for Employers 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, your medical team will be able to advise on the most suitable course of action for you.
- In England the support available is listed here or call 0800 0288327, the Government’s dedicated helpline.
- In Wales the support available is listed here. If you have been asked to self-isolate via the NHS COVID-19 app and you cannot work from home, you may be eligible for a £500 payment. Further details are here.
- In Scotland you can call the free national helpline number on 0800 111 4000. Further support is listed here.
- In Northern Ireland you can call the free COVID-19 Community Helpline on 0808 802 0020 and details of support for vulnerable people can be found here. You can also register for help or support from community groups and volunteers in Northern Ireland here.
- Anthony Nolan provides Grants of up to £250 to help cover costs linked to stem cell transplant and recovery from transplant: www.anthonynolan.org/grants
- We have set up our Telephone Emotional Support Service, run by a team of wellbeing specialists including qualified psychologists at Working to Wellbeing, so our patients and family members can talk to someone about their concerns and wellbeing during this difficult time. Find out more by emailing us: email@example.com
- You can connect with other patients and families to share advice and support on our Patients & Families Forum or our Patients & Families Facebook page
- Our mental health information gives extra advice on managing your emotional wellbeing before, during and after your transplant.
- You can call our Anthony Nolan Patient Services helpline on 0303 303 0303 or firstname.lastname@example.org
Information first published: 11/03/2020
Last update: 20/10/2021