UPDATED 6 May 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 related restrictions we are updating our advice for people who have received or are 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.
- Will the COVID-19 vaccines be suitable for me?
- Should I still be shielding?
- What will happen now shielding advice has ended?
- Can I return to work?
- What are the current restrictions where I live?
- What government support is available?
- What if I'm not in the high risk group?
- What further steps should I be taking?
- How will my treatment be affected?
- Will my stem cell transplant still go ahead?
- Where can I get extra help?
You can contact the Anthony Nolan Patient Services helpline on 0303 303 0303 or email@example.com
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.
- None of the approved COVID-19 vaccines are ‘live’ vaccines. This means they are all expected to be suitable for people who have had a stem cell transplant. Novavax's vaccine, which has recently completed its phase III clincial trial, is also not a live vaccine.
- All potential COVID-19 vaccines must be reviewed by the Medicines and Health Regulatory Agency (MHRA) before they are deemed to be safe to give to people. All three high profile vaccines - Pfizer’s vaccine, the AstraZeneca vaccine (aka the Oxford vaccine) and the Moderna vaccine - have now been approved for use in the UK. The Novavax vaccine is now awaiting MHRA approval.
- The UK government has decided who should get the vaccines first. Priority groups have been created based on age, medical history and profession. In England and Wales anyone over 16 who is living with someone with a weakened immune system will also be prioritised - in Wales household contacts can use this self referral form to request vaccination.
- If you feel you, or anyone in your household, have not been appropriately prioritised for a Covid vaccine, discuss this with your GP or hospital team.
- 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 UK government's Joint Committee on Vaccination and Immunisation (JCVI) has recommended that anyone with an underlying health condition continues to receive their second dose of the AstraZeneca COVID-19 vaccine as planned. This is because the benefits of prompt vaccination with the AstraZeneca vaccine far outweigh the risk of potentially developing blood clots.
- However as a precaution, anyone under 30 who does not have an underlying health condition will now be offered the Pfizer or Moderna vaccine as an alternative. This also applies to adults under 30 who are carers or living with immunosuppressed individuals. The JCVI's full statement is here.
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' category, you were previously advised to follow rigorous ‘shielding’ measures to keep yourself safe from COVID-19. Shielding advice includes:
- stay at home
- limit those who visit your home to people providing essential support
- ensure all visitors wash their hands regularly
- maintain safe distancing measures whenever possible.
Clinically extremely vulnerable people in Scotland and Northern Ireland are currently advised to follow similar shielding measures.
But the governments in England and Wales no longer advise clinically vulnerable people to 'shield' from COVID-19. They will send a letter to everyone CEV listing the precautions they now recommend.
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.
Each government has published extra advice for anyone clinically extremely vulnerable in:
Wherever you live in the UK, if you feel you should be added to the list of clinically extremely vulnerable patients, contact your GP or hospital team.
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.
The governments in England and Wales 'paused' their shielding programme on 1 April. This means they no longer advise clinically extremely vulnerable (CEV) people to shield from coronavirus. Anyone classed as CEV is due to receive a letter explaining this.
Since 12 April, the government in Northern Ireland has advised clinically extremely vulnerable people to continue to work from home where possible - but they also advise that you can return to your workplace if:
- you can travel to work in a way that enables social distancing
- your employer has taken measures to enable social distancing at your workplace.
Since 26 April, the government in Scotland also advises that clinically extremely vulnerable people can return to the workplace if it is safe for them to do so.
We continue to recommend that you discuss your situation with your own medical team before making any changes to the precautions you follow.
A number of other changes have taken place now shielding is paused:
- Clinically extremely vulnerable (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.
- CEV people who cannot work from home remain eligible for support from the government's furlough scheme until September 2021.
- Access to supermarket delivery priority slots will continue until 21st June in England. No end date has been set in Wales.
Anthony Nolan has urged the UK governments to continue supporting clinically extremely vulnerable people after shielding is paused.
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.
- 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 developed this workplace risk assessment tool.
- More information on how coronavirus could impact your work is available on the ACAS website.
If you are classed as clinically extremely vulnerable and you cannot work from home, you may be eligible for support from the government's furlough scheme until September 2021. We recommend you discuss this with your employer.
If you are unable to work, you may also be eligible for:
Note: since 1 April 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.
Across the UK shops, gyms, hairdressers, barbers and swimming pools have now reopened, and pubs, cafes and restaurants are allowed to serve people outside.
Each of the UK’s devolved nations currently has its own set of extra restrictions in place. These are summarised below and in this BBC News website article. These restrictions are being lifted in stages, subject to various factors including case numbers and the emergence of new COVID-19 variants:
- England – Up to six adults or two households of any size can now mix outdoors. Current restrictions are outlined here.
- Wales – Up to six adults from six households can now mix outdoors. The ban on travel in and out of Wales has been lifted. Current restrictions are outlined here.
- Scotland – Up to six adults from six households can mix outdoors. Pubs, cafes and restaurants are allowed to serve people indoors but no alcohol can be sold. Galleries and museums can reopen. Travel restrictions around Scotland have been relaxed. All areas of Scotland are currently at level three. Current restrictions are outlined here.
- Northern Ireland – Up to 10 adults from two households can now mix outdoors. Travel restrictions remain in place. 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.
- 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.
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, 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.
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 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.
The Anthony Nolan Patient Services team is working hard to ensure we can still provide support to patients and families throughout the coronavirus pandemic:
- Anthony Nolan provides Grants of up to £250 to stem cell transplant patients for expenses with a direct link to coronavirus: 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: firstname.lastname@example.org
- 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 email@example.com
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-19 vaccines - you can watch it here.
- On 25th February 2021 the African Caribbean Leukaemia Trust (ACLT) hosted an online panel discussion where healthcare professionals and community leaders addressed concerns within the UK's black community about COVID-19 vaccination. You can watch it here.
- On 25th March 2021 Blood Cancer UK hosted an expert panel to discuss current research into how effective COVID-19 vaccines are among blood cancer patients. You can watch it here.
What are the different types of vaccine?
The three approved vaccines (from 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 any one of the vaccines will give a better level of immunity than the others for stem cell transplant patients. All of them should be suitable for you.
How will the vaccines be given?
All three COVID-19 vaccines are being given as two injections, a number of weeks apart from each other.
The vaccines are being given at specially set up vaccination centres, at hospitals, as well as local GPs and pharmacies. In England the vaccination programme is being co-ordinated by 50 hospital hubs.
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. In England, anyone who is in Priority Group four (for clinically extremely vulnerable patients) or anyone aged over 70 can now book their own COVID-19 vaccination appointments online here.
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
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.
In April 2021 the UK government reached its target of offering a first vaccine dose to everyone in the first nine priority groups. Its Joint Committee on Vaccination and Immunisation (JCVI) has recommended an age-based approach for the next phase, as the quickest way to protect as many people as possible. While this means household members of people at higher risk have not been prioritised, the JCVI believes that an age-based rollout will mean that everyone will receive a vaccine in the quickest time frame.
More information and the complete list of priority groups is available on the BBC website.
Will the vaccines be suitable for all stem cell transplant patients?
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:
- 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.
During your transplant your immune system is replaced, so if you received a COVID-19 vaccine before your transplant, you will need to be vaccinated again after your transplant. Your transplant team will help you to arrange this. We have further information on post-transplant vaccination here.
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 beforehand. Providing a list of the medications you are currently taking would also be helpful.
Will the timing of my second dose change how effective it is?
All three COVID-19 vaccines are delivered as two injections, a number of weeks apart. In the UK you will receive your second vaccine dose up to 12 weeks after your first.
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 research by King's College London and the Francis Crick Institute have suggested that patients undergoing cancer treatment may be less protected against COVID-19 than other people after one dose of the Pfizer vaccine. An early second dose appeared to boost their protection.
While this is a small study in its 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 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.
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.
Information first published: 11/03/2020
Last update: 06/05/2021