Covid Vaccines

General advice
1

I was wondering if Anthony Nolan medical team knows what the position will be with the current vaccines that look like they will shortly be available. Will they:

  • be available to those pre-transplant,
  • and subsequently again post-transplant with all the childhood vaccines (or earlier),
  • are all the current possible vaccines dead (as I understand live vaccines are not possible for post-transplant patients),
  • what will the conditions or circumstances be, if any, where the vaccine will not be appropriate,
  • which drugs, especially commonly taken drugs post-transplant, might interfere with the vaccines,
  • will patients with GvHD and especially those on treatments such as ECP make having a vaccine inappropriate (given that the ECP is to kill T-cells and the vaccines appear to stimulate T-cells),
  • is it expected that the vaccines will be given by the hospital you are treated at, or by your GP surgery, and,
  • any other advice and help possible in relation to the current probable vaccines.

Thanks

2

Hi AH67,

Thank you for your questions re: the suitability of COVID-19 vaccines for stem cell transplant patients.

The data we have on the current trial vaccines is not specific to stem cell transplant recipients. However we are in the process of gathering that information from our medical director and a consultant haematologist who is also expert in the field of ECP. As soon as we have that updated information, we’ll share it with you and the stem cell transplant community.

In the meantime you may find this information helpful:

  • None of the three COVID-19 vaccines in the most high profile clinical trials – by Pfizer, Moderna and AstraZeneca (aka the Oxford vaccine) – are ‘live’ vaccines. This means they are all expected to be suitable for people who have had a stem cell transplant.

  • 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.

  • Once they are found to be safe, the vaccines will be given to people wherever the UK government sets up its rapid response clinics. These locations have not yet been confirmed but may include your hospital or GP surgery as you have suggested, as well as locations where COVID-19 testing is currently being carried out.

I hope that’s useful. As I say, I’ll be able to update you as soon as we receive that further information, which is expected this week.

All the best,

Tom

3

AH67 thats a great question and one that I’ve been thinking about myself. I think Tom’s answer gives some comfort in that none of the potential vaccines are ‘live’ so should hopefully be safe to use in patients post transplant (not sure about pre-transplant).

Since my transplant I’ve had all of my childhood vaccinations again and have the flu jab each year, but have been conscious that the flu jab is ‘inactive’ due to my medical history and that my teenage sons also had this jab as opposed to the ‘live’ squirt up the nose at school.

I’ve seen reports in various places over the weekend that the likelihood is that those considered ‘extremely clinically vulnerable’ will be given a high priority equivalent to over 70s. I guess it’s an evolving situation and one that I’m keeping an eye on. Even approaching 8 years post transplant I’m on the NHS’s list and have had an ‘extremely clinically vulnerable’ letter from the Department of Health so may be in line for the vaccine early.

Here’s hoping that the trials prove that it is fully effective, safe and with no side effects so that the world can get back to some form of normality.

Steve

4

Hi AH67 & Steve,

I hope you’re well. After discussion with our medical director and consultant haematologists we have the latest information on COVID-19 vaccines for stem cell transplant patients and their families.

We’re updating the information regularly on our webpage Coronavirus (COVID-19) and your treatment | Anthony Nolan so do keep an eye on that. I’ve put the latest information below:

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.

What are the different types of vaccine?
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, they all stimulate our cells to make proteins found only in coronavirus. This does not mean we get COVID-19, but it does trigger our immune system 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.

How will the vaccines be given?
Once 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, roughly one month 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.

Will I be prioritised for a vaccine?
If you were previously told to shield because you were clinically extremely vulnerable (you should hopefully have received a letter informing you of this) you will be a placed into the fourth priority group. This is likely to be if you received a stem cell transplant in the last six months. If you think you are clinically extremely vulnerable but are concerned because you didn’t received a letter, please talk to your medical team about it. They will be able to clarify the situation.

If you have had a transplant but are not classed as clinically extremely vulnerable, you will be placed into the sixth priority group. 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.

Your individual situation will be assessed in detail by your medical team to make sure you are vaccinated at the most suitable time.

Will my other medications or treatments impact how effective the vaccine is?
For the vaccine to work, your body needs an active immune system so that it can react to it and provide immunity. Treatments such as steroids and other immunosuppressors, usually given to treat GvHD, are all designed to control your immune system. This means they could also reduce your body’s response to the vaccine.

Due to the relatively low number of patients who receive ECP treatment for GvHD, it is not yet clear if it is likely to affect the vaccine. 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 it because even some protection is better than none.

When you have had your vaccine, you must 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.

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 our information page: Coronavirus (COVID-19) and your treatment | Anthony Nolan

All the best,

Tom

5

Hi everyone,

In case you didn’t catch it there was a really good discussion event on Facebook yesterday about the vaccines relative to blood cancer patients. A panel of experts were answering questions that blood cancer patients had been asking and they addressed most of the reservations we may be having about being vaccinated by either of the two vaccines currently available.

The panel was chaired by Rachel Kahn of Blood Cancer UK, and consisted of Dr Graham Collins, Blood Cancer Consultant; Dr Teresa Inkster, Consultant Microbiologist; Professor Edd James, Professor in Cancer Immunology; and Professor Jeremy Brown, Clinician Scientist in Respiratory Medicine. They all spoke very clearly and concisely in language that was easy to understand.

I watched it live and found it really reassuring, not that I’m particularly nervous about having the vaccine anyway, but I thought it might be of some interest to others here. Hopefully the link below should take you to a recording of the event.

The event was organised jointly by Blood Cancer UK and Anthony Nolan, so thanks to both organisations for arranging this. I saw that there were around 300 people watching the live broadcast and hopefully many more have watched the event recording and found it of some use.

I hope it’s of interest to you all out there and that it answers some of your concerns.

Take care everybody and stay safe.

Steve

6

Hello Steve

I managed to catch some of the live discussion and also found it very helpful. Unfortunately I caught the last 20 minutes so will definately revisit via the link you have shared so thank you for doing that.

Honestly, finding things harder with lockdown no.3 as is everyone else. I’m trying to engage in my hobbies but there is more of an unsettled feeling at the back of mind.

I’m confident everyone else is experiencing something similar.

Hope everyone is ok

All the best,

Michelle

7

Hi - I hope you are all OK.

At Anthony Nolan we’ve received a number of questions about prioritisation for the Covid vaccine. We address this on our Covid webpage (Coronavirus (COVID-19) and your treatment | Anthony Nolan) and I’ve shared our answer here in case you find it useful:

‘As a stem cell transplant recipient will I be prioritised for a Covid vaccine?’

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 are currently being treated for a blood cancer or blood disorder
  • you had your transplant within the last six months
  • 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 6 (for people with serious underlying health conditions) if:

  • you had your transplant more than six months ago.

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.

We’ve further information on vaccination for stem cell transplant recipients on our Covid webpage: Coronavirus (COVID-19) and your treatment | Anthony Nolan

If you have any further questions or concerns, you can always email us: patientinfo@anthonynolan.org or call our helpline on 0303 303 0303.

All the best,

Tom