If a patient had stem cell transplant after receiving a COVID vaccine should that patient be revaccinated? Does CAR-T work the same?

There's a lot of questions have been asked about what is the timing of the vaccine in context with the transplant. If somebody was vaccinated, which would be within few months of, you know, when the vaccine rolled out, what we have done is delay the vaccine if they were going to transplant today or in the next month so that they can receive the vaccine after the transplant, which is 90 days after the transplant. However, if somebody got really early on, what we do not know is how much immunity is left after they receive the transplant. Will it become part of the routine vaccination after the transplant? I believe it will, but I do not know at this point how much immunity is preserved after the transplant, after receiving a vaccine. And that may depend on the vaccine and also how these vaccines evolve because it may become a yearly vaccine. So I don't know that for sure. Vaccination after transplant has been obviously a big concern for people who are in the midst of pandemic. When do I take my vaccine? So for individuals who were about to go to a transplant, we recommended them to wait for the vaccine. For example, it was within a month or six weeks. Get the transplant and then get the vaccination. However, what we did, encourage their household member, all of them to get vaccinated. So there is almost like a ring of protection around them at the very least. For individuals who were vaccinated, say for example, somebody who got vaccinated in January and now they're getting their transplant. And what do we do post transplant? I think we would have to see what the data shows in the setting because there are current trials that we are doing in the transplant population to better understand what would be the timing and need of revaccination. Would I recommend? I think I would if I have access to the vaccine because it's easier to say, yes, get the vaccine, but am I holding somebody else not getting the vaccine? What is the distribution of vaccine? So there is an issue of equity as well. So I think there is much more to learn. And if we have access, there might be a time where we would do them post transplant as well. Our guidelines for transplant cell therapy as a whole also include CAR T patients where we would vaccinate them three months after the CAR T for COVID vaccines. So I do believe that some of the nuances would be similar for CAR T patients as well, especially in the context of COVID vaccine. Vaccination of our transplants are a very important tool to maintain immune responses to the pathogens in the community. So we do recommend and we have a very robust system in place to get all the post transplant patients immunized according to the guidelines. That would include the influenza, the pneumococcal, the meningitis, the hepatitis, the varicella, the measles, mumps, and rubella when they can get there with a robust immune system when they have developed it because they're live vaccines. So what we are doing is separating them out from COVID vaccine at least by two weeks because we have to do that by the guidelines. But yes, still very much advocate for vaccines after transplant. All the post transplant vaccines are done by our transplant center and done in post transplant follow-up clinic until two years, until the schedule is done. The guidelines are endorsed by the American site of transplant cellular therapy. So there are bodies that have endorsed those guidelines for them to be administered in a scheduled fashion for patients after the transplant. I have to tell you what exact committee it came out of, but these are 209 guidelines which have been present for a decade and we still do it the same way.