Patients with multiple myeloma (MM) have a diminished immune response to coronavirus disease 2019 (COVID-19) vaccines. Risk factors for an impaired immune response are yet to be determined. We aimed to summarize the COVID-19 vaccine immunogenicity and to identify factors that influence the humoral immune response in patients with MM. Two reviewers independently conducted a literature search in MEDLINE, Embase, ISI Web of Science, Cochrane library, and Clinicaltrials.gov from existence until 24 May 24 2022. (PROSPERO: CRD42021277005). A total of 15 studies were included in the systematic review and 5 were included in the meta-analysis. The average rate (range) of positive functional T-lymphocyte response was 44.2% (34.2%-48.5%) after 2 doses of messenger RNA (mRNA) COVID-19 vaccines. The average antispike antibody response rates (range) were 42.7% (20.8%-88.5%) and 78.2% (55.8%-94.2%) after 1 and 2 doses of mRNA COVID-19 vaccines, respectively. The average neutralizing antibody response rates (range) were 25% (1 study) and 62.7% (53.3%-68.6%) after 1 and 2 doses of mRNA COVID-19 vaccines, respectively. Patients with high-risk cytogenetics or receiving anti-CD38 therapy were less likely to have a humoral immune response with pooled odds ratios of 0.36 (95% confidence interval [95% CI], 0.18, 0.69), I2 = 0% and 0.42 (95% CI, 0.22, 0.79), I2 = 14%, respectively. Patients who were not on active MM treatment were more likely to respond with pooled odds ratio of 2.42 (95% CI, 1.10, 5.33), I2 = 7%. Patients with MM had low rates of humoral and cellular immune responses to the mRNA COVID-19 vaccines. Further studies are needed to determine the optimal doses of vaccines and evaluate the use of monoclonal antibodies for pre-exposure prophylaxis in this population.

Background Infectious diseases and ophthalmology professional societies have disagreed regarding ocular screening in patients with candidemia. This study aimed to summarize the current evidence on the prevalence of ocular candidiasis (OC) and Candida endophthalmitis (CE) according to the standardized definitions. Methods A literature search was conducted from the 1990s through October 16th, 2022, using PubMed, Embase, and SCOPUS. Pooled prevalence of ocular complications was derived from generalized linear mixed models. (PROSPERO CRD42022326610) Results A total of 70 and 35 studies were included in the meta-analysis for OC and concordant CE (chorioretinitis with vitreous involvement), respectively. This study represented 8,599 patients with candidemia who underwent ophthalmologic examination. The pooled prevalence [95% confidence interval] of OC, overall CE, concordant CE, and discordant CE were 10.7% [8.4%-13.5%], 3.1% [2.1%-4.5%], 1.8% [1.3%-2.6%], and 7.4% [4.5%-12%] of patients screened, respectively. Studies from Asian countries had significantly higher concordant CE prevalence of patients screened [95% CI] of 3.6% [2.9% - 4.6%] compared to studies from European countries of 1.4% [0.4% - 5%] and American countries of 1.4% [0.9% - 2.2%], p-value <0.01. Presence of total parenteral nutrition and C. albicans were associated with CE with pooled odds ratios [95% CI] of 6.92 [3.58–13.36] and 3.02 [1.67–5.46], respectively. Conclusion Prevalence of concordant CE overall and among Asian countries was two-times and four-times higher than the prevalence previously reported by American Academy of Ophthalmology of < 0.9%, respectively. There is an urgent need to study optimal screening protocols and to establish joint recommendations by the Infectious Diseases and Ophthalmology Societies.

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