Immunogenicity of COVID-19 vaccines in patients with haematological malignancy: A systematic review and meta-analysis

Abstract

The objectives of this study were to assess the immunogenicity and safety of COVID-19 vaccines in patients with haematological malignancy. A systematic review and meta-analysis of clinical studies of immune responses to COVID-19 vaccination stratified by underlying malignancy and published from 1 January 2021 to 31 August 2021 was conducted using MEDLINE, EMBASE and CENTRAL. Primary outcome was the rate of seropositivity following 2 doses of COVID-19 vaccine with rates of seropositivity following 1 dose, rates of positive neutralising antibody (nAb), cellular responses and adverse events as secondary outcomes. Rates were pooled from single arm studies while rates of seropositivity were compared against the rate in healthy controls for comparator studies using a random effects model and expressed as a pooled odds ratio with 95% confidence intervals.Forty-four studies (16 mixed group, 28 disease specific) with 7064 patients were included in the analysis (2331 following first dose, 4733 following second dose). Overall seropositivity rates were 61-67% following 2 doses and 37-51% following 1 dose of COVID-19 vaccine. The lowest seropositivity rate was 51% in CLL patients and was highest in patients with acute leukaemia (93%). Following 1 dose, nAb and cellular response rates were 18-63% and 33-86% respectively. Active treatment, ongoing or recent treatment with targeted and CD-20 monoclonal antibody therapies within 12 months was associated with poor COVID-19 vaccine immune responses. New approaches to prevention are urgently required to reduce COVID-19 infection morbidity and mortality in high-risk patient groups that respond poorly to COVID-19 vaccination.

Patients with Chronic Lymphocytic Leukemia Have a Very High Risk of Ineffective Response to the BNT162b2 Vaccine

“…Our data, even though based on a small patient cohort, highlight that CLL patients have a very low rate of response to SARS-CoV-2 immunization and a very high risk for severe disease and death due to COVID-19, according to what was previously reported in literature so far [ 5 , 6 , 15 , 16 , 17 , 18 ]. In particular, patients on active treatment with target therapies and anti-CD20 MoAb are at high risk for low rate of response [ 8 , 9 , 19 ].…”

“…Patients with CLL are reported to have high rates of both severe disease and death for COVID-19 [ 3 , 4 ]. In addition, poor serological response to the SARS-CoV-2 vaccines in those patients has already been described [ 2 , 5 ]. However, immunocompromised patients were excluded from early trials of COVID-19 immunization.…”

Immunological Response to ChAdOx1 nCoV-19 Vaccine among Health Care Workers at a Tertiary Care Hospital in Chennai

“…We also found there were no non responders to Covishield which is in contrast to other studies which showed the presence of non responders in persons with Immune Mediated Inflammatory disease (IMId) and persons with hematological malignancies. 8,9 In our study, we found 9.5% of the study participants did not have protective antibody titers 6 months following 2 doses of Covishield. Other studies have also documented waning immunity following 2 doses of COVId-19 vaccines they have not clearly stated the duration after which immune waning occurs.…”

Infektionsmanagement bei Immunsupprimierten

“…Letztere kann mit einer erheblichen Morbidität und Letalität einhergehen. Eine SARS-CoV-2-Infektion in der immunsupprimierten Population unterscheidet sich von Infektionen bei Gesunden durch eine erhöhte Morbidität und Letalität sowie ein erhöhtes Ansteckungsrisiko, unter anderem durch suboptimale impfinduzierte Immunantwort sowie protrahierte Verläufe mit persistierendem Virusnachweis 18 19 .…”

“…Während bei Immunkompetenten in vielen Fällen Antikörpertiter als Schutzsurrogat verwendet werden, ist dies bei Immunsupprimierten aufgrund von B-Zell-Depletion durch Therapie und/oder Grunderkrankung nur bedingt oder gar nicht möglich. Hier scheint die T-Zell-Antwort eine entsprechend größere Rolle zu spielen, wie nicht zuletzt bei COVID-19-Impfungen gezeigt wurde 18 . Die zelluläre Immunantwort bietet insbesondere Schutz vor schweren Krankheitsverläufen, spielt aber bei der Abwehr der initialen Infektion im Gegensatz zu Antikörpern nur eine geringe Rolle.…”