Serological response to COVID-19 vaccination in patients with cancer older than 80 years

Iacono, Daniela; Cerbone, Linda; Palombi, Lucia; Cavalieri, Elena; Sperduti, Isabella; Cocchiara, Rosario Andrea; Mariani, Bruno; Parisi, Gabriella; Garufi, Carlo

doi:10.1016/j.jgo.2021.06.002

“…Five studies were included for qualitative analysis of titres but not for meta-analysis of seroconversion rates. 109 110 111 112 113 In addition, 11 studies reporting seroconversion data of a third vaccine dose were included for qualitative analysis (see supplementary table 5). 43 114 115 116 117 118 119 120 121 122 123 One study was included in both meta-analysis and qualitative analysis of a third vaccine dose.…”

Section: Resultsmentioning

confidence: 99%

Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis

Lee

¹

,

Wong

²

,

Chai

³

et al. 2022

BMJ

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Objective To compare the efficacy of covid-19 vaccines between immunocompromised and immunocompetent people. Design Systematic review and meta-analysis. Data sources PubMed, Embase, Central Register of Controlled Trials, COVID-19 Open Research Dataset Challenge (CORD-19), and WHO covid-19 databases for studies published between 1 December 2020 and 5 November 2021. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched in November 2021 to identify registered but as yet unpublished or ongoing studies. Study selection Prospective observational studies comparing the efficacy of covid-19 vaccination in immunocompromised and immunocompetent participants. Methods A frequentist random effects meta-analysis was used to separately pool relative and absolute risks of seroconversion after the first and second doses of a covid-19 vaccine. Systematic review without meta-analysis of SARS-CoV-2 antibody titre levels was performed after first, second, and third vaccine doses and the seroconversion rate after a third dose. Risk of bias and certainty of evidence were assessed. Results 82 studies were included in the meta-analysis. Of these studies, 77 (94%) used mRNA vaccines, 16 (20%) viral vector vaccines, and 4 (5%) inactivated whole virus vaccines. 63 studies were assessed to be at low risk of bias and 19 at moderate risk of bias. After one vaccine dose, seroconversion was about half as likely in patients with haematological cancers (risk ratio 0.40, 95% confidence interval 0.32 to 0.50, I 2 =80%; absolute risk 0.29, 95% confidence interval 0.20 to 0.40, I 2 =89%), immune mediated inflammatory disorders (0.53, 0.39 to 0.71, I 2 =89%; 0.29, 0.11 to 0.58, I 2 =97%), and solid cancers (0.55, 0.46 to 0.65, I 2 =78%; 0.44, 0.36 to 0.53, I 2 =84%) compared with immunocompetent controls, whereas organ transplant recipients were 16 times less likely to seroconvert (0.06, 0.04 to 0.09, I 2 =0%; 0.06, 0.04 to 0.08, I 2 =0%). After a second dose, seroconversion remained least likely in transplant recipients (0.39, 0.32 to 0.46, I 2 =92%; 0.35, 0.26 to 0.46), with only a third achieving seroconversion. Seroconversion was increasingly likely in patients with haematological cancers (0.63, 0.57 to 0.69, I 2 =88%; 0.62, 0.54 to 0.70, I 2 =90%), immune mediated inflammatory disorders (0.75, 0.69 to 0.82, I 2 =92%; 0.77, 0.66 to 0.85, I 2 =93%), and solid cancers (0.90, 0.88 to 0.93, I 2 =51%; 0.89, 0.86 to 0.91, I 2 =49%). Seroconversion was similar between people with HIV and immunocompetent controls (1.00, 0.98 to 1.01, I 2 =0%; 0.97, 0.83 to 1.00, I 2 =89%). Systematic review of 11 studies showed that a third dose of a covid-19 mRNA vaccine was associated with seroconversion among vaccine non-responders with solid cancers, haematological cancers, and immune mediated inflammatory disorders, although response was variable in transplant recipients and inadequately studied in people with HIV and those receiving non-mRNA vaccines. Conclusion Seroconversion rates after covid-19 vaccination were significantly lower in immunocompromised patients, especially organ transplant recipients. A second dose was associated with consistently improved seroconversion across all patient groups, albeit at a lower magnitude for organ transplant recipients. Targeted interventions for immunocompromised patients, including a third (booster) dose, should be performed. Systematic review registration PROSPERO CRD42021272088.

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“…Forty-three studies reported immunogenicity in patients with haematological malignancy ( n = 6259, 79.9%) and cancer ( n = 1480, 18.9%) ( Table S3 ) [ 30 , 33 , 35 , 42 , 43 , 49 , 52 , 59 , 60 , 70 , 71 , 76 ], [ [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] , [101] , [102] , [103] , [104] , [105] , [106] , [107] , [108] , [109] , [110] , [111] , [112] , [113] ]. Twenty-three of these studies included a control population (overall n = 1931) [ 30 , 33 , 42 , 43 , 60 , 71 , 76 , [85] , [86] , [87] , [88] , [89] , 91 , 92 , 96 , 98 , 104 , [106] , [107] , [108] ...…”

Section: Resultsmentioning

confidence: 99%

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

Galmiche

¹

,

Ngũyen

²

,

Tartour

³

et al. 2022

Clinical Microbiology and Infection

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“…The majority of the studies [ 19 , 21 , 24 – 26 , 28 , 30 – 35 , 37 – 42 ] had a prospective cohort design ( n = 18). Five studies [ 18 , 20 , 22 , 23 , 29 ] had a retrospective cohort design and three [ 17 , 27 , 36 ] were cross-sectional.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis of 9 studies [ 17 , 19 , 24 , 25 , 27 , 29 , 31 , 32 , 34 ] (I 2 = 97.92) revealed IC patients with malignancy were 0.25 times less likely to seroconvert than healthy controls (RRR = 0.25; 95% CI 0.11, 0.37; P < 0.01). Subgroup meta-analysis was conducted based on type of malignancy (hematologic vs. solid organ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

Mehrabinejad

¹

,

Moosaie

²

,

Dehghanbanadaki

³

et al. 2022

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Background Immunocompromised (IC) patients are at higher risk of severe SARS-CoV-2 infection, morbidity, and mortality compared to the general population. They should be prioritized for primary prevention through vaccination. This study aimed to evaluate the efficacy of COVID-19 mRNA vaccines in IC patients through a systematic review and meta-analysis approach. Method PubMed-MEDLINE, Scopus, and Web of Science were searched for original articles reporting the immunogenicity of two doses of mRNA COVID-19 vaccines in adult patients with IC condition between June 1, 2020 and September 1, 2021. Meta-analysis was performed using either random or fixed effect according to the heterogeneity of the studies. Subgroup analysis was performed to identify potential sources of heterogeneity. Results A total of 26 studies on 3207 IC patients and 1726 healthy individuals were included. The risk of seroconversion in IC patients was 48% lower than those in controls (RR = 0.52 [0.42, 0.65]). IC patients with autoimmune conditions were 54%, and patients with malignancy were 42% more likely to have positive seroconversion than transplant recipients (P < 0.01). Subgroup meta-analysis based on the type of malignancy, revealed significantly higher proportion of positive seroconversion in solid organ compared to hematologic malignancies (RR = 0.88 [0.85, 0.92] vs. 0.61 [0.44, 0.86], P = 0.03). Subgroup meta-analysis based on type of transplantation (kidney vs. others) showed no statistically significant between-group difference of seroconversion (P = 0.55). Conclusions IC patients, especially transplant recipients, developed lower immunogenicity with two-dose of COVID-19 mRNA vaccines. Among patients with IC, those with autoimmune conditions and solid organ malignancies are mostly benefited from COVID-19 vaccination. Findings from this meta-analysis could aid healthcare policymakers in making decisions regarding the importance of the booster dose or more strict personal protections in the IC patients.

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Serological response to COVID-19 vaccination in patients with cancer older than 80 years

Cited by 32 publications

References 11 publications

Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis

Efficacy of covid-19 vaccines in immunocompromised patients: systematic review and meta-analysis

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

Immunogenicity of COVID-19 mRNA vaccines in immunocompromised patients: a systematic review and meta-analysis

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