Antibody response after vaccination against SARS-CoV-2 in adults with hematological malignancies: a systematic review and meta-analysis

Abstract

Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against COVID-19, especially in fragile patients. We aimed to systematically analyse the outcomes of patients with haematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (two doses of mRNA or one dose of vector-based vaccines). We identified 49 studies comprising 11086 individuals. Overall risk of bias was low. The pooled response for haematological malignancies was 64% (95% confidence interval [CI], 59-69; I²=93%) vs 96% (95% CI, 92-97; I²=44%) for solid cancer and 98% (95% CI, 96-99; I²=55%) for healthy controls (P<0.001). Outcome was different across haematological malignancies (P<0.001). The pooled response was 50% (95% CI, 43-57; I²=84%) for chronic lymphocytic leukaemia, 76% (95% CI, 67-83; I²=92%) for multiple myeloma, 83% (95% CI, 69-91; I²=85%) for myeloproliferative neoplasms, 91% (95% CI, 82-96; I²=12%) for Hodgkin’s lymphoma, and 58% (95% CI, 44-70; I²=84%) for aggressive and 61% (95% CI, 48-72; I²=85%) for indolent non-Hodgkin’s lymphoma. The pooled response for allogeneic and autologous haematopoietic cell transplantation was 82% and 83%, respectively. Being in remission and prior COVID-19 showed significantly higher responses. Low pooled response was identified for active treatment (35%), anti-CD20 therapy ≤1 year (15%), Bruton kinase inhibition (23%), venetoclax (26%), ruxolitinib (42%), and chimeric antigen receptor T-cell therapy (42%). Studies on timing, value of boosters, and long-term efficacy are needed. This study is registered with PROSPERO (CRD42021279051).

Serologic response following SARS-COV2 vaccination in patients with cancer: a systematic review and meta-analysis

“…Our study showed that the proportion of patients achieving a serologic response after a single or two doses of COVID-19 vaccine was 54% and 88%, respectively, which are much lower than the rates reported by Shroti et al Among studies that included control patients without cancer, the OR of achieving serologic response among patients with cancer was significantly lower after the first and second dose. The results of our study are consistent with recent meta-analyses reporting lower response rates in hematological cancers vs. solid cancers or controls [ 42 , 43 ].…”

B-cell cytopenia and time to last B-cell-depleting therapy predict response to SARS-COV-2 vaccines in patients with lymphoproliferative disorders

“…In accordance with previous studies, our NHL patients generate poor antibody responses upon COVID vaccine administration, with a more pronounced deficiency detected after exposure to rituximab [18] , [19] , [20] , [21] , [22] . Our data demonstrates that poor seroconversion rates occur concomitantly with severe B-cell cytopenia, which is most severe within the first year post rituximab.…”

Longitudinal analysis of anti-SARS-CoV-2 S-RBD IgG antibodies before and after the third dose of the BNT162b2 vaccine

“…Overall, most literature evidence on healthy individuals describes a significant reduction of antibody levels four-six months after the second COVID-19 vaccine dose. Fragile patients, such as patients with haematological malignancies and haemodialysis, show an overall reduced response to anti-SARS-CoV-2 vaccination than healthy individuals 26 , 27 . Additionally, some Authors reported that fragile patients have a significantly more substantial decline of anti-SARS-CoV-2 antibody titers within 6 months compared to healthy individuals 28 , 29 .…”