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

Abstract

Purpose Patients with cancer have an increased risk of coronavirus disease 2019 (COVID-19) and an attenuated responses to various vaccines. This meta-analysis aims to assess the serologic response to COVID-19 vaccination in patients with cancer. Methods Electronic databases were systematically searched on August 1, 2021 for studies that reported the serologic response to COVID-19 vaccine in cancer patients. Random effects models were used to achieve pooled serologic response rates and odds ratios (ORs). Results We analyzed 16 observational studies with a total of 1453 patients with cancer. A majority of studies used mRNA vaccines (BNT162b2 or mRNA-1273). The proportion of patients achieving a serologic response after a single and two doses of COVID-19 vaccine were 54.2% (95% confidence interval [CI] 41.0–66.9) and 87.7% (95% CI 82.5–91.5), respectively. Patients with hematologic cancers had a lower response rate after the second dose of vaccine compared to those with solid organ cancers (63.7% vs. 94.9%), which was attributable to the low response rates associated with certain conditions (chronic lymphocytic leukemia, lymphoma) and therapies (anti-CD20, kinase inhibitors). A lower proportion of patients with cancer achieved a serologic response compared to control patients after one and two doses of vaccine (OR0.073 [95% CI 0.026–0.20] and 0.10 [95% CI 0.039–0.26], respectively). Conclusions Patients with cancer, especially those with hematologic B-cell malignancies, have a lower serologic response to COVID-19 vaccines. The results suggest that cancer patients should continue to follow safety measures including mask-wearing after vaccination and suggest the need for additional strategies for prophylaxis.

Efficacy and safety profile of COVID-19 mRNA vaccine in patients with hematological malignancies: Systematic review and meta-analysis

“…Some populations have been shown to have higher susceptibility to this disease, including those with malignancies. Immunodeficiency in individuals with malignancies can be caused by the properties of the disease itself and by the effects of the radiation or chemotherapy ( 10 ). A study with 507,307 patients with COVID-19 showed that cancer patients who also received anticancer treatment within 3 months before the diagnosis of COVID-19 had an increased risk of hospitalization, admission to intensive care units, and death ( 38 ).…”

“…( 15 ) and Sakuraba et al. ( 10 ). However, due to the small number of included studies and the wide confidence interval, the results might seem insignificant.…”

“…Despite the success of COVID-19 vaccines with its high efficacy on the healthy population, concerns on the efficacy and safety of COVID-19 vaccines in the immunocompromised population remain unresolved. The seroconversion rate has been found to be significantly lower in immunocompromised patients, especially organ transplant recipients, with only one third achieving seroconversion status, followed by patients with immune-mediated inflammatory disorders (75%), and malignancies or cancers ranging from 63% –90% achieving seroconversion ( 7 , 10 ). The same concern is also directed at patients with hematological malignancies, especially due to their high risk of being immunosuppressed due to the pathogenesis and molecular mechanism of the disease.…”

Vaccination for the Prevention of Infection among Immunocompromised Patients: A Concise Review of Recent Systematic Reviews

“…The COVID-19 vaccine systematic reviews predominantly used seroconversion as a marker for vaccine efficacy. In general, the studies showed that patients with chronic kidney failure on dialysis (not requiring organ transplantation) [ 10 , 11 , 12 ], immune-mediated inflammatory diseases [ 13 , 14 , 15 , 16 ], and solid tumors [ 17 ] had seroconversion rates that were high and similar to healthy controls (seroconversion rates among patients ranged from about 83% to 97%). In contrast, patients with receipt of anti-CD20 therapy [ 18 ] and solid organ transplants [ 11 , 19 , 20 ] (thus requiring anti-rejection immunosuppression) had markedly low vaccine seroconversion rates (rates ranged from about 26% to 45% after two vaccine doses).…”

Characteristics of Patients with Hematologic Malignancies Without Seroconversion Post-COVID19 Third Vaccine Dosing

“…[7][8][9] A recently published metaanalysis put the pooled proportion of patients achieving a serologic response after a second dose of the vaccine around 87% but was sure to acknowledge that patients with HMs are less likely to mount a response as compared with patients with solid organ cancers (63.7% vs 94.9%), likely due to the type of HM and/or current treatments. 10,11 Another large study, the CAPTURE study, showed that in patients with HMs, neutralizing antibodies, our current indication of vaccine effectiveness, are significantly reduced, and this appears to hold true with the most recent variant of concern (VOC), Omicron. 1,4,12, In the summer of 2021, when the "booster dose" was authorized under the United States Food and Drug Administration (FDA) Emergency Use Authorization (EUA), cancer patients were rightly prioritized for this third shot (3V).…”