PDF(Pubmed)
Abstract：
The exclusion of patients with cancer in clinical trials evaluating COVID-19 vaccine efficacy and safety, in combination with the high rate of severe infections, highlights the need for optimizing vaccination strategies. The aim of this study was to perform a systematic review and meta-analysis of the published available data from prospective and retrospective cohort studies that included patients with either solid or hematological malignancies according to the PRISMA Guidelines. A literature search was performed in the following databases: Medline (Pubmed), Scopus, Clinicaltrials.gov, EMBASE, CENTRAL and Google Scholar. Overall, 70 studies were included for the first and second vaccine dose and 60 studies for the third dose. The Effect Size (ES) of the seroconversion rate after the first dose was 0.41 (95%CI: 0.33-0.50) for hematological malignancies and 0.56 (95%CI: 0.47-0.64) for solid tumors. The seroconversion rates after the second dose were 0.62 (95%CI: 0.57-0.67) for hematological malignancies and 0.88 (95%CI: 0.82-0.93) for solid tumors. After the third dose, the ES for seroconversion was estimated at 0.63 (95%CI: 0.54-0.72) for hematological cancer and 0.88 (95%CI: 0.75-0.97) for solid tumors. A subgroup analysis was performed to evaluate potential factors affecting immune response. Production of anti-SARS-CoV-2 antibodies was found to be more affected in patients with hematological malignancies, which was attributed to the type of malignancy and treatment with monoclonal antibodies according to the subgroup analyses. Overall, this study highlights that patients with cancer present suboptimal humoral responses after COVID-19 vaccination. Several factors including timing of vaccination in relevance with active therapy, type of therapy, and type of cancer should be considered throughout the immunization process.
摘要：
在评估COVID-19疫苗有效性和安全性的临床试验中排除癌症患者，加上严重感染率高，强调了优化疫苗接种策略的必要性。这项研究的目的是根据PRISMA指南，对前瞻性和回顾性队列研究中已发表的可用数据进行系统评价和荟萃分析，这些研究包括患有实体或血液系统恶性肿瘤的患者。在以下数据库中进行了文献检索：Medline(Pubmed)，Scopus,Clinicaltrials.gov,EMBASE,CENTRAL和谷歌学者。总的来说,第一和第二疫苗剂量包括70项研究，第三剂量包括60项研究。首次给药后血清转换率的效应大小（ES）对于血液恶性肿瘤为0.41（95CI：0.33-0.50），对于实体瘤为0.56（95CI：0.47-0.64）。第二次给药后，血液恶性肿瘤的血清转换率为0.62（95CI：0.57-0.67），实体瘤的血清转换率为0.88（95CI：0.82-0.93）。第三次服药后，对于血液肿瘤,血清转换的ES估计为0.63(95CI:0.54-0.72),对于实体瘤为0.88(95CI:0.75-0.97).进行亚组分析以评估影响免疫反应的潜在因素。发现在血液系统恶性肿瘤患者中，抗SARS-CoV-2抗体的产生受到更大的影响，根据亚组分析，这归因于恶性肿瘤的类型和单克隆抗体的治疗。总的来说,这项研究强调,癌症患者在接种COVID-19疫苗后体液反应欠佳.几个因素，包括与积极治疗相关的疫苗接种时间，治疗类型,在整个免疫过程中应该考虑癌症的类型。
