背景:多发性骨髓瘤的免疫反应受损使患者容易受到感染,如COVID-19,并可能导致对疫苗的反应更差。研究人员应该分析这个问题,以便制定特殊的预防措施,例如增加加强剂量。因此,本荟萃分析旨在评估COVID-19疫苗在多发性骨髓瘤患者中的应答和疗效.
方法:这项荟萃分析遵循了PRISMA2020指南,使用指定的关键字进行全面的数据库搜索。研究选择涉及两个阶段的标题/摘要和全文筛选过程。数据提取由两名研究人员进行,统计分析涉及荟萃分析,基于疫苗剂量和研究时间的亚组分析,随机效应元回归,和使用Q检验的异质性检验。
结果:荟萃分析显示,与健康对照组相比,多发性骨髓瘤(MM)患者在接种COVID-19疫苗后产生可检测抗体的可能性较低(对数比值比,95%CI:-3.34[-4.08,-2.60])。不同剂量后的抗体反应分析显示,MM患者的血清阳性持续降低(首次剂量后:-2.09,[-3.49,-0.69],第二:-3.80,95CI[-4.71,-3.01],加强剂量:-3.03,[-5.91,-0.15])。然而,MM患者和对照组之间的抗S抗体平均水平无显著差异(Cohen'sd-0.72,[-1.86,0.43]).T细胞应答的评估表明与对照相比,MM患者中T细胞介导的免疫降低。七项研究报告了临床反应,在接种疫苗的MM患者中观察到突破性感染。
结论:这些发现强调了MM患者在接种COVID-19疫苗后体液和细胞免疫反应受损,这表明需要进一步的调查和潜在的干预措施。
BACKGROUND: Impaired immune response in multiple myeloma renders the patients vulnerable to infections, such as COVID-19, and may cause worse response to vaccines. Researchers should analyze this issue to enable the planning for special preventive measures, such as increased booster doses. Therefore, this meta-analysis aimed to evaluate the response and efficacy of COVID-19 vaccines in patients with multiple myeloma.
METHODS: This meta-analysis followed PRISMA 2020 guidelines, conducting a comprehensive database search using specified keywords. Study selection involved a two-phase title/abstract and full-text screening process. Data extraction was performed by two researchers, and statistical analysis involved meta-analysis, subgroup analysis based on vaccine dosage and study time, random effects meta-regression, and heterogeneity testing using the Q test.
RESULTS: The meta-analysis revealed that patients with multiple myeloma (MM) had a lower likelihood of developing detectable antibodies after COVID-19 vaccination compared to healthy controls (Log odds ratio with 95% CI: -3.34 [-4.08, -2.60]). The analysis of antibody response after different doses showed consistent lower seropositivity in MM patients (after first dose: -2.09, [-3.49, -0.69], second: -3.80, 95%CI [-4.71, -3.01], a booster dose: -3.03, [-5.91, -0.15]). However, there was no significant difference in the mean level of anti-S antibodies between MM patients and controls (Cohen\'s d -0.72, [-1.86, 0.43]). Evaluation of T-cell responses indicated diminished T-cell-mediated immunity in MM patients compared to controls. Seven studies reported clinical response, with breakthrough infections observed in vaccinated MM patients.
CONCLUSIONS: These findings highlight the impaired humoral and cellular immune responses in MM patients after COVID-19 vaccination, suggesting the need for further investigation and potential interventions.