Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg.
University of Insubria, Varese.
Haematologica. 2022 Aug 1;107(8):1840-1849. doi: 10.3324/haematol.2021.280163.
Vaccines against SARS-CoV-2 have shown remarkable efficacy and thus constitute an important preventive option against coronavirus disease 2019 (COVID-19), especially in fragile patients. We aimed to systematically analyze the outcomes of patients with hematological malignancies who received vaccination and to identify specific groups with differences in outcomes. The primary end point was antibody response after full vaccination (2 doses of mRNA or one dose of vectorbased vaccines). We identified 49 studies comprising 11,086 individuals. Overall risk of bias was low. The pooled response for hematological malignancies was 64% (95% confidence interval [CI]: 59-69; I²=93%) versus 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 hematological malignancies (P<0.001). The pooled response was 50% (95% CI: 43-57; I²=84%) for chronic lymphocytic leukemia, 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 lymphoma, and 58% (95% CI: 44-70; I²=84%) for aggressive and 61% (95% CI: 48-72; I²=85%) for indolent non-Hodgkin lymphoma. The pooled response for allogeneic and autologous hematopoietic 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 (clinicaltrials gov. Identifier: CRD42021279051).
针对 SARS-CoV-2 的疫苗已显示出显著的疗效,因此成为预防 2019 年冠状病毒病(COVID-19)的重要选择,尤其是在脆弱患者中。我们旨在系统地分析接受过疫苗接种的血液系统恶性肿瘤患者的结局,并确定结局存在差异的特定人群。主要终点是完全接种疫苗(2 剂 mRNA 或 1 剂基于载体的疫苗)后的抗体反应。我们确定了 49 项研究,共纳入 11086 人。整体偏倚风险较低。血液系统恶性肿瘤的总体反应率为 64%(95%置信区间[CI]:59-69;I²=93%),而实体瘤为 96%(95%CI:92-97;I²=44%),健康对照组为 98%(95%CI:96-99;I²=55%)(P<0.001)。不同的血液系统恶性肿瘤之间的结果也不同(P<0.001)。慢性淋巴细胞白血病的总体反应率为 50%(95%CI:43-57;I²=84%),多发性骨髓瘤为 76%(95%CI:67-83;I²=92%),骨髓增生性肿瘤为 83%(95%CI:69-91;I²=85%),霍奇金淋巴瘤为 91%(95%CI:82-96;I²=12%),侵袭性和惰性非霍奇金淋巴瘤为 58%(95%CI:44-70;I²=84%)。同种异体和自体造血细胞移植的总体反应率分别为 82%和 83%。处于缓解期和既往 COVID-19 感染的患者具有更高的反应率。正在接受治疗(35%)、抗 CD20 治疗<1 年(15%)、布鲁顿酪氨酸激酶抑制剂(23%)、维奈托克(26%)、鲁索利替尼(42%)和嵌合抗原受体 T 细胞治疗(42%)的患者的总体反应率较低。需要进一步研究接种时机、加强针的价值和长期疗效。本研究已在 PROSPERO(clinicaltrials.gov 标识符:CRD42021279051)注册。
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