癌症患者接种第三剂抗 SARS-CoV-2 疫苗:是否需要监测体液免疫应答?一篇立场文章。
Third dose of anti-SARS-CoV-2 vaccine for patients with cancer: Should humoral responses be monitored? A position article.
机构信息
Medical Oncology Department, Polyclinique Saint-Jean, 92 Avenue Dr Donat, FR-06800, Cagnes-sur-Mer, France.
Infectious Diseases Department, Côte D'Azur University, CHU de Nice, Hôpital Archet 1, FR-06000, Nice, France.
出版信息
Eur J Cancer. 2022 Feb;162:182-193. doi: 10.1016/j.ejca.2021.12.011. Epub 2021 Dec 16.
Taking into account higher risk of severe coronavirus disease 2019 or death among patients with cancer, as well as impaired immunogenicity after anti-SARS-CoV-2 vaccines, in addition to waning immunity, booster dosing appears mandatory in this patient population. This review sought to provide reasonable evidence so as to assist oncologists in their daily practice, helping them decide when an anti-SARS-Cov2 antibody (Ab) dosage should be scheduled after a full two-dose vaccination and, if necessary, propose an early third dose (D3). Such D3 could apply to non-responder patients with anti-Spike (S) Abs titres <40 binding Ab unit (BAU)/mL. For lowresponder patients with anti-S Ab titres between 40 BAU/mL and 100/260 BAU/mL (suggested area of uncertainty), an early D3 may similarly be proposed. Nevertheless, this D3 could be administered in a less urgent manner, taking into account associated comorbidities and regional epidemic incidence rates. This latter strategy may comprise a monthly dosage of anti-S titres so as to better assess the kinetics of waning immunity. For responder patients with anti-S titres above 260 BAU/mL, we suggest to follow the recommendations outlined for the general population. Given this context, patients with anti-S titres above 1000 BAU/mL should be given the possibility to undergo anti-S titre control after three months, designed to assess rapid humoral waning immunity. We strongly recommend that patients with cancer be included into observational serological monitoring studies or clinical trials that are dedicated to severe immunocompromised patients without any humoral seroconversion after D3.
考虑到癌症患者罹患 2019 年冠状病毒病严重病例或死亡的风险较高,以及抗 SARS-CoV-2 疫苗接种后的免疫原性受损,除了免疫减弱之外,此类患者群体似乎需要加强剂量。本综述旨在提供合理的证据,以协助肿瘤学家的日常实践,帮助他们决定在全剂量两剂疫苗接种后何时应安排抗 SARS-CoV-2 抗体(Ab)剂量,如果有必要,提出早期的第三剂量(D3)。此类 D3 可应用于抗尖峰(S)抗体滴度<40 结合抗体单位(BAU)/毫升的非应答患者。对于抗 S Ab 滴度在 40 BAU/mL 至 100/260 BAU/mL 之间的低应答患者(建议的不确定区域),也可提出早期 D3。然而,这种 D3 可以以不那么紧急的方式给予,同时考虑到相关合并症和区域流行发病率。后一种策略可以每月进行一次抗 S 滴度剂量,以更好地评估免疫减弱的动力学。对于抗 S 滴度高于 260 BAU/mL 的应答患者,我们建议遵循针对一般人群的建议。鉴于这种情况,抗 S 滴度高于 1000 BAU/mL 的患者应给予可能在三个月后进行抗 S 滴度控制的机会,以评估快速体液免疫减弱的情况。我们强烈建议将癌症患者纳入针对严重免疫功能低下患者的观察性血清学监测研究或临床试验中,这些患者在 D3 后没有任何体液血清转化率。
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