Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Eur J Cancer. 2022 Sep;172:65-75. doi: 10.1016/j.ejca.2022.05.029. Epub 2022 Jun 3.
Patients with cancer have an increased risk of severe disease and mortality from COVID-19, as the disease and antineoplastic therapy cause reduced vaccine immunogenicity. Booster doses have been proposed to enhance protection, and efficacy data are emerging from several studies.
To evaluate the proportion of COVID-19 primary vaccination non-responders with cancer who seroconvert after a booster dose.
PubMed, EMBASE, CENTRAL and medRxiv were searched from 1st January 2021 to 10th March 2022. Quality was assessed using the Joanna Briggs Institute Critical Appraisal checklist.
After the eligibility assessment, 22 studies were included in this systematic review and 17 for meta-analysis of seroconversion in non-responders, pooling a total of 849 patients with haematological cancer and 82 patients with solid cancer. Haematological cancer non-responders exhibited lower seroconversion at 44% (95% CI 36-53%) than solid cancer at 80% (95% CI 69-87%). Individual patient data meta-analysis found the odds of having a meaningful rise in antibody titres to be significantly associated with increased duration between the second and third dose (OR 1.02, 95% CI 1.00-1.03, P ≤ 0.05), age of patient (OR 0.960, 95% CI 0.934-0.987, P ≤ 0.05) and cancer type. With patients with haematological cancer as a reference, patients with lung cancer had 16.8 times the odds of achieving a meaningful increase in antibody titres (OR 16.8, 95% CI 2.95-318, P ≤ 0.05) and gastrointestinal cancer patients had 25.4 times the odds of achieving a meaningful increase in antibody titres (OR 25.4, 95% CI 5.26-492.21, P ≤ 0.05).
administration of a COVID-19 vaccine booster dose is effective in improving seroconversion and antibody levels. Patients with haematological cancer consistently demonstrate poorer response to booster vaccines than patients with solid cancer.
癌症患者患 COVID-19 后出现重症和死亡的风险增加，因为疾病和抗肿瘤治疗会降低疫苗的免疫原性。已提出使用加强针来增强保护作用，并且一些研究正在出现疗效数据。
评估癌症患者中 COVID-19 初次疫苗接种无应答者在加强针接种后发生血清转化的比例。
从 2021 年 1 月 1 日至 2022 年 3 月 10 日，在 PubMed、EMBASE、CENTRAL 和 medRxiv 上进行了搜索。使用 Joanna Briggs 研究所的批判性评估清单评估质量。
在进行资格评估后，本系统评价纳入了 22 项研究，其中 17 项研究用于分析无应答者的血清转化率，共纳入 849 例血液系统癌症患者和 82 例实体瘤癌症患者。血液系统癌症无应答者的血清转化率为 44%（95%CI 36-53%），低于实体瘤癌症的 80%（95%CI 69-87%）。个体患者数据的荟萃分析发现，抗体滴度有明显升高的可能性与第二剂和第三剂之间的间隔时间延长显著相关（OR 1.02，95%CI 1.00-1.03，P≤0.05）、患者年龄（OR 0.960，95%CI 0.934-0.987，P≤0.05）和癌症类型。以血液系统癌症患者为参考，肺癌患者实现抗体滴度明显升高的可能性是其 16.8 倍（OR 16.8，95%CI 2.95-318，P≤0.05），胃肠道癌症患者实现抗体滴度明显升高的可能性是其 25.4 倍（OR 25.4，95%CI 5.26-492.21，P≤0.05）。
COVID-19 疫苗加强针的接种可有效提高血清转化率和抗体水平。血液系统癌症患者对加强疫苗的反应始终比实体瘤癌症患者差。
