Ge Chenghao, Du Kelei, Luo Mingjie, Shen Kaini, Zhou Yangzhong, Guo Kaiyuan, Liu Yang, Yin Chen, Li Yi, Li Guanqiao, Chen Xiaoyuan
Tsinghua Clinical Research Institute, School of Medicine, Tsinghua University, Beijing, China.
School of Medicine, Tsinghua University, Beijing, China.
Exp Hematol Oncol. 2022 Aug 16;11(1):46. doi: 10.1186/s40164-022-00299-6.
Patients receiving hematopoietic stem cell transplantation (HSCT) or chimeric antigen receptor T cell (CAR T-cell) therapy are immunocompromised and at high risk of viral infection, including SAR2-CoV-2 infection. However, the effectiveness and safety of COVID-19 vaccines in these recipients is not well characterized. The present meta-analysis evaluated the serologic response and safety of COVID-19 vaccines in these population.
Literature databases (MEDLINE, EMBASE, Web of Science, MedRvix and BioRvix) were searched for original studies with serologic response post COVID-19 vaccination in HSCT or CAR T-cell recipients published until July 14, 2022. The analysis included 27 observational studies with a total of 2899 patients receiving allogeneic HSCT (2506), autologous HSCT (286) or CAR T-cell therapy (107), and 683 healthy participants with serologic response data. Random effects models were used to pool the rate of serologic response to COVID-19 vaccination in HSCT or CAR T-cell recipients and odds ratio comparing with healthy controls.
The pooled seropositivity rates in HSCT and CAR T-cell recipients were 0.624 [0.506-0.729] for one dose, 0.745 [0.712-0.776] for two doses. The rates were significantly lower than those in healthy controls (nearly 100%). In subgroup analysis, CAR T-cell recipients exhibited an even lower seroconversion rate (one dose: 0.204 [0.094-0.386]; two doses: 0.277 [0.190-0.386]) than HSCT counterparts (one dose: 0.779 [0.666-0.862]; two doses: 0.793 [0.762-0.821]). The rates were comparable between autologous and allogeneic HSCT recipients. Other possible impact factors related to seropositivity were time interval between therapy and vaccination, use of immunosuppressive drugs and immune cell counts. Most vaccine-related adverse effects were mild and resolvable, comparable to general population.
This analysis revealed a diminished response to COVID-19 vaccines in HSCT or CAR T-cell recipients. Our findings may inform regular COVID-19 vaccination at appropriate intervals after HSCT or CAR T-cell therapy.
接受造血干细胞移植（HSCT）或嵌合抗原受体T细胞（CAR T细胞）治疗的患者免疫功能低下，有病毒感染的高风险，包括感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。然而，2019冠状病毒病（COVID-19）疫苗在这些接受者中的有效性和安全性尚未得到充分表征。本荟萃分析评估了COVID-19疫苗在这些人群中的血清学反应和安全性。
检索文献数据库（MEDLINE、EMBASE、科学网、MedRvix和BioRvix），查找截至2022年7月14日发表的关于HSCT或CAR T细胞接受者接种COVID-19疫苗后血清学反应的原始研究。该分析纳入了27项观察性研究，共有2899例接受异基因HSCT（2506例）、自体HSCT（286例）或CAR T细胞治疗（107例）的患者，以及683例有血清学反应数据的健康参与者。采用随机效应模型汇总HSCT或CAR T细胞接受者接种COVID-19疫苗的血清学反应率以及与健康对照相比的优势比。
HSCT和CAR T细胞接受者接种一剂疫苗后的合并血清阳性率为0.624[0.506 - 0.729]，接种两剂后的合并血清阳性率为0.745[0.712 - 0.776]。这些比率显著低于健康对照者（接近100%）。在亚组分析中，CAR T细胞接受者的血清转化率更低（接种一剂：0.204[0.094 - 0.386]；接种两剂：0.277[0.190 - 0.386]），低于HSCT接受者（接种一剂：0.779[0.666 - 0.862]；接种两剂：0.793[0.762 - 0.821]）。自体和异基因HSCT接受者的比率相当。与血清阳性相关的其他可能影响因素包括治疗与接种疫苗之间的时间间隔、免疫抑制药物的使用和免疫细胞计数。大多数与疫苗相关的不良反应较轻且可缓解，与普通人群相当。
该分析显示HSCT或CAR T细胞接受者对COVID-19疫苗的反应减弱。我们的研究结果可能为HSCT或CAR T细胞治疗后在适当间隔进行定期COVID-19疫苗接种提供参考。
