Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
BMC Geriatr. 2024 May 8;24(1):411. doi: 10.1186/s12877-024-05006-0.
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.
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.
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.
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.
多发性骨髓瘤患者的免疫反应受损，使他们容易感染 COVID-19 等疾病，并且可能对疫苗的反应更差。研究人员应分析这个问题，以便为特殊预防措施（如增加加强剂量）做好规划。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反应和疗效。
本荟萃分析遵循 PRISMA 2020 指南，使用指定的关键词进行全面的数据库搜索。研究选择包括两阶段的标题/摘要和全文筛选过程。由两名研究人员进行数据提取，统计分析包括荟萃分析、基于疫苗剂量和研究时间的亚组分析、随机效应荟萃回归以及使用 Q 检验进行异质性检验。
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（95%CI 的对数优势比：-3.34[-4.08，-2.60]）。对不同剂量的抗体反应分析表明，MM 患者的血清阳性率一致较低（第 1 剂后：-2.09[-3.49，-0.69]，第 2 剂后：-3.80，95%CI[-4.71，-3.01]，加强剂量后：-3.03[-5.91，-0.15]）。然而，MM 患者和对照组之间的抗-S 抗体平均水平没有显著差异（Cohen's d-0.72[-1.86，0.43]）。T 细胞反应的评估表明，与对照组相比，MM 患者的 T 细胞介导免疫受损。有 7 项研究报告了临床反应，接种疫苗的 MM 患者发生了突破性感染。
这些发现强调了 MM 患者在 COVID-19 疫苗接种后体液和细胞免疫反应受损，表明需要进一步研究和潜在干预措施。
