Patients with hematologic malignancies (HM) have demonstrated impaired immune responses following SARS-CoV-2 vaccination. Factors associated with poor immunogenicity remain largely undetermined. A literature search was conducted using PubMed, EMBASE, Cochrane, and medRxiv databases to identify studies that reported humoral or cellular immune responses (CIR) following complete SARS-CoV-2 vaccination. The primary aim was to estimate the seroconversion rate (SR) following complete SARS-CoV-2 vaccination across various subtypes of HM diseases and treatments. The secondary aims were to determine the rates of development of neutralizing antibodies (NAb) and CIR following complete vaccination and SR following booster doses. A total of 170 studies were included for qualitative and quantitative analysis of primary and secondary outcomes. A meta-analysis of 150 studies including 20,922 HM patients revealed a pooled SR following SARS-CoV-2 vaccination of 67.7% (95% confidence interval [CI], 64.8–70.4%; I2 = 94%). Meta-regression analysis showed that patients with lymphoid malignancies, but not myeloid malignancies, had lower seroconversion rates than those with solid cancers (R2 = 0.52, P < 0.0001). Patients receiving chimeric antigen receptor T-cells (CART), B-cell targeted therapies or JAK inhibitors were associated with poor seroconversion (R2 = 0.39, P < 0.0001). The pooled NAb and CIR rates were 52.8% (95% CI; 45.8–59.7%, I2 = 87%) and 66.6% (95% CI, 57.1–74.9%; I2 = 86%), respectively. Approximately 20.9% (95% CI, 11.4–35.1%, I2 = 90%) of HM patients failed to elicit humoral and cellular immunity. Among non-seroconverted patients after primary vaccination, only 40.5% (95% CI, 33.0–48.4%; I2 = 87%) mounted seroconversion after the booster. In conclusion, HM patients, especially those with lymphoid malignancies and/or receiving CART, B-cell targeted therapies, or JAK inhibitors, showed poor SR after SARS-CoV-2 vaccination. A minority of patients attained seroconversion after booster vaccination. Strategies to improve immune response in these severely immunosuppressed patients are needed.
血液恶性肿瘤患者接种SARS-CoV-2疫苗后表现出免疫应答受损，但其免疫原性低下的相关因素尚不明确。本研究通过检索PubMed、EMBASE、Cochrane及medRxiv数据库，筛选出报告完整SARS-CoV-2疫苗接种后体液或细胞免疫应答的研究。主要目的是评估不同亚型血液恶性肿瘤及其治疗患者完成全程疫苗接种后的血清转换率；次要目标包括确定全程接种后中和抗体产生率、细胞免疫应答率以及加强针后的血清转换率。共纳入170项研究进行主要和次要结局的定性与定量分析。对包含20,922名血液恶性肿瘤患者的150项研究进行荟萃分析显示，SARS-CoV-2疫苗接种后总体血清转换率为67.7%（95%置信区间[CI]：64.8–70.4%；I²=94%）。元回归分析表明，与实体癌患者相比，淋巴系统恶性肿瘤（而非髓系恶性肿瘤）患者的血清转换率较低（R²=0.52，P<0.0001）。接受嵌合抗原受体T细胞疗法、B细胞靶向治疗或JAK抑制剂治疗的患者血清转换率较差（R²=0.39，P<0.0001）。中和抗体与细胞免疫应答的合并发生率分别为52.8%（95% CI：45.8–59.7%，I²=87%）和66.6%（95% CI：57.1–74.9%；I²=86%）。约20.9%（95% CI：11.4–35.1%，I²=90%）的血液恶性肿瘤患者未能激发体液与细胞免疫。在基础免疫未发生血清转换的患者中，仅40.5%（95% CI：33.0–48.4%；I²=87%）在接种加强针后出现血清转换。综上所述，血液恶性肿瘤患者（特别是淋巴系统恶性肿瘤和/或接受嵌合抗原受体T细胞疗法、B细胞靶向治疗、JAK抑制剂治疗者）在SARS-CoV-2疫苗接种后血清转换率较低，且加强针仅能使少数患者获得血清转换。因此，亟需制定针对这类严重免疫抑制患者的免疫应答提升策略。
肿瘤(癌症)患者之家