Booster doses of COVID-19 vaccines for patients with haematological and solid cancer: a systematic review and individual patient data meta-analysis

Aaron Shengting Mai; Ainsley Ryan Yan Bin Lee; Ryan Yong Kiat Tay; Lauren Shapiro; Astha Thakkar; Balazs Halmos; Albert Grinshpun; Yair Herishanu; Ohad Benjamini; Tamar Tadmor; Rachna T Shroff; Bonnie J LaFleur; Deepta Bhattacharya; Siyu Peng; Jeremy Tey; Soo Chin Lee; Louis Yi Ann Chai; Yu Yang Soon; Raghav Sundar; Matilda Xinwei Lee

doi:10.1016/j.ejca.2022.05.029

Booster doses of COVID-19 vaccines for patients with haematological and solid cancer: a systematic review and individual patient data meta-analysis

Eur J Cancer. 2022 Sep:172:65-75. doi: 10.1016/j.ejca.2022.05.029. Epub 2022 Jun 3.

Authors

Aaron Shengting Mai¹, Ainsley Ryan Yan Bin Lee¹, Ryan Yong Kiat Tay¹, Lauren Shapiro², Astha Thakkar², Balazs Halmos², Albert Grinshpun³, Yair Herishanu⁴, Ohad Benjamini⁵, Tamar Tadmor⁶, Rachna T Shroff⁷, Bonnie J LaFleur⁸, Deepta Bhattacharya⁹, Siyu Peng¹⁰, Jeremy Tey¹¹, Soo Chin Lee¹², Louis Yi Ann Chai¹³, Yu Yang Soon¹⁴, Raghav Sundar¹⁵, Matilda Xinwei Lee¹⁶

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
² Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
³ Sharett Institute of Oncology, Hadassah Medical Center and the Faculty of Medicine, The Hebrew University, Jerusalem, Israel.
⁴ Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
⁵ Hematology Division, Chaim Sheba Medical Center, Ramat-Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
⁶ Hematology Unit, Bnai Zion Medical Center, Haifa, Israel; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
⁷ Division of Hematology and Oncology, Department of Medicine, University of Arizona Cancer Center, Tucson, AZ, USA.
⁸ BIO5 Institute, University of Arizona, Tucson, AZ, USA.
⁹ BIO5 Institute, University of Arizona, Tucson, AZ, USA; Department of Immunobiology, University of Arizona College of Medicine, Tucson, AZ, USA.
¹⁰ Department of Medicine, National University Health System, Singapore.
¹¹ Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore.
¹² Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore.
¹³ Division of Infectious Diseases, Department of Medicine, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Synthetic Biology for Clinical and Technological Innovation, National University of Singapore, Singapore; National University Cancer Institute, Singapore, Singapore.
¹⁴ Department of Radiation Oncology, National University Cancer Institute, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
¹⁵ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore; The N.1 Institute for Health, National University of Singapore, Singapore; Singapore Gastric Cancer Consortium, Singapore. Electronic address: mdcragh@nus.edu.sg.
¹⁶ Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore.

Abstract

Importance: 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.

Objective: To evaluate the proportion of COVID-19 primary vaccination non-responders with cancer who seroconvert after a booster dose.

Methods: 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.

Results: 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).

Conclusions: 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.

Keywords: COVID-19; COVID-19 vaccine; haematological cancer; immunocompromise; solid cancer.

Publication types

Meta-Analysis
Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

COVID-19 Vaccines
COVID-19* / prevention & control
Hematologic Neoplasms* / therapy
Humans
Immunization, Secondary
Neoplasms* / therapy

Substances

COVID-19 Vaccines

Supplementary concepts

COVID-19 vaccine booster shot