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Vaccine response following anti-CD20 therapy: a systematic review and meta-analysis of 905 patients.
Vijenthira, Abi; Gong, Inna; Betschel, Stephen D; Cheung, Matthew; Hicks, Lisa K.
  • Vijenthira A; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON, Canada.
  • Gong I; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Betschel SD; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Cheung M; Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Hicks LK; Division of Allergy and Immunology, St. Michael's Hospital, Toronto, ON, Canada.
Blood Adv ; 5(12): 2624-2643, 2021 06 21.
Article in English | MEDLINE | ID: covidwho-1277908
ABSTRACT
The objective of this study was to perform a systematic review of the literature on vaccine responsiveness in patients who have received anti-CD20 therapy. PubMed and EMBASE were searched up to 4 January 2021 to identify studies of vaccine immunogenicity in patients treated with anti-CD20 therapy, including patients with hematologic malignancy or autoimmune disease. The primary outcomes were seroprotection (SP), seroconversion (SC), and/or seroresponse rates for each type of vaccine reported. As the pandemic influenza vaccine (2009 H1N1) has standardized definitions for SP and SC, and represented a novel primary antigen similar to the COVID-19 vaccine, meta-analysis was conducted for SC of studies of this vaccine. Pooled estimates, relative benefit ratios (RBs), and 95% confidence intervals (CIs) were calculated using a random-effects model. Thirty-eight studies (905 patients treated with anti-CD20 therapy) were included (19 studies of patients with hematologic malignancies). Patients on active (<3 months since last dose) anti-CD20 therapy had poor responses to all types of vaccines. The pooled estimate for SC after 1 pandemic influenza vaccine dose in these patients was 3% (95% CI, 0% to 9%), with an RB of 0.05 (95% CI, 0-0.73) compared with healthy controls and 0.22 (95% CI, 0.09-0.56) compared with disease controls. SC compared with controls seems abrogated for at least 6 months following treatment (3-6 months post anti-CD20 therapy with an RB of 0.50 [95% CI, 0.24-1.06] compared with healthy and of 0.44 [95% CI, 0.23-0.84] compared with disease controls). For all vaccine types, response to vaccination improves incrementally over time, but may not reach the level of healthy controls even 12 months after therapy.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza, Human / Influenza A Virus, H1N1 Subtype / COVID-19 Type of study: Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Humans Language: English Journal: Blood Adv Year: 2021 Document Type: Article Affiliation country: Bloodadvances.2021004629

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Influenza, Human / Influenza A Virus, H1N1 Subtype / COVID-19 Type of study: Randomized controlled trials / Reviews / Systematic review/Meta Analysis Topics: Vaccines Limits: Humans Language: English Journal: Blood Adv Year: 2021 Document Type: Article Affiliation country: Bloodadvances.2021004629