Affiliation:
1. Harvard University
2. Henry M. Jackson Foundation
3. Lumen Foundation
4. Brigham and Women's Hospital
5. Tufts University
6. Internal Medicine Solutions
Abstract
Abstract
Background
Hematopoietic stem cell transplant (HSCT) recipients are uniquely vulnerable to adverse outcomes of SARS-CoV-2 infection. Small, mostly observational studies suggest that some HSCT recipients may not generate protective antibody responses following SARS-CoV-2 vaccination. We conducted a meta-analysis to estimate the prevalence and identify predictors of vaccine non-response.
Methods
A comprehensive search of electronic databases, including MEDLINE (Ovid), Embase (Elsevier), Web of Science Core Collection (Clarivate), the Cochrane Central Register of Controlled Trials (Wiley), and the Cochrane COVID-19 Study Register was conducted on January 20, 2023. We defined a non-response as not achieving a seroconversion (positive anti-S IgG titer) after receiving at least two vaccine doses, indicated by study-specific assay cut-off value. Only studies assessing COVID-19 vaccine induced antibody (anti-S IgG) responses in adult (≥ 18 years) HSCT recipients were included. With 95% confidence intervals (CI) across all studies, a random-effects model was used to combine the pooled effect sizes. Quality and risk of bias assessment were determined using the Newcastle-Ottawa scale and ROBINS-I tool, respectively.
Results
Out of 903 unique articles identified and 439 screened, 45 were included in this analysis comprising 4568 participants. Pooled absent sero-conversion was 20% (95% CI: 17% − 24%) with significant heterogeneity (I2 = 95.10%) among included studies (1 clinical trial, 1 cross-sectional study, 1 case-control study, and 42 observational cohort studies). Subgroup analyses showed no difference between autologous [0.21 (95%CI 0.12–0.31)] and allogeneic [0.20 (95%CI 0.17–0.24)] transplant recipients. Identified predictors of non-response included time interval between transplantation and vaccination (< 12 months), concurrent anti-CD20 therapy, and specific treatments (high-dose glucocorticosteroid, calcineurin inhibitor, and anti-thymocyte globulin) for graft versus host disease. No publication bias was observed but the Galbraith’s plot asymmetry showed evidence of small-study effects.
Conclusion
Our findings emphasize the significant prevalence of non-responsiveness to SARS-CoV-2 vaccination in HSCT recipients and underscore need for close monitoring and aggressive risk factor management in this immunocompromised population.
Publisher
Research Square Platform LLC