COVID-19 Vaccination in Patients With Malignancy; A Systematic Review and Meta-Analysis of the Efficacy and Safety

Abstract

Background: Data on the efficacy and safety of COVID-19 vaccines in patients with malignancy are immature. In this paper, we assessed the literature involving the use of COVID-19 vaccines in cancer patients and reported the seroconversion rates as the main outcome and severity of COVID-19 infection and side effects following COVID-19 vaccination as the secondary outcomes.

Methods: A systematic review with meta-analysis was performed. Searches were conducted in electronic websites, databases, and journals, including Scopus, PubMed, Embase, and Web of Science from January 01, 2019, to November 30, 2021. Studies reporting data on the safety and efficacy of COVID vaccine in cancer patients using any human samples were included. The risk of bias was assessed using the NEWCASTLE-OTTAWA scale in the included studies.

Results: A total of 724 articles were identified from databases, out of which 201 articles were duplicates and were discarded. Subsequently, 454 articles were excluded through initial screening of the titles and abstracts. Moreover, 41 studies did not report the precise seroconversion rate either based on the type of cancer or after injection of a second dose of COVID vaccine. Finally, 28 articles met all the inclusion criteria and were included in this systematic review. The overall seroconversion rates after receiving a second dose of COVID-19 vaccine, based on type of cancer were 88% (95% CI, 81%-92%) and 70% (95% CI, 60%-79%) in patients with solid tumors and hematologic malignancies, respectively.

Conclusion: Overall, we conclude that vaccination against COVID-19 in patients with active malignancies using activated and inactivated vaccines is a safe and tolerable procedure that is also accompanied by a high efficacy.

Keywords: COVID-19; COVID-19 vaccines; SARS-CoV-2; cancer; meta-analysis; neoplasms; seroconversion; vaccine.

Figure 1

PRISMA Flow Diagram.

Figure 2

funnel plot of standard error by logit event rate. The Egger’s test was used, SE 3.7 (95% CI, 1.03, 6.37), t-valu82, df 32, P = 0.008 indicating a strong publication bias across the articles.

Figure 3

Seroconversion rate after more than 2 weeks of receiving second dose of COVID-19 vaccine in cancer patients. Addeo et al. (25), Agha et al. (34), Ariamanesh et al. (7), Barrière et al. (29), Cavanna et al. (15), Goshen-Lago et al. (32), Gounant et al. (18), Grinshpun et al. (31), Herishanu et al. (20), Karacin et al. (24), Mahil et al. (11), Malard et al. (36), Massarweh et al. (21), Monin et al. (16), Ollila et al. (12), Oosting et al. (27), Perry et al. (19), Pimpinelli et al. (22), Pimpinelli et al. (26), Ram et al. (37), Revon-Riviere et al. (35), Roeker et al. (13), Shah et al. (14), Shmueli et al. (17), Thakkar et al. (30), van Oekelen et al. (23), Waldhorn et al. (33), Webber et al. (28).

Figure 4

subgroup analysis of Seroconversion rate after more than 2 weeks of receiving second dose of COVID-19 vaccine in cancer patients. Addeo et al. (25), Agha et al. (34), Ariamanesh et al. (7), Barrière et al. (29), Cavanna et al. (15), Goshen-Lago et al. (32), Gounant et al. (18), Grinshpun et al. (31), Herishanu et al. (20), Karacin et al. (24), Mahil et al. (11), Malard et al. (36), Massarweh et al. (21), Monin et al. (16), Ollila et al. (12), Oosting et al. (27), Perry et al. (19), Pimpinelli et al. (22), Pimpinelli et al. (26), Ram et al. (37), Revon-Riviere et al. (35), Roeker et al. (13), Shah et al. (14), Shmueli et al. (17), Thakkar et al. (30), van Oekelen et al. (23), Waldhorn et al. (33), Webber et al. (28).