Document Detail


Safety and efficacy of intravesical bacillus Calmette-Guerin instillations in steroid treated and immunocompromised patients.
MedLine Citation:
PMID:  16813873     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: We assessed the safety and efficacy of intravesical bacillus Calmette-Guerin instillations in steroid treated and immunocompromised patients. MATERIALS AND METHODS: We retrospectively reviewed the charts of 697 patients treated with bacillus Calmette-Guerin instillations at our institution from 1991 to 2004. In 24 patients (3.5%) an underlying comorbidity directly affecting the immune system was diagnosed before bacillus Calmette-Guerin administration or steroids were administered at least 6 weeks before and at the time of bacillus Calmette-Guerin instillations. The immunosuppressive effect of steroids was assessed by the percent of lymphocytes. End points were the bacillus Calmette-Guerin response at 6 months, defined as normal cystoscopy, cytology and biopsy when available, and treatment related toxicity. RESULTS: Four patients (17%) had active lymphoma or chronic lymphocytic leukemia during bacillus Calmette-Guerin administration and 21 (88%) had a concurrent condition for which oral steroids (11), inhaled steroids (14) or oral and inhaled steroids (4) were administered. Patients treated with oral steroids had a lower percent of lymphocytes than patients treated with inhaled steroids and 15 age matched patients with high risk superficial bladder cancer and no steroid treatment (12.3% vs 17.5% and 18.6%, respectively). The overall bacillus Calmette-Guerin response rate at 6 months was 58%. Ten of the 24 patients had disease recurrence and 3 had disease progression at a median followup of 63.5 months (IQR 19.5, 89). One patient treated with oral steroids had self-limited febrile disease and worsening of myalgia 48 hours after his third bacillus Calmette-Guerin cycle. No other systemic adverse event following bacillus Calmette-Guerin therapy was recorded and all patients completed scheduled treatments. CONCLUSIONS: Intravesical bacillus Calmette-Guerin is a viable therapeutic option in patients with high risk superficial bladder cancer and concomitant lymphoma or chronic lymphocytic leukemia, treatment with low dose oral steroids or treatment with inhaled steroids. The bacillus Calmette-Guerin response rate at 6 months and the side effects profile associated with bacillus Calmette-Guerin therapy in these patients were comparable to those in patients with no evidence of immunosuppression. Further studies are warranted to assess the safety and efficacy of bacillus Calmette-Guerin instillations in critically immunocompromised patients.
Authors:
Ofer Yossepowitch; Scott E Eggener; Bernard H Bochner; S Machele Donat; Harry W Herr; Guido Dalbagni
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  176     ISSN:  0022-5347     ISO Abbreviation:  J. Urol.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-07-03     Completed Date:  2006-08-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  482-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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MeSH Terms
Descriptor/Qualifier:
Adjuvants, Immunologic / administration & dosage*,  adverse effects
Administration, Intravesical
Adult
Aged
Aged, 80 and over
BCG Vaccine / administration & dosage*,  adverse effects
Carcinoma in Situ / drug therapy*,  immunology*
Female
Humans
Immunocompromised Host*
Male
Middle Aged
Retrospective Studies
Steroids / therapeutic use*
Urinary Bladder Neoplasms / drug therapy*,  immunology*
Chemical
Reg. No./Substance:
0/Adjuvants, Immunologic; 0/BCG Vaccine; 0/Steroids

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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