Traditionally we do not prescribe BCG therapy for immunocompromised patients such as patients taking immunosuppressive medications including corticosteroids and immune system modulators that are commonly taken for autoimmune diseases such as multiple sclerosis (MS), rheumatoid arthritis (RA), and others, as well as for patients with solid organ transplants.
BCG therapy has traditionally been felt to be not useful in these patients because of attenuated immune response in immunocompromised patients as well as the potential for increased risk of infectious complications from administering attenuated life BCG bacterial vaccine.
A new study from Sloan-Kettering suggests that BCG therapy may be both effective and relatively safe in carefully selected and monitored patients with bladder cancer. This study included patients undergoing chemotherapy, those with history of solid organ transplants, and those taking immunosuppressant medications including steroids. While this study is small and has a number of limitations, it did suggest that patients with bladder cancer who are immunocompromised respond appropriately to BCG therapy with fairly good treatment success rates and relatively good safety record. The patient’s with history of organ transplant have a somewhat lower response rate likely to more severe immunocompromise.
While larger and more robust studies would be beneficial, the newly reported data suggests that carefully balanced consideration of risks and benefits in patients with immunocompromise should be performed. Certain patients may experience a significant benefit from BCG therapy in the presence of immunocompromise.
Reference: