RIFINAHBCG : : 99/9/30

Question

Question

Patient History47Past history Urothelial carcinoma in situ of bladder Renal transplantation HypertensionPrevious operation history End stage renal disease s/p cadarveric renal transplantation on 97/10/17 Transurethral resection of bladder tumor (TURBT) on 2010-04-27

BCG (BCG Immunotherapeutic)

DESCRIPTION

ImmuCyst Bacillus Calmette-Guerin(BCG)Connaught(Mycobacterium bovis)

INDICATIONS

(CIS)(TUR)a1

PHARMACOLOGYBCG promotes a local acute inflammatory and sub-acute granulomatous reaction with macrophage and leukocyte infiltration in the urothelium and lamina propria of the urinary bladder. The local inflammatory effects are associated with an elimination or reduction of non-muscle invasive cancerous lesions of the urinary bladder. The exact mechanism of action is unknown, but the anti-tumour effect appears to be T-lymphocyte dependent.BCG

Contraindications

Bacillus of Calmette and Guerin Vaccine, Live 1) immunocompromised status 2) urinary tract infection or hematuria 3) acute febrile illness 4) 7 to 14 days following biopsy, transurethral resection, or traumatic catheterization; increased risk for systemic BCG infection 5) active tuberculosis 6) hypersensitivity to BCG products

DOSAGE AND ADMINISTRATION

(TUR)71466136121824303613

Adverse Reaction

*ImmuCyst

< 48pyridium propantheline bromide oxybutynin chloride acetaminophen 48ImmuCyst isoniazid (INH) 300 mg/day15 day(UTI)ImmuCyst ImmuCyst isoniazid (INH) 300mg/day + rifampin 600mg/day3-6

Question

1#BID0.5#Q12H2#Q12H3#Q12H1#QD1#QD SL1 vial IVCT1 vial IVCT1#QD

05/2105/2806/0406/1106/01807/2107/2808/0408/11amlodipineyyyyyyyyyterazosinyyyyyyyyyMycophenolate sodium 180mg/tabyyyyyyyyyTacrolimus 1mg/capyyyyyyyyyPrednisolone 5mg/tabyyyyyyyyynifedipineyyyyBacillus Calmette-Guerin (BCG)81mg/vailyyyyyyyyRifampin 300mg+Isoniazid 150mg/tabyyyyyyyyTranexamic acidyyyDiphenidol yy

RIFINAHBCG

1.Rifinah??2.?300mg 150mg3.?

INTRAVESICAL BACILLUS CALMETTE-GUERIN FOR THETREATMENT OF SUPERFICIAL BLADDER CANCER IN RENALTRANSPLANT PATIENTS

INTRAVESICAL BACILLUS CALMETTE-GUERIN FOR THETREATMENT OF SUPERFICIAL BLADDER CANCER IN RENALTRANSPLANT PATIENTS

Conclusion

Because there was no experience with renal transplant patients and BCG, we decided to treat the patients prophylactically with isoniazid and rifampin, because this is the , treatment recommended for patients with severe symptoms local or systemic side effects secondary to BCG Rifampicin induces cytochromeP450 3A4 and so increases the metabolism of cyclosporine and tacrolimus, necessitating dose adjustment to maintain stable levels of immunosuppression and avoid rejection.

Drug-Drug Interactions

ReferenceBCG intravesical instillations: recommendations for side-effects management.Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK.Eur Urol. 2000;37 Suppl 1:33-6.Practice guidelines inoncology-v.1.2009TheOncologist,Vol.10,No.10,792-798,November2005; doi:10.1634/theoncologist.10-10-792GarimaldiS,Farina LA, Cabezas CA, et al. Afectacion difusa y progresionrapidadeuncarcinomatransicionaldealtogradoenunpacientetrasplantadorenal.ActasUrolEsp2000;24:179181.7.KhalifaMA,ElfvingP,MansonW,etal.TheeffectofisoniazidonBCG Inducedtoxicityinpatientswithsuperficialbladd ercancer.EurUrol2000;37(suppl1):2630VegtPDJ,MeijdenAPM,SylvesterR,etal.DoesisoniazidreducesideeffectsofintravesicalbacillusCalmette-Guerintherapyinsuperfi-cialbladdercancer?InterimresultsofEuropeanorganizationforresearchandtreatmentofcancerprotocol30911.JUrol1997;15712461249.7 Impaired immune response by isoniazid treatment during intravesical BCG administration in the guinea pig. J Urol. 1992 Nov;148(5):1577-82.8 http://www.rxlist.com/theracys-drug.htm#

Thank you for your attention

Contraindications immunocompromised status including HIV infection (percutaneous and intravesical) urinary tract infection or hematuria (intravesical) acute febrile illness (intravesical) 7 to 14 days following biopsy, transurethral resection, or traumatic catheterization; increased risk for systemic BCG infection (intravesical) active tuberculosis (intravesical) hypersensitivity to BCG products

PreventionNo measures have been demonstrated to be effective in preventing the occurrence of disseminated BCG infection.

Intravesical BCG instillations for the treatment of superficial bladder tumours in renal transplant recipientsSuperficial urothelial tumours of the bladder are more frequent and more often at higher risk of progression and recurrence in renal transplant recipients. When conservative treatment of these tumours is indicated, BCG instillations are recommended. However, immunosuppression of renal transplant recipients constitutes a classical contraindication to BCG therapy. Some authors have nevertheless used BCG instillations in renal transplant recipients. The authors reviewed the use of BCG in renal transplant recipients by studying the effects of immunosuppression on the mechanisms of action of BCG and the various clinical experiences reported in the international literature

Contraindicationimmunocompromised status including HIV infection (percutaneous and intravesical) urinary tract infection or hematuria (intravesical) acute febrile illness (intravesical) 7 to 14 days following biopsy, transurethral resection, or traumatic catheterization; increased risk for systemic BCG infection (intravesical) active tuberculosis (intravesical) hypersensitivity to BCG productsBCGBCG7-14