Skip to main content
Erschienen in: Wiener klinische Wochenschrift 7-8/2013

01.04.2013 | original article

Intravesical bacillus Calmette-Guérin instillation therapy for non-muscle-invasive bladder cancer following solid organ transplantation

verfasst von: Natalia Swietek, Matthias Waldert, Martin Susani, Georg Schatzl, Priv.-Doz. Dr. Tobias Klatte

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 7-8/2013

Einloggen, um Zugang zu erhalten

Summary

Background

Solid organ recipients have a substantial risk of developing bladder cancer, with high-risk non-muscle-invasive bladder cancer (NMIBC) being the most frequent diagnosis. Theoretically, adjuvant bacillus Calmette–Guérin (BCG) therapy is contraindicated, but limited data indicate its feasibility. The objective of this study was to evaluate the safety and efficacy of BCG following solid organ transplantation.

Materials and methods

We reviewed the data of four solid organ recipients who received adjuvant BCG for high-risk NMIBC at our institution. Additionally, individual data of 12 patients were extracted from case series and case reports, which were identified through a systematic review of the literature. A meta-analysis was performed.

Results

Fourteen patients (88 %) had received a kidney, one a heart, and one a liver transplant. The median time from transplantation to bladder cancer was 60.5 months. The regimen of immunosuppression was not modified in 12 patients (75 %). Forty-two percent of patients did not receive prophylactic antibiotics, and 70 % had no side effects. Ten patients (63 %) experienced recurrence after a median of 14 months. Progression to muscle-invasive or metastatic disease was observed in two patients (13 %). Four patients (25 %) underwent radical cystectomy, and two patients died of the disease.

Conclusions

BCG therapy is a safe option for patients with high-risk NMIBC following solid organ transplantation. However, there is a substantial risk of recurrence and progression. Urologists and patients considering BCG therapy should be aware of this and may consider early cystectomy. There is no evidence to support the need for prophylactic antibiotics.
Literatur
1.
Zurück zum Zitat Engels EA, Pfeiffer RM, Fraumeni JF Jr, Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011;306(17):1891–901.PubMedCrossRef Engels EA, Pfeiffer RM, Fraumeni JF Jr, Kasiske BL, Israni AK, Snyder JJ, et al. Spectrum of cancer risk among US solid organ transplant recipients. JAMA. 2011;306(17):1891–901.PubMedCrossRef
2.
Zurück zum Zitat Adami J, Gabel H, Lindelof B, Ekstrom K, Rydh B, Glimelius B, et al. Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer. 2003;89(7):1221–7.PubMedCrossRef Adami J, Gabel H, Lindelof B, Ekstrom K, Rydh B, Glimelius B, et al. Cancer risk following organ transplantation: a nationwide cohort study in Sweden. Br J Cancer. 2003;89(7):1221–7.PubMedCrossRef
3.
Zurück zum Zitat Wallerand H, Ravaud A, Ferriere JM. Bladder cancer in patients after organ transplantation. Curr Opin Urol. 2010;20(5):432–6.PubMedCrossRef Wallerand H, Ravaud A, Ferriere JM. Bladder cancer in patients after organ transplantation. Curr Opin Urol. 2010;20(5):432–6.PubMedCrossRef
4.
Zurück zum Zitat Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. 2011;59(6):997–1008.PubMedCrossRef Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. 2011;59(6):997–1008.PubMedCrossRef
5.
Zurück zum Zitat Tomaszewski JJ, Larson JA, Smaldone MC, Hayn MH, Jackman SV. Management of bladder cancer following solid organ transplantation. Adv Urol. 2011;2011:256985. Tomaszewski JJ, Larson JA, Smaldone MC, Hayn MH, Jackman SV. Management of bladder cancer following solid organ transplantation. Adv Urol. 2011;2011:256985.
6.
Zurück zum Zitat Yossepowitch O, Eggener SE, Bochner BH, Donat SM, Herr HW, Dalbagni G. Safety and efficacy of intravesical bacillus Calmette-Guerin instillations in steroid treated and immunocompromised patients. J Urol. 2006;176(2):482–5.PubMedCrossRef Yossepowitch O, Eggener SE, Bochner BH, Donat SM, Herr HW, Dalbagni G. Safety and efficacy of intravesical bacillus Calmette-Guerin instillations in steroid treated and immunocompromised patients. J Urol. 2006;176(2):482–5.PubMedCrossRef
7.
Zurück zum Zitat Wang HB, Hsieh HH, Chen YT, Chiang CY, Cheng YT. The outcome of post-transplant transitional cell carcinoma in 10 renal transplant recipients. Clin Transplant. 2002;16(6):410–3.PubMedCrossRef Wang HB, Hsieh HH, Chen YT, Chiang CY, Cheng YT. The outcome of post-transplant transitional cell carcinoma in 10 renal transplant recipients. Clin Transplant. 2002;16(6):410–3.PubMedCrossRef
8.
Zurück zum Zitat Palou J, Angerri O, Segarra J, Caparros J, Guirado L, Diaz JM, et al. Intravesical bacillus Calmette-Guerin for the treatment of superficial bladder cancer in renal transplant patients. Transplantation. 2003;76(10):1514–6.PubMedCrossRef Palou J, Angerri O, Segarra J, Caparros J, Guirado L, Diaz JM, et al. Intravesical bacillus Calmette-Guerin for the treatment of superficial bladder cancer in renal transplant patients. Transplantation. 2003;76(10):1514–6.PubMedCrossRef
9.
Zurück zum Zitat Elkentaoui H, Robert G, Pasticier G, Bernhard JC, Couzi L, Merville P, et al. Therapeutic management of de novo urological malignancy in renal transplant recipients: the experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology. 2010;75(1):126–32.PubMedCrossRef Elkentaoui H, Robert G, Pasticier G, Bernhard JC, Couzi L, Merville P, et al. Therapeutic management of de novo urological malignancy in renal transplant recipients: the experience of the French Department of Urology and Kidney Transplantation from Bordeaux. Urology. 2010;75(1):126–32.PubMedCrossRef
10.
Zurück zum Zitat Kamal MM, Soliman SM, Shokeir AA, Abol-Enein H, Ghoneim MA. Bladder carcinoma among live-donor renal transplant recipients: a single-centre experience and a review of the literature. BJU Int. 2008;101(1):30–5.PubMed Kamal MM, Soliman SM, Shokeir AA, Abol-Enein H, Ghoneim MA. Bladder carcinoma among live-donor renal transplant recipients: a single-centre experience and a review of the literature. BJU Int. 2008;101(1):30–5.PubMed
11.
Zurück zum Zitat Shang PF, Kwong J, Wang ZP, Tian J, Jiang L, Yang K, et al. Intravesical Bacillus Calmette-Guerin versus epirubicin for Ta and T1 bladder cancer. Cochrane Database Syst Rev. 2011(5):CD006885.PubMed Shang PF, Kwong J, Wang ZP, Tian J, Jiang L, Yang K, et al. Intravesical Bacillus Calmette-Guerin versus epirubicin for Ta and T1 bladder cancer. Cochrane Database Syst Rev. 2011(5):CD006885.PubMed
12.
Zurück zum Zitat Neuzillet Y, Davin JL, Lechevallier E. Utilisation des instillations intra-vésicales de bacille de Calmette et Guérin (BCG) pour le traitement des tumeurs superficielles de vessie chez les patients transplantés rénaux. Prog Urol. 2006;16(1):32–5.PubMed Neuzillet Y, Davin JL, Lechevallier E. Utilisation des instillations intra-vésicales de bacille de Calmette et Guérin (BCG) pour le traitement des tumeurs superficielles de vessie chez les patients transplantés rénaux. Prog Urol. 2006;16(1):32–5.PubMed
13.
Zurück zum Zitat Neuzillet Y, Lebret T. Les vraies contre-indications du BCG dans le traitement des tumeurs de vessie. Prog Urol. 2010;20 Suppl 1:S41–5.PubMedCrossRef Neuzillet Y, Lebret T. Les vraies contre-indications du BCG dans le traitement des tumeurs de vessie. Prog Urol. 2010;20 Suppl 1:S41–5.PubMedCrossRef
14.
Zurück zum Zitat Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Calais Da Silva F, Powell PH, et al. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–73.PubMedCrossRef Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Calais Da Silva F, Powell PH, et al. Long-term efficacy results of EORTC genito-urinary group randomized phase 3 study 30911 comparing intravesical instillations of epirubicin, bacillus Calmette-Guerin, and bacillus Calmette-Guerin plus isoniazid in patients with intermediate- and high-risk stage Ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–73.PubMedCrossRef
15.
Zurück zum Zitat Sylvester RJ, van der Meijden AP, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168(5):1964–70.PubMedCrossRef Sylvester RJ, van der Meijden AP, Lamm DL. Intravesical bacillus Calmette-Guerin reduces the risk of progression in patients with superficial bladder cancer: a meta-analysis of the published results of randomized clinical trials. J Urol. 2002;168(5):1964–70.PubMedCrossRef
16.
Zurück zum Zitat Yates DR, Roupret M. Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy. World J Urol. 2011;29(4):415–22.PubMedCrossRef Yates DR, Roupret M. Contemporary management of patients with high-risk non-muscle-invasive bladder cancer who fail intravesical BCG therapy. World J Urol. 2011;29(4):415–22.PubMedCrossRef
17.
Zurück zum Zitat Chade DC, Shariat SF, Dalbagni G. Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review. Int Braz J Urol. 2009;35(6):640–50; discussion 51.PubMedCrossRef Chade DC, Shariat SF, Dalbagni G. Intravesical therapy for urothelial carcinoma of the urinary bladder: a critical review. Int Braz J Urol. 2009;35(6):640–50; discussion 51.PubMedCrossRef
18.
Zurück zum Zitat Fonseca FP, Bachega W Jr, Zequi SC, Sarkis AS, Guimaraes G, Priante AV, et al. Treatment of patients with superficial bladder cancer stratified by risk groups treated with lyophilized Moreau-Rio de Janeiro BCG strain. Int Braz J Urol. 2002;28(5):426–35; discussion 35–6.PubMed Fonseca FP, Bachega W Jr, Zequi SC, Sarkis AS, Guimaraes G, Priante AV, et al. Treatment of patients with superficial bladder cancer stratified by risk groups treated with lyophilized Moreau-Rio de Janeiro BCG strain. Int Braz J Urol. 2002;28(5):426–35; discussion 35–6.PubMed
19.
Zurück zum Zitat Tillou X, Raynal G, Limani K, Saint F, Petit J. Carcinome in situ vésical et urétral chez un patient transplanté rénal: échec de la BCG thérapie. Prog Urol. 2008;18(13):1097–9.PubMedCrossRef Tillou X, Raynal G, Limani K, Saint F, Petit J. Carcinome in situ vésical et urétral chez un patient transplanté rénal: échec de la BCG thérapie. Prog Urol. 2008;18(13):1097–9.PubMedCrossRef
20.
Zurück zum Zitat Vegt PD, van der Meijden AP, Sylvester R, Brausi M, Holtl W, de Balincourt C. Does isoniazid reduce side effects of intravesical bacillus Calmette-Guerin therapy in superficial bladder cancer? Interim results of European Organization for Research and Treatment of Cancer Protocol 30911. J Urol. 1997;157(4):1246–9.PubMedCrossRef Vegt PD, van der Meijden AP, Sylvester R, Brausi M, Holtl W, de Balincourt C. Does isoniazid reduce side effects of intravesical bacillus Calmette-Guerin therapy in superficial bladder cancer? Interim results of European Organization for Research and Treatment of Cancer Protocol 30911. J Urol. 1997;157(4):1246–9.PubMedCrossRef
21.
Zurück zum Zitat Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK. BCG intravesical instillations: recommendations for side-effects management. Eur Urol. 2000;37 Suppl 1:33–6.PubMedCrossRef Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK. BCG intravesical instillations: recommendations for side-effects management. Eur Urol. 2000;37 Suppl 1:33–6.PubMedCrossRef
22.
Zurück zum Zitat Durek C, Rüsch-Gerdes S, Jocham D, Böhle A. Interference of modern antibacterials with bacillus Calmette-Guerin viability. J Urol. 1999;162(6):1959–62.PubMedCrossRef Durek C, Rüsch-Gerdes S, Jocham D, Böhle A. Interference of modern antibacterials with bacillus Calmette-Guerin viability. J Urol. 1999;162(6):1959–62.PubMedCrossRef
23.
Zurück zum Zitat Kasiske BL, Zeier MG, Craig JC, Ekberg H, Garvey CA, Green MD, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9 Suppl 3:S1–155. Kasiske BL, Zeier MG, Craig JC, Ekberg H, Garvey CA, Green MD, et al. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant. 2009;9 Suppl 3:S1–155.
Metadaten
Titel
Intravesical bacillus Calmette-Guérin instillation therapy for non-muscle-invasive bladder cancer following solid organ transplantation
verfasst von
Natalia Swietek
Matthias Waldert
Martin Susani
Georg Schatzl
Priv.-Doz. Dr. Tobias Klatte
Publikationsdatum
01.04.2013
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 7-8/2013
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-013-0343-1

Weitere Artikel der Ausgabe 7-8/2013

Wiener klinische Wochenschrift 7-8/2013 Zur Ausgabe

mitteilungen der gesellschaft der ärzte in wien

Jahreshauptversammlung 2013