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      Interstitial pneumonitis secondary to intravesical bacillus calmette-guerin for carcinoma in-situ of the bladder

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      Author(s): ,
      Publication date (Print and electronic):
      Journal: International braz j urol
      Publisher: Sociedade Brasileira de Urologia
      Keywords: bladder neoplasms, BCG, intravesical injection, pneumonitis

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          Abstract

          We report an 81-year-old male who developed severe interstitial pneumonitis on maintenance intravesical Bacillus Calmette-Guerin (BCG) for in-situ carcinoma of the bladder. The patient was treated with steroids and anti-tuberculin therapy with complete response. While there is no established standard of care for the treatment of interstitial pneumonitis, recent reports describe success with combination of corticosteroids and anti-tuberculin medications. We elected to follow this precedent and treated our patient with corticosteroids and anti-tuberculin therapy with good outcome.

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          Maintenance bacillus Calmette-Guerin immunotherapy for recurrent TA, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized Southwest Oncology Group Study.

          D L Lamm, B A Blumenstein, J Crissman … (2000)
          Bacillus Calmette-Guerin (BCG) immunotherapy has been widely accepted as the optimal treatment for carcinoma in situ and high grade superficial transitional cell carcinoma. However, controversy remains regarding the role of maintenance therapy, and its long-term effect on recurrence and progression. All patients in the study had transitional cell carcinoma of the bladder with carcinoma in situ or an increased risk of recurrence. The criteria for increased risk were 2 or more episodes of tumor within the most recent year, or 3 or more tumors within 6 months. At least 1 week following biopsy of carcinoma in situ and resection of any stage Ta or T1 transitional cell tumors 660 patients were started on a 6-week induction course of intravesical and percutaneous Connaught BCG. Three months following initiation of BCG induction therapy 550 consenting patients were stratified by purified protein derivative skin test and the presence of carcinoma in situ, and then randomized by central computer to receive BCG maintenance therapy (maintenance arm) or no BCG maintenance therapy (no maintenance arm). Maintenance therapy consisted of intravesical and percutaneous BCG each week for 3 weeks given 3, 6, 12, 18, 24, 30 and 36 months from initiation of induction therapy. The 384 eligible patients who were disease-free at randomization constitute the primary intent to treat analytic group because they could be followed for disease recurrence. All patients were followed for adverse effects of treatment, recurrence, disease worsening and survival. No toxicities above grade 3 were noted in the 243 maintenance arm patients. The policy of withholding maintenance BCG from patients with increased side effects may have diminished the opportunity to observe severe toxicity. Estimated median recurrence-free survival was 35.7 months (95% confidence interval 25.1 to 56.8) in the no maintenance and 76.8 months (64.3 to 93.2) in the maintenance arm (log rank p<0.0001). Estimated median time for worsening-free survival, defined as no evidence of progression including pathological stage T2 disease or greater, or the use of cystectomy, systemic chemotherapy or radiation therapy, was 111.5 months in the no maintenance and not estimable in the maintenance arm (log rank p = 0.04). Overall 5-year survival was 78% in the no maintenance compared to 83% in the maintenance arm. Compared to standard induction therapy maintenance BCG immunotherapy was beneficial in patients with carcinoma in situ and select patients with Ta, T1 bladder cancer. Median recurrence-free survival time was twice as long in the 3-week maintenance arm compared to the no maintenance arm, and patients had significantly longer worsening-free survival.
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            Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer.

            D L Lamm, A P M van der Meijden, R. MORALES … (1992)
            Intravesical therapy with bacillus Calmette-Guerin (BCG) has proved to be more effective in the prophylaxis and treatment of superficial bladder tumors and carcinoma in situ than most chemotherapeutic agents. Compared to intravesical chemotherapy, instillations with BCG provoke more local and systemic reactions. In addition to the commonly induced granulomatous inflammatory changes in the bladder, which produce irritative symptoms, this therapy may cause systemic side effects varying from mild malaise and fever to, in rare instances, life-threatening or fatal sepsis. We report the incidence and varieties of toxicities in 2,602 patients treated with intravesical BCG. Side effects are classified according to local and systemic toxicity. Treatment options vary according to the severity of toxicity from delaying or withholding instillations to treatment with antituberculous drugs for up to 6 months. In general, 95% of the patients have no serious side effects. Recognition of risk factors, particularly traumatic catheterization or concurrent cystitis, that result in systemic BCG absorption, as well as the prompt and appropriate treatment of early side effects should significantly decrease the incidence of severe toxicity.
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              Hypersensitivity systemic reaction following intravesical bacillus Calmette-Guerin: successful treatment with steroids.

              J. M. Molina, C Rabian, M F d'Agay … (1992)
              Intravesical bacillus Calmette-Guerin (BCG) is an effective treatment for superficial bladder carcinoma. Serious complications, including disseminated BCG infection, are infrequent. We report a case of granulomatous hepatitis with pneumonitis following intravesical administration of BCG. Cultures for mycobacteria were negative in sputum, bronchoalveolar lavage, liver and blood specimens. All symptoms disappeared within days after steroid therapy. Hypersensitivity reaction should be considered in patients with systemic symptoms after immunotherapy with BCG.
              Article 0 comments Cited 15 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (publisher-id): ibju
                Title: International braz j urol
                Abbreviated Title: Int. braz j urol.
                Publisher: Sociedade Brasileira de Urologia (Rio de Janeiro, RJ, Brazil )
                ISSN (Print): 1677-5538
                ISSN (Electronic): 1677-6119
                Publication date (Print and electronic): October 2004
                Volume: 30
                Issue: 5
                Pages: 400-402
                Affiliations
                [01] Washington DC orgnameWashington Hospital Center orgdiv1Department of Urology USA
                Article
                Publisher ID: S1677-55382004000500008 Publisher ID: S1677-5538(04)03000508
                DOI: 10.1590/S1677-55382004000500008
                PubMed ID: 15610574
                SO-VID: a6e321aa-e76b-4030-a046-2637f0af6195
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                Date received : 07 April 2004
                Date accepted : 07 April 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 3, Pages: 3
                Product

                SciELO Brazil

                Self URI: Full text available only in PDF format (EN)
                Categories
                Subject: Case Report

                Keywords: BCG,bladder neoplasms,intravesical injection,pneumonitis
                Data availability:
                Keywords: BCG, bladder neoplasms, intravesical injection, pneumonitis

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