Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guérin therapy

Jared G. Heiner, Martha Kennedy Terris

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Purpose: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age. Materials and Methods: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented. Results: In our patient population, 22 of 58 (37.9%) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6%. Patients ≥70 years old had a complication rate of 48.6%. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3%. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course. Conclusions: Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.

Original languageEnglish (US)
Pages (from-to)137-140
Number of pages4
JournalUrologic Oncology: Seminars and Original Investigations
Volume26
Issue number2
DOIs
StatePublished - Mar 1 2008

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Bacillus
Therapeutics
Anticoagulants
Maintenance
Transitional Cell Carcinoma

Keywords

  • BCG
  • Complications
  • Transitional cell carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

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title = "Effect of advanced age on the development of complications from intravesical bacillus Calmette-Gu{\'e}rin therapy",
abstract = "Purpose: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Gu{\'e}rin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age. Materials and Methods: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented. Results: In our patient population, 22 of 58 (37.9{\%}) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6{\%}. Patients ≥70 years old had a complication rate of 48.6{\%}. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3{\%}. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course. Conclusions: Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.",
keywords = "BCG, Complications, Transitional cell carcinoma",
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T1 - Effect of advanced age on the development of complications from intravesical bacillus Calmette-Guérin therapy

AU - Heiner, Jared G.

AU - Terris, Martha Kennedy

PY - 2008/3/1

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N2 - Purpose: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age. Materials and Methods: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented. Results: In our patient population, 22 of 58 (37.9%) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6%. Patients ≥70 years old had a complication rate of 48.6%. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3%. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course. Conclusions: Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.

AB - Purpose: Advanced age is considered a risk factor for complications in patients receiving intravesical bacillus Calmette-Guérin (BCG) therapy. However, there is no clear delineation of BCG-related complication rates relative to patient age. Materials and Methods: We reviewed the clinical course of 58 consecutive men receiving maintenance BCG therapy from December 1999 to July 2004 for transitional cell carcinoma. Patients ranged in age from 51 to 92 years (mean 72.4). Age and BCG-related complications warranting discontinuance of therapy were documented. Results: In our patient population, 22 of 58 (37.9%) patients experienced complications. The complication rate for patients <70 years old on intravesical BCG maintenance therapy was 17.6%. Patients ≥70 years old had a complication rate of 48.6%. Excluding patients taking anticoagulants, the complication rate in patients age 70 and older was 53.3%. Patients who had complications (mean age 76.0 years) were significantly older than those who had no complications (mean age 70.3 years) (P < 0.00001). The peak incidence of complications occurred with the third BCG course. Conclusions: Maintenance BCG therapy should be given with caution in patients over age 70 and should be avoided in patients over age 80. Elderly patients at high risk for TCC recurrence and progression may be better served with a single 6-week course of BCG or alternative intravesical agents. Anticoagulants may be somewhat protective against complications in elderly patients but have been shown to significantly decrease the effectiveness of intravesical BCG, further supporting the consideration of alternative agents.

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