[CIS PIDD] [cis-pidd] FW: Immunology question

[CIS-PIDD]

According to the green book: 

 

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/14
7824/Green-Book-Chapter-6-v2_0.pdf

 


patients receiving immunosuppressive drugs (e.g. azathioprine, cyclosporin,
methotrexate, cyclophosphamide, leflunomide and the newer cytokine
inhibitors) should not receive live vaccines until at least six months after
terminating such treatment.

 

According to CDC:

 

https://www.cdc.gov/vaccines/pubs/pinkbook/downloads/genrec.pdf

 

Live vaccines can be given after chemotherapy has been discontinued for at
least 3 months.

 

Restarting immunosuppression after live viral vaccination has not been
studied, but some experts would recommend at least a 1-month period.

 

Kind regards,

Alexandros Grammatikos

 

Clinical Immunology and Allergy

North Bristol NHS Trust

 

 

 

From: CIS-PIDD [mailto:cis-pidd at lists.clinimmsoc.org] 
Sent: Thursday, July 21, 2016 10:56 PM
To: CIS-PIDD
Subject: [cis-pidd] FW: Immunology question

 

Colleagues:

 

A patient with tuberous sclerosis has been on immunosuppressant everolimus
for quite some time to treat his subependymal giant cell astrocytoma.  This
is a benign brain tumor that is responsive to everolimus.  

 

The patient's mom would like to take him off of everolimus to give him the
MMR and varicella vaccines.   His neurologist says it's OK to take him off
for "a time."

 

My questions:

.        How long will the immunosuppressive effect of evrolimus last, i.e.
when could he receive the live virus vaccines?

.        How long after the vaccines should they wait for immune responses
to "take" before restarting the everolimus?

 

Thank you.

 

Joe Church

Children's Hospital Los Angeles

 

 

 


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