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

[CIS-PIDD]

Dear all,

This is the protocol Novartis reached consensus with our oncology group regarding treatment with Votubia® (everolimus):
For live vaccines, Votubia® needs to be interrupted for 3-4 weeks and vaccine should be administered in the middle of this interval.
They have been doing this for the last 3 years without problems.

Best regards,


Laia Alsina, MD, PhD

Adjunta de la Secció d'Immunoal.lèrgia; Unitat Funcional d'Immunologia, Hospital Sant Joan de Déu-Hospital Clínic.
Cap d'Estudis i Presidenta de la Comisió Local de Docència de l'Hospital Sant Joan de Déu, Barcelona.
http://orcid.org/0000-0002-3559-0018



El 21 jul 2016, a las 23:43, CIS-PIDD <cis-pidd at lists.clinimmsoc.org<mailto:cis-pidd at lists.clinimmsoc.org>> escribió:

According to the green book:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/147824/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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