Background and Aims

The safety of intravesical Bacillus Calmette-Guerin (BCG), a live attenuated strain of Mycobacterium bovis, in primary antibody deficiency (PAD) is unknown. Here we report outcomes of intravesical BCG used to treat non-muscular-invasive bladder cancer in 3 patients with PAD.

Methods

Immunological phenotype, biopsy results, and treatment outcomes were collected via retrospective chart review.

Results

Patient-A: 69-year-old female with hypogammaglobulinemia (IgG 500s/IgM 30s/normal IgA), suboptimal polysaccharide vaccine responses, and lymphopenia (CD3/CD4/CD8 408/334/74), normal lymphocyte proliferation to mitogens (PHA/Con-A/Pokeweed) and decreased to Candida/Tetanus. Diagnosed with non-invasive low-grade papillary urothelial (PU) carcinoma December 2018, underwent transurethral resection of bladder tumor (TURBT) followed by intravesical BCG. She had complete response (CR), follow-up bladder biopsy 1 year later showed no evidence of recurrence.

Patient-B: 65-year-old female with common variable immunodeficiency (CVID) IgG 300s/IgM 20s/low normal IgA, and low memory-B-cells (CD19+CD27+ <1%), on IgG replacement (IgGR) diagnosed with non-invasive low-grade PU carcinoma October 2018, underwent TURBT followed by intravesical BCG. Repeat cystoscopy April 2019 showed CR.

Patient-C: 74-year-old female, with hypogammaglobulinemia (IgG 400s, normal IgA/IgM) on IgGR. She had Non-invasive low-grade PU carcinoma diagnosed in 2003. It was excised but had new superficial/non-invasive lesions, had re-excision in 2011 and intravesicular BCG in 2013 with apparent resolution. Follow-up cystoscopy every 3 months shows CR.

Intravesical BCG was well tolerated in all patients, without any infectious complications.

Conclusions

Intravesical BCG might be considered safe in treating non-invasive bladder cancer in PAD. Further studies with larger sample size are warranted to adequately capture side effects and efficacy of this therapy in immunodeficiency.