What are the contraindications to Bacillus Calmette-Guérin (BCG) immunotherapy for bladder cancer?

Updated: Nov 12, 2019
  • Author: Gary David Steinberg, MD, FACS; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Contraindications to bacillus Calmette-Guérin (BCG) vaccine therapy include immunosuppression, cancer invading the bladder muscle, and large tumor volume. Because BCG is a live attenuated organism, it can cause an acute disseminated tuberculosislike illness if it enters the bloodstream (BCG sepsis), possibly resulting in death. Reports have described BCG vaccine organisms identified on vascular grafts in patients who have died following BCG vaccine sepsis. Therefore, the use of BCG is contraindicated in patients with gross hematuria, traumatic catheterization, and recent bladder tumor resection. Additionally, total bladder incontinence is a contraindication, as patients cannot retain the BCG solution.

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