Table. Immunosuppressive potential of cancer and organ rejection therapies
| Immunosuppressant category | Licensed indication(s) | Overall immunosuppressive potential | Mechanism of action | Half-life (mean) | Duration of immunosuppression |
|---|---|---|---|---|---|
| Conventional chemotherapy for haematological malignancies | Haematological malignancies | Severe | Most agents interfere with (or inhibit) DNA, RNA or protein synthesis | Varies by medication | Lymphocyte recovery generally takes 3–6 months after completion of chemotherapy for various oncology diagnoses. Reduced T-cell (especially CD4+) and B-cell counts may be seen for up to 12 months |
| Immunosuppressive therapies to prevent organ rejection within 6 months after solid organ transplant | Prevention of rejection after solid organ transplant | Severe | Most agents inhibit lymphocyte proliferation to prevent organ rejection. Agents may include a combination of anti-thymocyte globulin, corticosteroids, conventional immunosuppressive agents (eg calcineurin inhibitors, mycophenolate mofetil), mammalian target of rapamycin (mTOR) inhibitors and monoclonal antibodies | Varies by medication | Varies by medication |
| Conditioning agents for haematopoietic stem cell transplant (HSCT) | Haematological malignancies, syndromes impairing bone marrow function (such as severe inborn errors of immunity) and some difficult-to-treat solid tumours | Severe | Agents include myeloablative chemotherapeutic agents, monoclonal antibodies and irradiation, which synergistically result in myelodepletion and lymphodepletion before stem cell infusion | Varies by medication | Varies by medication |
| Chimeric antigen receptor modified T-cell (CAR-T) therapy | Haematological malignancies, especially of B-cell origin | Severe | CAR-T therapy involves reprogramming a patient’s own T-cells to identify and eliminate malignant cells. Both the CAR-T products and lymphodepleting agents given before CAR-T infusion result in profound and prolonged lymphocyte aplasia. Immunocompetence is often further affected by subsequent immunoglobulin administration as replacement therapy | Not applicable | B-cell aplasia lasts for at least 6–9 months |
| Note: This is not an exhaustive list. Licensed indications were referenced from database of the Australian Therapeutic Goods Administration (TGA). Furthermore, the underlying disease for which the medication is prescribed, and concomitant immunosuppressant use, may alter this categorisation. For further information regarding the immunosuppressive potential of underlying conditions, please also consider Table. Immunosuppressive potential of certain medical conditions. | |||||
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