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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