Table. Types of medical conditions and immunosuppressive therapy and associated levels of immunocompromise
Type of immunosuppression | Example conditions (not an exhaustive list) | Specific therapies that may affect level of immunocompromise | Overall level of immunocompromise |
---|---|---|---|
Inborn errors of immunity, including primary immunodeficiency |
Antibody (B-cell) immunodeficiencies: less severe
|
No routine immunosuppressive therapies prescribed | Moderate |
Antibody (B-cell) immunodeficiencies: severe
|
Some patients may proceed to stem cell transplant, which will increase this level of immunosuppression | Severe | |
T-cell or combined (T- and B-cell) immunodeficiencies: less severe
|
Some patients may proceed to stem cell transplant, which will increase this level of immunosuppression | Moderate | |
T-cell or combined (T- and B-cell) immunodeficiencies: severe
|
Some patients may proceed to stem cell transplant, which will increase this level of immunosuppression | Severe | |
Phagocytic and neutrophil disorders
|
No routine immunosuppressive therapies prescribed, but antibiotic prophylaxis may be indicated | Moderate | |
Defects of innate immunity
|
No routine immunosuppressive therapies prescribed, but antibiotic prophylaxis may be indicated |
Moderate Susceptibilities to different pathogens depends on specific types of innate immune defects. See Defects of innate immunity: recommendations for vaccination |
|
Complement deficiencies (primary)
|
No routine immunosuppressive therapies prescribed, but antibiotic prophylaxis may be indicated |
Mild However, specific risk of infection with encapsulated bacteria (eg Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) |
|
Complement deficiencies (secondary) Secondary complement deficiencies due to prescribing complement inhibitors | May be treated with complement inhibitors (eg eculizumab, ravulizumab) |
Mild However, specific risk of infection with encapsulated bacteria (eg Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) |
|
Common autoimmune and inflammatory conditions |
Rheumatological
Dermatological
Gastrointestinal
Neurological
|
No active treatment and disease in remission | Mild |
Treated with selected or low-dose conventional immunosuppressive therapies:
|
Generally mild to moderate, depending on prescribed dosage and mechanism of action. See Table. Recommended timing of live vaccine administration for people receiving immunosuppressive therapies and Table. Recommended timing of live vaccine administration for people receiving corticosteroids for more detail. | ||
Treated with selected or high-dose immunosuppressive therapies:
|
Severe during or <3 months after therapy completion | ||
Moderate: >3 months after therapy completion | |||
Treated with high-dose corticosteroids: >20 mg/day (infants and children <10kg: >2 mg/kg/day) for >14 days | Severe during or <4 weeks after therapy completion | ||
Moderate: >4 weeks after therapy completion | |||
Treated with B-cell depleting biological therapies (eg rituximab) | Severe: during or <6 months after therapy completion | ||
Moderate: >6 months after therapy completion | |||
Treated with small molecule targeted therapies JAK inhibitors (eg tofacitinib) |
Mild However, specific risk of infection with certain viruses (eg herpes zoster reactivation) |
||
Oncological diagnoses | Haematological | Chronic malignancies not on active treatment and in cancer remission | Moderate |
Treated with small molecule targeted therapies
|
Moderate | ||
Treated with immunomodulatory drugs (eg thalidomide, lenalidomide, pomalidomide) | Severe: during relapsed/refractory stage or multidrug regimens | ||
Moderate: during maintenance stage | |||
Treated with B-cell and T-cell targeting biological therapies (eg rituximab, ofatumumab, alemtuzumab) or bispecific agents | Severe: first 6 months after therapy completion | ||
Moderate: >6 months after therapy completion | |||
Treated with stem cell transplant or cellular therapies (eg HSCT, CAR-T therapy) | Severe: first 24 months after therapy completion | ||
Moderate: >24 months after therapy completion | |||
Solid tumours | Completed active therapy and in cancer remission | Mild | |
Treated with hormonal therapy | Mild | ||
Treated with immune checkpoint inhibitors | Mild | ||
Treated with small molecule targeted therapies
|
Mild | ||
Treated with radiotherapy | Generally mild, but may be moderate or severe depending on site and extent of radiotherapy. | ||
Treated with conventional chemotherapy | Severe: during or <3 months after therapy completion | ||
Moderate: >3 months after therapy completion | |||
Solid organ transplant | Before solid organ transplant |
Multiple immunosuppressants may be prescribed to treat the underlying organ failure, for details, see:
|
Moderate |
After solid organ transplant | Anti-rejection agents (such as mycophenolate, mTOR inhibitors, calcineurin inhibitors, corticosteroids) may be prescribed with reduced dosing over time | Severe: first 12 months after transplant | |
Moderate: >12 months after transplant | |||
Asplenia or hyposplenia | Anatomical or functional asplenia or hyposplenia (eg congenital asplenia, sickle cell anaemia, splenectomy) | No routine immunosuppressive therapies prescribed, but antibiotic prophylaxis may be indicated | Moderate, mainly due to risk of infection with specific bacterial pathogens. |
HIV infection |
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No routine immunosuppressive therapies prescribed, but highly active combination antiretroviral therapy prescribed (with or without agents to prevent opportunistic infections) | Mild |
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No routine immunosuppressive therapies prescribed, but highly active combination antiretroviral therapy prescribed (with or without agents to prevent opportunistic infections) | Moderate | |
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No routine immunosuppressive therapies prescribed, but highly active combination antiretroviral therapy prescribed (with or without agents to prevent opportunistic infections) | Severe | |
Acronyms used:
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