Malignant melanoma of the skin - Treatment with immunosuppressive drugs for solid organ or stem cell transplantation Factor
Immunosuppressive drugs are defined by the RMA to mean 'drugs or agents administered for the purpose of suppressing immune responses, but does not include inhaled or topical steroids'.
Immunosuppressive drug therapy is given for:
- Solid organ transplantation, blood and bone marrow transplants, and stem cell transplantation to prevent rejection of the 'foreign' organ, tissue or product.
- Immunosuppressive drugs may also be used as treatment for a systemic malignancy, autoimmune conditions such as SLE (systemic lupus erythematosus) and severe rheumatoid arthritis.
- Immunosuppressive agents include Azathioprine, Methotrexate, Cyclosporin, Cyclophosphamide. Corticosteroids are the most commonly prescribed immunosuppressive drugs e.g. prednisone (orally) or methylprednisolone (intravenously).
- Immunosuppressive therapy can rarely be stopped completely after a transplant. However, intensive immunosuppression is usually required only during the first few weeks after a transplant (starting at the time of the transplant) or during a rejection crisis. Subsequently the transplant often seems to become accommodated and can be maintained with relatively small doses of immunosuppressive drugs.
Solid organ transplantation
Solid organ transplantation involves surgical replacement of an organ (eg heart, kidney, liver) with the corresponding organ from another person and requires ongoing treatment with immunosuppressive drugs to prevent rejection of the 'foreign' organ.
Corneal transplants or grafts do not come within this definition of solid organ transplantation because the cornea does not have a blood supply. Blood and bone marrow transplants and stem cell transplants are also not covered.
Stem cell transplantation
A stem cell transplant is a procedure to replace bone marrow. Damaged bone marrow (due to disease or treatment of disease) may not produce sufficient healthy stem cells to produce the necessary white cells, red blood cells or platelets, thereby placing the person at risk of life-threatening infections, anaemia and bleeding. It may benefit both cancerous (eg leukaemia) and non-cancerous (eg aplastic anaemia) conditions.
A stem cell transplant may also be referred to as a bone marrow transplant, peripheral blood stem cell transplant, or cord blood transplant (stem cells obtained from umbilical cord blood).
The first step in the process is the collection of stem cells from a patient or a donor. When a patient's own stem cells are used, they are frozen and stored until needed. Stem cells can be collected from a donor when they are needed. The stem cells are infused into the patient's bloodstream, and they travel to the bone marrow to begin production of new blood cells.
Last reviewed for CCPS 26 September 2007.
Preliminary questions [38740]
38741 there is some evidence that treatment with immunosuppressive drugs for a solid organ or stem cell transplantation may be a factor in the development of the condition under consideration.
38742 the veteran has had a solid organ or stem cell transplantation at some time.
38743 the solid organ or stem cell transplantation required the veteran to be treated with immunosuppressive drugs.
38744 the solid organ or stem cell transplantation requiring the veteran to be treated with immunosuppressive drugs was for treatment of an illness or injury which is identifiable.
38745 the veteran has established the causal connection between the treatment with immunosuppressive drugs for solid organ or stem cell transplantation and VEA service for the clinical onset of the condition under consideration.
38747 the veteran has established the causal connection between the treatment with immunosuppressive drugs for solid organ or stem cell transplantation and eligible service for the clinical onset of the condition under consideration.
or
38746 the veteran has established the causal connection between the treatment with immunosuppressive drugs for solid organ or stem cell transplantation and operational service for the clinical onset of the condition under consideration.
Clinical onset and operational service [38746]
38748 as a consequence of the identified illness or injury, the veteran was treated with immunosuppressive drugs for the solid organ or stem cell transplantation at least one year before the clinical onset of the condition under consideration.
38750 the identified illness or injury for which the solid organ or stem cell transplant was given is causally related to operational service.
Clinical onset and eligible service [38747]
38749 as a consequence of the identified illness or injury, the veteran was treated with immunosuppressive drugs for the solid organ or stem cell transplantation at least two years before the clinical onset of the condition under consideration.
38751 the identified illness or injury for which the solid organ or stem cell transplant was given is causally related to eligible service.