Leprosy
Mailing List, January 23rd, 2009
Ref.: Treatment of HD in transplant recipients
From: Scollard, David M., Stryjewska B,
Baton Rouge
,
LA
,
USA
Dear
Salvatore,
In response
to Dr. Ariyawansa, LML Jan 19 09:
We
have experience with the treatment of HD in transplant recipients in
the
United States
, in addition to those that have been reported in the literature, as
well as with patients receiving immunosuppressive therapy for cancer.
There
is no standard MDT protocol for such patients, but we recommend
continuation of at least 2 drugs long after completing the standard MDT
regimen. We have seen that HD treatment can be discontinued after
a few more years of treatment and complete resolution of lesions, even
while they are still immunosuppressed. To be cautious, however,
we recommend that such patients should also be followed with
annual checkups for several additional years.
Generally, we
recommend that the management of Type 1or Type 2 reactions in
such patients is similar to that in non-immunosuppressed patients.
After the bacterial/ antigen load has been substantially reduced, the
occurrence of ENL will decline. There is no simple protocol for
this, either. Like Dr. Ariyawansa, we would be interested in
others' experience with such patients.
David
M. Scollard, M.D., Ph.D.
Barbara
Stryjewska, M.D.
National
Hansen's Disease Programs
1770
Physician Park Dr
.
Baton Rouge
,
LA
70816
tel
225-756-3713
FAX
225-756-3819
