Risk of tuberculosis in patients with solid cancers and haematological malignancies: a systematic review and meta-analysis

Dobler, Claudia C.; Cheung, Kelvin; Nguyen, John; Martin, Andrew

doi:10.1183/13993003.00157-2017

Cited by 81 publications

(72 citation statements)

References 48 publications

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“…Biological mechanisms may actually account for a significant part of this difference between male and female susceptibility to TB (Lienhardt et al, 2005;Neyrolles and Quintana-Murci, 2009). Females naturally present more effective immune responses and pathogen resistance, such as vaccination (Dobler et al, 2017). Our study found that certain cancer types were associated with higher risk of TB, including lung cancer, lymphoma, digestive organ cancer, hematopoietic and urinary tract cancer.…”

Section: Discussionmentioning

confidence: 58%

“…This leads to an increased risk of reactivating latent tuberculosis (TB) infections or new TB infection during the clinical course of cancer in endemic areas of the disease. Increased risk of TB infection has been found among certain cancer types, including lung, hematologic, colon, and oral (Cheng et al, 2016;Dobler et al, 2017;Huang et al, 2011;Teng et al, 2019). Thailand is among the 14 countries with the highest burden of TB, with an estimated incidence of 120,000 new cases of TB per year (WHO, 2018; Bureau of Tuberculosis, Department of Disease control Ministry Kaen University Ethics Committee for Human Research (reference number HE 611542).…”

Section: Introductionmentioning

confidence: 99%

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Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

Nanthanangkul

Promthet²,

Suwanrungruang

et al. 2020

Asian Pac J Cancer Prev

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Background and Objective: Cancer is a known risk factor for developing active tuberculosis (TB) disease. The incidence of and risk factors for TB are not known among cancer patients in Thailand. This study aimed to investigate risk factors for TB among cancer patients in an area with endemic TB infections. Methods: We used the Khon Kaen population-based cancer registry and two TB databases to conduct a retrospective cohort study of cancer patients. From 2001 to 2015, we identified 40,948 eligible cancer patients. Following until 2017, we identified cases of TB diagnosed after cancer diagnosis and analyzed primary cancer site, staging, treatment, and demographic factors. Adjusted incidence rate ratios (adj. IRR) were computed to identify risk factors among a subset of cancer types (n = 9,733) using Poisson regression. Results: Among all cancer patients, 472 cases of TB were diagnosed following cancer diagnosis (cumulative incidence = 1.15%, incidence rate = 421.86 cases per 100,000 patients per year). Among the subset of cancer types, 206 cases of TB were found (cumulative incidence = 2.11%, incidence rate = 848.26 cases per 100,000 patients per year). Risk factors for TB among cancer patients were sex (p < 0.001) (male adj. IRR = 1.87, 95% CI: 1.36-2.59), age (p < 0.001) (age >70 adj. IRR = 2.36, 95% CI: 1.56-3.55, compared to age ≤50) and cancer site (p < 0.001). Compared to thyroid cancer, TB infection was more associated with lung cancer without histopathological confirmation (adj. IRR = 6.22, 95% CI: 2.57-15.04). Cancer stage and treatment did not show statistically significant trends. Conclusion: Old age, male sex, and certain cancer types were independent risk factors for TB in cancer patients. Targeted latent TB screening may be appropriate among high risk groups.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

Nanthanangkul

Promthet²,

Suwanrungruang

et al. 2020

Asian Pac J Cancer Prev

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“…The post-migration incidence of TB in high-risk migrants identified in this way is estimated to be more than 100 times higher (relative risk (RR) 102-416) than in the general population in the destination country [69]. This risk is substantially higher than that of TB in other high-risk groups, such as close contacts of patients with TB (RR 47) [70], patients using tumour necrosis factor-α inhibitors (RR 2-29) [71], patients undergoing solid organ transplantation (RR 27) [72], patients with chronic renal failure requiring renal replacement therapy (RR 8) [73], or children with haematological malignancies or solid cancers (RR 17) [74]. Offering these high-risk migrants LTBI treatment should therefore be a priority for those receiving countries with a low incidence of TB.…”

Section: Post-migration Follow-upmentioning

confidence: 99%

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

et al. 2018

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In most settings with a low incidence of tuberculosis (TB), foreign-born people make up the majority of TB cases, but the distribution of the TB risk among different migrant populations is often poorly quantified. In addition, screening practices for TB disease and latent TB infection (LTBI) vary widely. Addressing the risk of TB in international migrants is an essential component of TB prevention and care efforts in low-incidence countries, and strategies to systematically screen for, diagnose, treat and prevent TB among this group contribute to national and global TB elimination goals.This review provides an overview and critical assessment of TB screening practices that are focused on migrants and visitors from high to low TB incidence countries, including pre-migration screening and post-migration follow-up of those deemed to be at an increased risk of developing TB. We focus mainly on migrants who enter the destination country application for a long-stay visa, as well as asylum seekers and refugees, but briefly consider issues related to short-term visitors and those with long-duration multiple-entry visas. Issues related to the screening of children and screening for LTBI are also explored.

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“…The reduction in LTBI incidence in the future among Japanese lung cancer patients, particularly patients born after the "baby boomer" generation, suggests that the total number of active tuberculosis cases comorbid with lung cancer will greatly decrease. Conversely, recent global meta-analyses have shown that among patients with malignant tumors, those with lung cancer, hematologic tumors, and head and neck cancer have a high risk of developing active tuberculosis [13,14]. Moreover, several reports have shown that reactivation of tuberculosis may be promoted by immune Fig.…”

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confidence: 99%

Recent trends in the incidence of latent tuberculosis infection in Japanese patients with lung cancer: A small retrospective study

Tamura

Fukami

Hebisawa

et al. 2020

Journal of Infection and Chemotherapy

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Active tuberculosis is an important complication in Japanese lung cancer patients. We studied the generation-wise trend of latent tuberculosis infection (LTBI) among lung cancer patients. We analyzed background data including birth year, lung cancer status, and interferon-gamma release assay (IGRA) data of lung cancer patients who were admitted to National Hospital Organization Tokyo National Hospital from 2010 to 2016. Of the 1450 cases, 7 showed active tuberculosis and 45 had previous tuberculosis. Of the remaining 1398 patients, 795 underwent IGRAs and 120 (15%) of them were found to have LTBI. Patients with LTBI were older (p ¼ 0.0005), and the proportion of smokers was also higher in this group (p ¼ 0.0159) than among those without LTBI. LTBI incidence decreased from 33% among patients born in the 1920s to 21%, 15%, 9.8%, and 5.1% among those born in the 1930s, 1940s, 1950s, and after 1960, respectively. A significant decrease in the smoking adjusted risk ratio was also observed with every generation (p < 0.0001). Our study suggests that the total number of patients with active tuberculosis comorbid with lung cancer will greatly decrease in the future in Japan. However, owing to recent improvements in lung cancer prognosis due to advances in cancer medication, careful monitoring for active tuberculosis development may be required in lung cancer patients with LTBI.

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Risk of tuberculosis in patients with solid cancers and haematological malignancies: a systematic review and meta-analysis

Cited by 81 publications

References 48 publications

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

Screening for tuberculosis in migrants and visitors from high-incidence settings: present and future perspectives

Recent trends in the incidence of latent tuberculosis infection in Japanese patients with lung cancer: A small retrospective study

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