The demanding attention of tuberculosis in allogeneic hematopoietic stem cell transplantation recipients: High incidence compared with general population

Abstract

BackgroundThe risk of developing tuberculosis (TB) in allogeneic hematopoietic stem cell transplantation (HSCT) recipients is expected to be relatively high in an intermediate TB burden country. This single-center retrospective study was conducted to investigate risk factors and the incidence of TB after allogeneic HSCT.MethodsFrom January 2004 to March 2011, 845 adult patients were enrolled. Starting April 2009, patients were given isoniazid (INH) prophylaxis based on interferon-γ release assay results. The incidence of TB was analyzed before and after April 2009, and compared it with that of the general population in Korea.ResultsTB was diagnosed in 21 (2.49%) of the 845 allogeneic HSCT patients. The median time to the development of TB was 386 days after transplantation (range, 49–886). Compared with the general population, the standardized incidence ratio of TB was 9.10 (95% CI; 5.59–14.79). Extensive chronic graft-versus-host disease (GVHD) was associated with the development of TB (P = 0.003). Acute GVHD, conditioning regimen with total body irradiation and conditioning intensity were not significantly related. INH prophylaxis did not reduce the incidence of TB (P = 0.548). Among 21 TB patients, one patient had INH prophylaxis.ConclusionAllogeneic HSCT recipients especially those who suffer from extensive chronic GVHD are at a high risk of developing TB. INH prophylaxis did not statistically change the incidence of TB, however, further well-designed prospective studies are needed.

Incidence and clinical profile of tuberculosis after allogeneic stem cell transplantation

“…Patients with hematological malignancies are immune‐compromised because of the disease process as well as chemotherapy. The cell‐mediated immunity of those undergoing allogeneic stem cell transplantation (alloSCT) are further reduced because of the intense conditioning regimen used, development of graft‐versus‐host disease (GVHD) and its treatment with immunosuppressive drugs, and subsequently delayed immune reconstitution . Therefore, these patients are at a very high risk of activation of latent TB infection, especially in a population with high TB burden.…”

“…Therefore, these patients are at a very high risk of activation of latent TB infection, especially in a population with high TB burden. Incidence of TB is 2‐40 times higher among alloSCT patients than in the general population . Frequency of tubercular infection after alloSCT patients from areas of high incidence has been reported to be 1%‐16% .…”

An update on Mycobacterium tuberculosis infection after hematopoietic stem cell transplantation in adults

“…We found a total of 16 studies that described 47 unique cases of TB in the adult HSCT population during the study period: three retrospective reviews, two prospective cohorts, and 11 case reports . Of these, nine were published by centers from Asia …”

“…All TST tests (7/7) were negative, while 6/8 (75%) IGRA results were positive. Only one of the patients who tested positive by TB‐IGRA received isoniazid prophylaxis . Among detailed case reports (n = 11), three specifically stated that patients did not undergo TST or TB‐IGRA, while the remainder had no mention of testing.…”

“…Detailed information on TB treatment was available only for 35/47 (74.5%) patients. Majority (29/35, 82.9%) received first‐line quadruple drug therapy with isoniazid (H), rifampin (R), pyrazinamide (Z), and ethambutol (E), while 1 received HRE plus a quinolone, 1 HRZ, and 4 received second line therapy (Table ) due to drug resistance (1), treatment failure (1), and intolerance (2) . Adverse drug reactions were not described in most studies, except in one study where 2/5 HSCT recipients developed mild hepatotoxicity.…”