The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study

Abstract

Patients with cancer are at high risk for tuberculosis (TB). This study combined the Israeli databases of cancer and TB and examined the development of TB among all newly diagnosed cancer cases from 1993 to 2013. Patients were classified into groups according to their different malignancies. Among 495,335 cancer patients, 335 developed TB following cancer diagnosis. The cumulative incidence of TB following cancer diagnosis was highest among MDS/MPN (148.8/100,000 patients) and lymphoma (154.1/100,000 patients) (p = .023). The HR of TB following cancer among hematologic patients was 2.51 (p < .001), relative to patients with in situ carcinomas/skin cancer and highest among MDS/MPN and lymphoma patients (2.74, p = .012 and 2.70, p < .001, respectively). Among lymphoma patients, a significant increased HR was found only among NHL patients (2.72, p < .001). The limitations include lack of information regarding risk factors for TB and of anti-cancer treatments. In conclusion, these data may encourage a heightened awareness for TB among patients with a background of lymphoma and MDS/MPN.

Fatal Infections Among Cancer Patients: A Population-Based Study in the United States

“…Among all cancers, patients with Kaposi sarcoma are at the highest risk of dying from tuberculosis and other infections (including HIV). The risk for tuberculosis in patients with cancer is due to the weak hostcaused by immunosuppression from the cancer itself or the chemotherapy [31][32][33], as well as local structural changes in the lungs by cancer or metastasis [34,35]. A retrospective study conducted between 2000 and 2015 estimated that tuberculosis-related mortality was 0.83% in the cancer population [33] compared to 0.28% in the general population [36].…”

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

“…Our results were consistent with several studies in which lymphoma increased the risk of the development of active TB. (Cheng et al, 2017;Ganzel et al, 2019) The incidence of TB in Non-Hodgkin lymphoma (NHL) patients is 35 times higher than in the general population. Furthermore, interleukin 10 (IL-10), which is increased in patients with NHL, has been implicated in the reactivation of TB.…”

Localized lymphadenopathy with myelodysplastic syndrome associated with tuberculosis

“…The investigators cautioned that patients with a background of MDS/MPN have a higher risk of developing TB. 4 The major host defense against TB is cell-mediated immunity. It has been reported that there are serious defects in the lymphoid system in addition to abnormalities in the myeloid populations of MDS patients, such as decreased absolute numbers of T lymphocytes and markedly decreased CD4+/CD8+ ratio.…”

“…investigated 195 MDS patients and revealed 12 TB patients in this cohort, 50% of whom had extrapulmonary involvement. 4 Thus, the initial symptom of TB appears to be extrapulmonary, which may be common in an immuno - compromised host.…”