Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome

Abstract

Summary:A national survey of tuberculosis after hematopoietic stem cell transplant (SCT) was undertaken to study incidence, clinical presentation and outcome. Twenty confirmed cases were found among 8013 patients (eight in 5147 autologous and 12 in 2866 allogeneic SCT). The estimated incidence in cases/10 5 patients/year (95% CI) was 101 (56.5-145) for the whole group, 71.1 (21.8-120) in autologous and 135.6 (58.9-212) in allogeneic transplants. Compared with the general population, tuberculosis was more frequent after allogeneic (RR 2.95) but not after autologous SCT. Tuberculosis after SCT is a late infection (median 324 days post transplant), predominately affects the lungs (80% of the cases), appears to respond well to treatment but has a high mortality (25%) in allogeneic recipients. It can also complicate the post-transplant management as antituberculosis drugs frequently decrease the serum levels of cyclosporine causing an aggravation of GVHD. Graft-versus-host disease, corticosteroid treatment and total body irradiation appear to be associated with tuberculosis in allogeneic recipients. No obvious factors were associated with tuberculosis in autologous transplants. Finally, we found that the published literature on tuberculosis after solid and SCT has overestimated its incidence due to the direct translation of tuberculosis frequency into incidence. Bone Marrow Transplantation (2000) 26, 291-298.

Disseminated tuberculosis following reduced-intensity cord blood transplantation for adult patients with hematological diseases

“…A high incidence of tuberculosis might be Tuberculosis after RI-UCBT T Maeda et al expected in RI-UCBT patients due to patients' age and prolonged immunosuppression associated with the use of CB as a stem cell source; however, the incidence of tuberculosis following RI-UCBT was comparable to that following allo-HSCT in previous reports from endemic countries. 15,[18][19][20][21] Tuberculosis is less frequent in RI-UCBT recipients than in the immunodeficient patients of different etiologies such as solid organ transplantation and AIDS. Immunosuppression after RI-UCBT is transient, 11 while AIDS patients and solid organ transplant recipients have a life-long immunosuppression.…”

“…11,12 Recent studies on tuberculosis following allogeneic hematopoietic stem cell transplantation (allo-SCT) have demonstrated that this is a significant problem in endemic countries with an incidence of 0.1-5.5%. [13][14][15][16][17][18][19][20][21] This is the first report, to our knowledge, on tuberculosis following RI-UCBT. Detailed description of this complication would be informative in the management of RI-UCBT.…”

Tuberculosis in umbilical cord blood transplant recipients: clinical characteristics and challenges

“…1,2 Although Mycobacterium tuberculosis (TB) infection is uncommon in UCBT recipients, few available reports [3][4][5] suggest a more severe clinical course as compared with the TB infections in auto-and allo-SCT recipients. [6][7][8] Here, we report a case of TB following UCBT and discuss its clinical characteristics and challenges.…”

“…The clinical course of TB in recipients of UCBT is therefore very different from TB in other hematopoietic SCT (HSCT) recipients. Whereas the median TB onset time in auto-and allo-SCT recipients is about 279 and 257 days, respectively, 6,7 it is only about 50 days in UCBT recipients; on the basis of the data extracted from the literature. In addition, in either autologous or allogeneic recipients, TB tends to be localized and mainly involves the lungs, whereas in UCBT recipients TB is almost all disseminated with very high mortality.…”

An unusual cause of acute abdomen following allogeneic transplantation: a zoonotic disease revisited

“…However, several centres have reported a varying and often surprisingly low incidence of this disease even in endemic populations, with no reported cases of Mycobacterium bovis, apart from disseminated bacille Calmette-Guerin. [1][2][3] A 31-year-old Mexican woman was diagnosed with AML when she was admitted with a 2-week history of fevers above 38 1C and neutropenia. Four years before, she had been treated for severe acquired aplastic anaemia with antithymocyte globulin and other immunosuppressants.…”