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

Abstract

Background: The 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.

Methods: From 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.

Results: TB 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.

Conclusion: Allogeneic 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.

Fig 1. Cumulative incidence of tuberculosis in allogeneic hematopoietic stem cell transplantation recipients with and without chronic graft-versus-host-disease.

Extensive chronic GVHD was associated with the development of TB (P = 0.003) There is a 4.89 ± 1.32% probability of having TB disease at 1000 days after allogeneic HSCT for extensive chronic GVHD and 1.42 ± 0.50% for limited or without chronic GVHD. cGVHD, chronic graft-versus-host disease; HSCT, hematopoietic stem cell transplantation; TB, tuberculosis.

Fig 2. Isoniazid prophylaxis and tuberculosis.

INH prophylaxis did not significantly reduce the incidence of TB (P = 0.548). Among 5 TB patients in group B, one patient had INH prophylaxis. IGRA negative included indeterminate results. IGRA, interferon-γ release assays; INH, isoniazid; TB, tuberculosis.