Successful Management of Active Tuberculosis During Allogeneic Hematopoietic Stem Cell Transplantation in a Patient With Relapsed Acute Myeloid Leukemia: A Case Report and Literature Review

Abstract

Acute myeloid leukemia (AML) is a hematologic malignancy that often requires hematopoietic stem cell (HSC) allografting after relapse. Tuberculosis (TB) remains a significant concern in regions where it is endemic, posing a challenge in the management of these patients. A 38-year-old male with AML, who achieved complete remission after induction chemotherapy and three consolidation courses, relapsed one year later with additional chromosomal abnormalities. He received FLAG-Ida salvage chemotherapy and achieved both hematological and cytogenetic remission. During the pre-allograft check-up, an abdominal ultrasound revealed mesenteric adenopathies, and biopsy confirmed tuberculous adenitis. Given the urgency of HSC transplantation, the patient initiated anti-bacillary therapy (ERIP K4 capsules per day for three weeks) before starting his FB4 conditioning regimen. The therapy was continued during the transplant process. The patient completed six months of anti-bacillary treatment, with no TB reactivation observed at the latest follow-up. This case highlights the critical need for screening both donors and recipients for latent and active TB infection in endemic regions. Current literature supports the importance of pre-transplant TB screening and tailored management to address the complexities of TB treatment in stem cell transplantation, particularly in TB-endemic areas.

Keywords: acute myeloid leukemia (aml); hematopoietic stem cell; hsc transplantation; treatment; tuberculosis (tb).

Figure 1. CT images of the patient demonstrating abdominal lymphadenopathy

(A) Axial section of a contrast-enhanced abdominal-pelvic CT scan showing a round celiac-mesenteric lymphadenopathy, measuring 36.2 mm and 45.5 mm in diameter with enhancement. (B) Axial section of a non-contrast-enhanced CT scan showing a mesenteric lymphadenopathy with calcifications typical of TB. CT: computed tomography, TB: tuberculosis