评价加拿大癌症中心一项常规筛查方案，即应用结核菌素皮肤试验检测多发性骨髓瘤患者潜伏性结核感染的检出率及其对活动性结核的预防作用。
Evaluation of a routine screening program with tuberculin skin testing on rates of detection of latent tuberculosis infection and prevention of active tuberculosis in patients with multiple myeloma at a Canadian cancer centre.
机构信息
Department of General Internal Medicine, University Health Network, University of Toronto, Toronto, ON.
Immunocompromised Hosts Infectious Diseases Service, Division of Infectious Diseases, Department of Medicine, University Health Network, University of Toronto, Toronto, ON.
出版信息
Curr Oncol. 2020 Jun;27(3):e246-e250. doi: 10.3747/co.27.5577. Epub 2020 Jun 1.
BACKGROUND
Chemotherapy-induced T cell dysfunction, resulting from treatment of multiple myeloma (mm), enhances the risk for reactivation of latent tuberculous infection (ltbi). However, routine screening for ltbi has its limitations. The objective of the present study was to assess the number of patients treated for ltbi both before and after the introduction of a consistent tuberculin skin test (tst) screening program for patients with mm at our cancer centre.
METHODS
This retrospective observational study analyzed adult patients with mm treated with autologous hematopoietic stem-cell transplantation from 1 January 2013 to 31 December 2014, for whom tst was consistently performed at our cancer facility. Baseline demographic characteristics of patients who received tst testing and ltbi therapy were compared with those of a pre-intervention cohort of patients (1 January 2008 to 31 December 2009) who were not tested.
RESULTS
During the post-intervention period, 170 patients with mm had a tst. In 14 patients (8.2%) results were positive, and 11 of the 14 received ltbi therapy. Of another 12 patients with radiographic imaging changes consistent with prior granulomatous disease and negative tst results, 2 were treated. No cases of tuberculosis (tb) reactivation were noted in individuals who completed ltbi therapy. One case of active tb was diagnosed in a patient with a negative tst. In contrast, in the pre-intervention matched cohort of 170 patients, no tsts were performed, and no cases of active tb were documented.
CONCLUSIONS
Patients with mm could benefit from a consistent tst testing policy coupled with subsequent ltbi therapy. However, universal testing might not be required. A targeted program combining evaluation of host risk factors, imaging findings, and screening tests might optimize ltbi diagnosis and management, and thus be effective in preventing the development of active tb in at-risk patients with mm.
背景
多发性骨髓瘤（mm）的化疗诱导 T 细胞功能障碍会增加潜伏性结核感染（ltbi）重新激活的风险。然而，常规的 ltbi 筛查存在局限性。本研究的目的是评估在我们癌症中心为 mm 患者引入一致的结核菌素皮肤试验（tst）筛查方案前后，治疗 ltbi 的患者数量。
方法
这项回顾性观察性研究分析了 2013 年 1 月 1 日至 2014 年 12 月 31 日期间在我们癌症中心接受自体造血干细胞移植治疗的成年 mm 患者，他们在我们癌症中心接受了一致的 tst 检测。比较了接受 tst 检测和 ltbi 治疗的患者与未接受检测的干预前队列（2008 年 1 月 1 日至 2009 年 12 月 31 日）患者的基线人口统计学特征。
结果
在干预后期间，有 170 名 mm 患者进行了 tst。14 名患者（8.2%）结果阳性，其中 11 名接受了 ltbi 治疗。另有 12 名患者的影像学改变与既往肉芽肿性疾病一致且 tst 结果为阴性，其中 2 名接受了治疗。在完成 ltbi 治疗的患者中未发现结核病（tb）再激活病例。在 tst 阴性的患者中诊断出 1 例活动性 tb。相比之下，在干预前的 170 名匹配患者队列中，未进行 tst 检测，也未记录到活动性 tb 病例。
结论
mm 患者可能受益于一致的 tst 检测政策，并随后进行 ltbi 治疗。然而，可能不需要进行普遍检测。将宿主危险因素评估、影像学发现和筛查试验相结合的靶向方案可能会优化 ltbi 的诊断和管理，从而有效预防高危 mm 患者发生活动性 tb。
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