Kapoor Jyotsna, Mirgh Sumeet Prakash, Khushoo Vishvdeep, Mehta Pallavi, Ahmed Rayaz, Bansal Nitin, Bhurani Dinesh, Agrawal Narendra
Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi, India.
Adult Hematolymphoid and BMT Unit, Tata Memorial Hospital ACTREC, Navi Mumbai, India.
Ther Adv Infect Dis. 2021 Apr 12;8:20499361211008674. doi: 10.1177/20499361211008674. eCollection 2021 Jan-Dec.
Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients.
Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if (MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause.
Among 381 alloSCT recipients, 15 patients (3.9%) developed TB at median of 246 (74-279) days post AlloSCT, after being symptomatic for a median of 22 (7-60) days, amounting to a cumulative incidence of 4.9%. All patients were started on four-drug anti tubercular therapy, ATT [Rifampicin, Isoniazid, Ethambutol, Pyrazinamide (RHEZ)], of which five patients developed hepatotoxicity at a median of 12 days after start of ATT, leading to drug modification. At last follow up, TB was cured in 13 (86.67%) patients, one succumbed to disease relapse, while others are still on treatment. Age ⩾ 30 years, immunosuppression for graft host disease (GvHD) > 6 months, prior use of tyrosine kinase inhibitors (TKI) and chronic GvHD on univariate analysis and immunosuppression for GvHD > 6 months on multivariate analysis were found to be associated with development of TB.
A high index of suspicion with timely workup and treatment of TB is the key in AlloSCT recipients, especially in endemic TB populations.
异基因干细胞移植（AlloSCT）受者发生结核病（TB）的风险仍然较高，尤其是在结核病流行地区的人群中。我们进行了一项回顾性研究，以确定我们的AlloSCT受者中活动性结核病的发病率、临床表现和危险因素。
回顾了2012年1月1日至2020年7月31日期间所有移植患者的记录。对患者进行随访直至2020年9月30日观察结局。所有患者均未接受预防性抗结核药物治疗。如果从临床样本中培养出结核分枝杆菌（MTB），或在萋-尼（ZN）染色、组织病理学或Xpert MTB检测中发现抗酸杆菌（AFB）或MTB，则考虑确诊为活动性结核病；如果组织病理学结果提示干酪样坏死/上皮样细胞肉芽肿，且无任何恶性肿瘤证据，或淋巴细胞丰富的渗出性积液（胸膜/心包）且无其他原因，则考虑可能诊断为结核病。
在381例AlloSCT受者中，15例（3.9%）在AlloSCT后中位246（74 - 279）天发生结核病，出现症状的中位时间为22（7 - 60）天，累积发病率为4.9%。所有患者均开始接受四联抗结核治疗，即ATT[利福平、异烟肼、乙胺丁醇、吡嗪酰胺（RHEZ）]，其中5例患者在开始ATT治疗后中位12天出现肝毒性，导致药物调整。在最后一次随访时，13例（86.67%）患者的结核病治愈，1例死于疾病复发，其他患者仍在接受治疗。单因素分析显示，年龄≥30岁、移植物抗宿主病（GvHD）免疫抑制>6个月、既往使用酪氨酸激酶抑制剂（TKI）和慢性GvHD与结核病发生相关；多因素分析显示，GvHD免疫抑制>6个月与结核病发生相关。
对于AlloSCT受者，尤其是在结核病流行地区的人群中，对结核病保持高度怀疑并及时进行检查和治疗是关键。
