Arslan O, Gürman G, Dilek I, Ozcan M, Koç H, Ilhan O, Akan H, Konuk N, Uysal A, Beksaç M
Hematology-Oncology Department, Ibni-Sina Hospital, Ankara University, Turkey.
Haematologia (Budap). 1998;29(1):59-62.
Tuberculosis (TB) is generally seen in immunodeficient states and its incidence would be expected to increase after hematopoietic stem cell transplantation (SCT), particularly in the allogeneic setting. However, recent reports from developed countries did not support this hypothesis. Turkey is one of the countries where the disease is endemic. Over a period of 10 years two cases of TB among 120 allogeneic and 65 autologous bone marrow or peripheral blood SCT were encountered. The first patient was a 42-year-old male with acute nonlymphoblastic leukemia (ANLL) who underwent allogenic SCT from his HLA-identical sister in first remission. His early post transplant period was unremarkable and showed no clinical acute or chronic graft versus host disease (GVHD). His chest X-ray and CT scan revealed alveolar infiltrate of the left apical lobe one year after the procedure and sputum showed acid-fast bacilli, later identified as Mycobacterium tuberculosis. He was put on combination chemotherapy. He is now well and disease-free 30 months after transplant with no complaints of pulmonary TB. The second patient with chronic phase CML underwent allogeneic peripheral SCT from his HLA-identical sister. He suffered from grade II acute and extensive chronic GVHD partially treated with immunosuppressive therapy. He showed pulmonary TB 15 months after transplantation. He is still on combination chemotherapy. Although our numbers are small, the annual incidence of TB after SCT is 1.1% (2/185) which is nearly 30 to 40 times higher than the incidence of TB in the general Turkish population. In other words, an immunosuppressive state after allogenic SCT seems to increase the risk of TB in Turkey. In conclusion, TB should be considered in the differential diagnosis of unexplained infections after SCT, especially in countries, where the disease is endemic.
结核病（TB）通常见于免疫缺陷状态，预计其发病率在造血干细胞移植（SCT）后会增加，尤其是在异基因移植情况下。然而，发达国家最近的报告并不支持这一假设。土耳其是该病的 endemic 国家之一。在 10 年期间，在 120 例异基因和 65 例自体骨髓或外周血 SCT 中遇到了 2 例 TB 病例。第一例患者是一名 42 岁男性，患有急性非淋巴细胞白血病（ANLL），在首次缓解期接受了来自 HLA 相同姐姐的异基因 SCT。他移植后的早期情况正常，未出现临床急性或慢性移植物抗宿主病（GVHD）。术后一年，他的胸部 X 光和 CT 扫描显示左肺尖叶有肺泡浸润，痰液中发现抗酸杆菌，后来鉴定为结核分枝杆菌。他接受了联合化疗。现在移植后 30 个月，他情况良好且无疾病，没有肺结核的症状。第二例慢性期 CML 患者接受了来自 HLA 相同姐姐的异基因外周 SCT。他患有 II 级急性和广泛的慢性 GVHD，部分通过免疫抑制治疗。移植后 15 个月他出现了肺结核。他仍在接受联合化疗。虽然我们的病例数较少，但 SCT 后 TB 的年发病率为 1.1%（2/185），几乎是土耳其普通人群 TB 发病率的 30 至 40 倍。换句话说，在土耳其，异基因 SCT 后的免疫抑制状态似乎增加了患 TB 的风险。总之，在 SCT 后不明原因感染的鉴别诊断中应考虑 TB，特别是在该病 endemic 的国家。
