Abstract
Patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression. We conducted a nested case control study to investigate the incidence and risk factors for TB after allo-HSCT. Between 2012 and 2017, 730 consecutive allo-HSCT recipients were enrolled, and 14 patients (1.92%) were diagnosed with TB. Relatively, 54 allo-HSCT recipients were selected as control. Patients who suffered TB had a significantly higher 3-year non-relapse mortality rate than the control group (30.36% vs 5.39%, P < 0.01). In multivariate analysis, invasive fungal disease (HR 4.87, 95% CI 1.39–17.09), treatment with a relatively high dose of prednisone (HR 10.34, 95% CI 1.12–95.47) and treatment with tacrolimus (HR 4.79, 95% CI 1.18–19.44) were identified independent risk factors for TB occurrence post allo-HSCT (P < 0.05). Meanwhile, donor type, dose and type of anti-thymocyte globulin (ATG) administrated, as well as treatment intensity, did not alter the incidence of TB. Therefore, allo-HSCT recipients with unexplained fever, especially those who suffer from invasive fungal disease and ongoing immunosuppression with a relatively high dose of prednisone or tacrolimus, are at a high-risk of developing active TB. Closely Monitoring TB occurrence, making a timely diagnosis and administering the proper treatment may be beneficial to those high-risk patients.
Highlights
Patients underwent allogeneic hematopoietic stem cell transplantation are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression
14 patients (1.92%) were diagnosed with active TB and 56 allo-hematopoietic stem cell transplantation (HSCT) recipients were selected as control
We identified grades 2 to 4 acute GVHD (aGVHD) (HR = 3.98, 95% CI, 1.33–11.88; P = 0.013), moderate to severe cGVHD (HR = 3.95, 95% CI, 1.11–14.03; P = 0.033), Epstein Barr virus viremia (HR = 9.21; 95% CI, 1.20–70.45; P = 0.032), invasive fungal disease (HR = 3.91, 95% CI, 1.35– 11.32; P = 0.012), treatment with etanercept (HR = 3.93, 95% CI, 1.38–11.22; P = 0.011), a relatively high dose of prednisone (HR = 17.83, 95% CI, 2.33–136.48, P = 0.006), and tacrolimus (HR = 4.34, 95% CI, 1.45–12.97, P = 0.009) as risk factors for the occurrence of TB
Summary
Patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk of acquiring tuberculosis (TB) due to a status of immunosuppression. We conducted a nested case control study to investigate the incidence and risk factors for TB after allo-HSCT. Invasive fungal disease (HR 4.87, 95% CI 1.39–17.09), treatment with a relatively high dose of prednisone (HR 10.34, 95% CI 1.12–95.47) and treatment with tacrolimus (HR 4.79, 95% CI 1.18–19.44) were identified independent risk factors for TB occurrence post allo-HSCT (P < 0.05). Allo-HSCT recipients with unexplained fever, especially those who suffer from invasive fungal disease and ongoing immunosuppression with a relatively high dose of prednisone or tacrolimus, are at a high-risk of developing active TB. We conducted a nested case control study to identify the disease features and risk factors for TB after allo-HSCT
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