Pulmonary tuberculosis in allogeneic hematopoietic stem cell transplantation

Area of Science:

• Infectious Diseases
• Hematology
• Transplantation Medicine

Background:

• Pulmonary tuberculosis (TB) is endemic in Taiwan.
• Hematopoietic stem cell transplantation (HSCT) is a complex procedure with potential complications.
• Understanding TB risk in HSCT recipients is vital for patient management.

Purpose of the Study:

• To define the clinical manifestations and outcomes of pulmonary TB in HSCT recipients.
• To assess the risk of pulmonary TB following HSCT in an endemic area.
• To inform strategies for TB prevention in HSCT candidates and recipients.

Main Methods:

• Retrospective study of 350 HSCT recipients over a 6-year period.
• Identification and analysis of patients diagnosed with pulmonary TB post-HSCT.
• Comparison of TB risk between allogeneic and autologous HSCT.
• Review of clinical presentations and outcomes, including chest CT findings.

Main Results:

• Eight out of 350 HSCT recipients developed pulmonary TB.
• The relative risk of pulmonary TB post-HSCT was 13.1-fold higher than in the general population.
• All eight cases occurred in allogeneic HSCT recipients, often during treatment for graft-versus-host disease (GVHD).
• Chest CT showed interstitial or alveolar infiltrates in most cases; four fatal cases had shorter HSCT-to-infection intervals.

Conclusions:

• Pulmonary TB is a significant concern for HSCT recipients in Taiwan.
• Allogeneic HSCT recipients, particularly those treated for GVHD, are at high risk.
• Development of effective prophylactic strategies for latent TB infection in HSCT candidates and recipients is necessary.