Tuberculosis after allogeneic hematopoietic stem cell transplantation: a decade nationwide case-control retrospective...

Data regarding tuberculosis (TB) in allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients in low areas of incidence is scarce. The objectives were to describe incidence, risk factors, clinical manifestations, treatment and outcome of tuberculosis after Allo-HSCT. We conducted a nationwide multicenter retrospective cohort study of adult Allo-HSCT recipients diagnosed with TB between 2012 and 2023 in France. Patients were identified through the SociétéFrancophone de Greffe de Moelle et de Thérapie cellulaire database. Each case was matched with 3 controls. Thirty-five patients were identified. The incidence rate was 60 per 100,000 patient-years. In multivariate analysis, being born in a high-incidence country for TB (OR = 19.4 [4.49-135.79], p < 0.001) was independently associated with TB. The median time from Allo-HSCT to TB diagnosis was 147 [range 30-7244] days. Extrapulmonary involvement was observed in 82% of cases (28/34). Median duration of anti-tuberculous therapy was 273 [range 10-424] days. Eight patients (25%) presented severe adverse reactions to anti-TB drugs. At the end of follow-up, two TB relapsed (6%). TB attributable mortality was 9% (N = 3, among a total of 7 deaths). Overall, our findings showed that TB post Allo-HSCT was rare and severe in low-incidence countries for TB, such as France. LTBI screening should be implemented for transplant candidates born in high-incidence countries for TB.