BCG Infection Following Therapy of Infant Acute Lymphoblastic Leukemia

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Immunology

Background:

• Bacillus Calmette-Guérin (BCG) vaccine is standard in tuberculosis-endemic areas.
• BCGitis, a rare adverse event, typically affects immunocompromised individuals.
• Limited data exist on BCGitis in infants with hematological malignancies.

Purpose of the Study:

• To investigate BCGitis in infants with acute lymphoblastic leukemia (ALL).
• To describe clinical characteristics, management, and outcomes of BCGitis in this population.

Main Methods:

• Retrospective analysis of five infant cases of BCGitis at a pediatric oncology center.
• Review of clinical data, treatment timing, immune parameters, and outcomes.

Main Results:

• BCGitis occurred in infants with ALL (median age 1.5 months), often during chemotherapy, immunotherapy, or post-hematopoietic stem cell transplantation (HSCT).
• Onset correlated with T-cell reconstitution or therapy-induced cytopenia.
• All cases resolved with antimycobacterial therapy.

Conclusions:

• BCGitis is a rare complication in infants with acute leukemia, associated with chemotherapy-induced immunodeficiency or immune reconstitution.
• Localized manifestations are typical, but careful management is crucial, particularly post-HSCT.
• Prophylactic antimycobacterial therapy may be considered for high-risk HSCT patients.