Tuberculosis Reactivation in Hematopoietic Stem Cell Transplant Recipients: A Preemptive Strategy in an Endemic Country

Karen Pellon-Téllez; Omar Eduardo Fernandez-Vargas; Patricia Cornejo-Juárez; Alexandra Martin-Onraet; Luis Felipe Rubalcava-Lara; Rosa Adriana Alvidrez-González; Andrés Yesid Bonilla-Salcedo; Luis Valero-Saldaña; Brenda Lizeth Acosta-Maldonado

doi:10.20944/preprints202406.0458.v1

Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Version 1 : Received: 6 June 2024 / Approved: 7 June 2024 / Online: 7 June 2024 (07:52:28 CEST)

Tuberculosis (TB) remains a global public health issue, particularly in developing countries. Hematopoietic stem cell transplant (HSCT) recipients are at elevated risk for TB due to immunosuppression. This retrospective study (2005-2022) assessed a preemptive latent tuberculosis infection (LTBI) screening and treatment strategy in 338 HSCT recipients and their donors. Screening included tuberculin skin test (TST) or QuantiFERON-TB Gold (QFT), and pulmonary imaging, with positive cases receiving isoniazid (INH) therapy. Statistical analyses aimed to compare TB reactivation rates, overall survival (OS), and relapse-free survival (RFS) across HSCT groups. Of 338 patients, 92 (27%) were diagnosed with LTBI. Screening involved TST in 325 cases and QFT in 13. INH therapy was completed by 81 patients, with 5 discontinuing due to hepatotoxicity. The cumulative incidence of active TB was 0.6%, and LTBI reactivation rate in patients who received INH was 1.2%. LTBI status did not affect OS or RFS. Our study exemplifies the effectiveness of LTBI protocols incorporating TST/QFT and CT-scan testing, followed by INH therapy, in reducing TB reactivation among HSCT recipients in a high-burden region.

Tuberculosis; Hematopoietic stem cell transplant; Antimicrobial prophylaxis; Tuberculosis control

Medicine and Pharmacology, Transplantation

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Tuberculosis Reactivation in Hematopoietic Stem Cell Transplant Recipients: A Preemptive Strategy in an Endemic Country

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