Latent Tuberculosis in Hematopoietic Stem Cell Transplantation: Diagnostic and Therapeutic Strategies to Prevent Disease Activation in an Endemic Population
Latent Tuberculosis in Hematopoietic Stem Cell Transplantation: Diagnostic and Therapeutic Strategies to Prevent Disease Activation in an Endemic Population
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DOI：
10.1016/j.bbmt.2020.03.013
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发表时间：
2020-07-01
影响因子：
4.3
通讯作者：
Ponce-de-Leon, Alfredo
中科院分区：
文献类型：
--
作者：
Bourlon, Christianne;Camacho-Hernandez, Rocio;Ponce-de-Leon, Alfredo
潜伏性肺结核感染（LTBI）影响着世界四分之一的人口。造血干细胞移植（HSCT）受者发生活动性结核感染（ATBI）的风险升高。在这项对2000年2月至2018年6月期间接受移植的供体和HSCT受者的回顾性研究中，我们的目的是确定LTBI和ATBI的患病率，并描述流行地区HSCT人群的诊断和治疗策略。409名参与者包括125名同种异体HSCT接受者，165名自体HSCT接受者和119名HSCT供体。通过结核菌素皮肤试验和胸部影像学对患者进行hsct前评估。在队列中，有26.2%的人被诊断为LTBI。病例占自体移植人群的20%，异体移植人群的20%，供体人群的41.2%。62.6%的队列进行了排除ATBI的hsct前评估；所有结果均为阴性。73.3%的LTBI患者使用异烟肼。在亚组中，91.7%的移植受者和51%的供者接受了治疗。移植前治疗的中位持续时间受体为70天，供体为48天。随访1年时，hsct后ATBI的发生率为0。LTBI在我们人群中的发病率高于预期，由于诊断测试的限制，仍然可能被低估。没有ATBI事件表明接受者，而不是供体，必须接受LTBI治疗。预防HSCT人群的感染并发症应优先考虑，以改善临床结果。需要来自合作工作组的前瞻性数据来确定这一弱势患者群体的最佳诊断和治疗方法。(c) 2020年美国移植与细胞治疗学会。Elsevier Inc.出版。
Latent tuberculosis infection (LTBI) affects one-fourth of the world's population. Hematopoietic stem cell transplantation (HSCT) recipients are at an elevated risk of developing active tuberculosis infection (ATBI). In this retrospective study of donors and HSCT recipients who underwent transplantation between February 2000 and June 2018, our aim was to determine the prevalence of LTBI and ATBI and to describe diagnostic and therapeutic strategies in an HSCT population in an endemic region. The cohort of 409 participants included 125 allogeneic HSCT (allo-HSCT) recipients, 165 autologous HSCT (auto-HSCT) recipients, and 119 HSCT donors. Patients were evaluated pre-HSCT with tuberculin skin test and thoracic imaging. LTBI was diagnosed in 26.2% of the cohort. Cases represented 20% of the auto-HSCT population, 20% of the allo-HSCT population, and 41.2% of the donor population. Pre-HSCT evaluation to rule out ATBI was performed in 62.6% of the cohort; all results were negative. Isoniazid was administered to 73.3% of those with LTBI. Within subgroups, 91.7% of HSCT recipients and 51% of donors received treatment. The median duration of therapy pre-HSCT was 70 days in recipients and 48 days in donors. The incidence of post-HSCT ATBI was 0 at 1-year follow-up. The incidence of LTBI in our population was higher than expected and still might have been underestimated owing to diagnostic test limitations. The absence of incident ATBI suggests that recipients, as opposed to donors, must receive LTBI treatment. Prevention of infectious complications in the HSCT population should be prioritized to improve clinical outcomes. Prospective data from collaborative working groups is needed to determine the best diagnostic and therapeutic approaches in this vulnerable patient population. (c) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.