Background: Screening for latent tuberculosis infection (LTBI) in patients with hematological malignancy is recommended because of their increased risk of tuberculosis (TB). We assessed the utility of tuberculin skin test (TST) screening in patients with acute leukemia and subsequent outcomes of LTBI treatment. Methods: We retrospectively evaluated patients ≥16 years of age with acute leukemia from 2013–2014 with a TST planted and read prior to the initiation of antineoplastic chemotherapy treatment. Demographics, clinical information and treatment outcomes of LTBI therapy were compared between patients with positive TST (≥10 mm induration) and negative TST. Results: A total of 389 patients with acute leukemia were included in the cohort. Of them, 37/389 (9.5%) had a positive TST. Only 3.4% (8/235) of individuals originating from North and South America as well as the Caribbean were TST positive, while 21% (20/95) of individuals from Asia were TST positive. Diagnostic imaging findings consistent with prior tuberculosis infection were higher in TST positive patients compared to TST negative ones (29.7% versus 9.4%, p < 0.0001). Furthermore, 31/38 patients (81.6%) who were TST positive received LTBI therapy, which was well tolerated. There was no significant difference in overall survival among those who received LTBI therapy compared to those who did not. No patients developed active TB. Conclusions: Universal screening with TST may be of low yield in individuals with acute leukemia unless patients originate from a TB endemic country. When therapy for LTBI is prescribed, patients with acute leukemia do not experience drug-induced liver toxicity and are likely to complete the intended duration of therapy, thus preventing the development of active tuberculosis.

The past decade has witnessed major advances in the management of CMV infection and disease following transplantation. An improved 2 of 2 EDITORIAL in whom ganciclovir is not a good option? Advantages of letermovir include the relative ease of access to the drug in many (but not all) jurisdictions, as well as its good safety profile. However, in the absence of well-designed controlled trials, its use in this setting should perhaps be limited to those with low viral loads or as secondary prophylaxis once ganciclovir refractory/resistant infection is treated. Other exciting areas to explore include use of combination regimens and variation of dosage.Overall, it is an exciting time in the CMV field. Advances noted above, coupled with emerging data on cell-based therapies, monoclonal antibodies and new types of vaccines all have the potential to quickly increase our armamentarium against what was once the scourge of transplantation. Ultimately, the key beneficiaries will be our patients.