Toxicity and adherence to treatment for latent tuberculosis infection in patients with hematologic malignancies

Sánchez-García, Elsa; Gamallo, R.; Blanco-Moure, A.; Viejo, Miguel Ángel Núñez; Amador, Lauro Fabian; Anibarro, Luis

doi:10.1007/s15010-013-0489-9

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…Only one of these patients was switched to an alternative agent. Once again, these data echo those of Sanchez-Garcia and colleagues who studied toxicity of LTBI treatment in patients with hematologic malignancies [ 18 ].…”

Section: Discussionsupporting

confidence: 80%

Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center

et al. 2022

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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.

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Section: Discussionsupporting

confidence: 80%

Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center

et al. 2022

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“…In immunosuppressed patients this risk increases [ 9 , 10 ], mainly in those with hematological neoplasms. For this reason, it has been recommended to screen for LTBI in immunosuppressed patients and to assess treatment in those who test positive, to reduce the probability of reactivation of tuberculosis [ 1 , 5 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of latent tuberculosis in patients with hematological neoplasms in a cancer referral hospital in Mexico City

et al. 2021

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Objective To determine the prevalence of Latent Tuberculosis in patients with hematological neoplasms at the Instituto Nacional de Cancerología in Mexico City using the Tuberculin skin test (TST). Methods This retrospective study included all patients with a recent diagnosis of hematological neoplasms who were admitted for treatment from 2017 to 2018 and who were screened for latent tuberculosis with the TST. The prevalence of latent tuberculosis in this group, tolerance and therapeutic adherence in treated patients are described. Results The files of 446 patients with hematological malignancy who had a TST were reviewed. The prevalence of latent tuberculosis was 31.2% (n = 139). Ninety-three patients received isoniazid, 15.1% had some adverse reactions, but only 4 (4.3%) had to discontinue treatment. Two patients with latent tuberculosis under treatment with Isoniazid reactivated tuberculosis infection. Conclusions The prevalence in our study was within the range of other similar Mexican populations. Isoniazid treatment had an adequate tolerance and adherence. Longer follow-up could offer more information on the risk of reactivation in both groups.

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“…Given concerns about polypharmacy and additive side effects, the ability or willingness on the part of patients with hematologic malignancies to complete ltbi therapy might be questioned. One study did compare 21 patients who simultaneously received ltbi and antineoplastic therapy 4 with 84 control participants who received ltbi therapy alone, finding that the two groups showed no significant differences in the rate of ltbi therapy completion. An increased rate of hepatotoxicity was observed in the group receiving antineoplastic therapy as well as ltbi; however, although 3 patients in the control group required withdrawal of their ltbi therapy because of extrahepatic complications, no patient in the group receiving antineoplastic therapy required withdrawal 4 .…”

Section: Discussionmentioning

confidence: 99%

“…One study did compare 21 patients who simultaneously received ltbi and antineoplastic therapy 4 with 84 control participants who received ltbi therapy alone, finding that the two groups showed no significant differences in the rate of ltbi therapy completion. An increased rate of hepatotoxicity was observed in the group receiving antineoplastic therapy as well as ltbi; however, although 3 patients in the control group required withdrawal of their ltbi therapy because of extrahepatic complications, no patient in the group receiving antineoplastic therapy required withdrawal 4 . In contrast, as demonstrated by Ahn et al 17 , development of active tb often results in treatment interruptions attributable to concomitant ltbi therapy and antineoplastic chemotherapy, with subsequent decreased response to therapy and adverse outcomes for those patients.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of a Routine Screening Program with Tuberculin Skin Testing on Rates of Detection of Latent Tuberculosis Infection and Prevention of Active Tuberculosis in Patients with Multiple Myeloma at a Canadian Cancer Centre

Gitman

Nguyen

et al. 2020

Current Oncology

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Background Chemotherapy-induced T cell dysfunction, resulting from treatment of multiple myeloma (mm), enhances the risk for reactivation of latent tuberculous infection (ltbi). However, routine screening for ltbi has its limitations. The objective of the present study was to assess the number of patients treated for ltbi both before and after the introduction of a consistent tuberculin skin test (tst) screening program for patients with mm at our cancer centre. Methods This retrospective observational study analyzed adult patients with mm treated with autologous hematopoietic stem-cell transplantation from 1 January 2013 to 31 December 2014, for whom tst was consistently performed at our cancer facility. Baseline demographic characteristics of patients who received tst testing and ltbi therapy were compared with those of a pre intervention cohort of patients (1 January 2008 to 31 December 2009) who were not tested. Results During the post-intervention period, 170 patients with mm had a tst. In 14 patients (8.2%) results were positive, and 11 of the 14 received ltbi therapy. Of another 12 patients with radiographic imaging changes consist with prior granulomatous disease and negative tst results, 2 were treated. No cases of tuberculosis (tb) reactivation were noted in individuals who completed ltbi therapy. One case of active tb was diagnosed in a patient with a negative tst. In contrast, in the pre-intervention matched cohort of 170 patients, no tsts were performed, and no cases of active tb were documented. Conclusions Patients with mm could benefit from a consistent tst testing policy coupled with subsequent ltbi therapy. However, universal testing might not be required. A targeted program combining evaluation of host risk factors, imaging findings, and screening tests might optimize ltbi diagnosis and management, and thus be effective in preventing the development of active tb in at-risk patients with mm.

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Toxicity and adherence to treatment for latent tuberculosis infection in patients with hematologic malignancies

Abstract: The safety of TLTBI is not influenced by simultaneous antineoplastic chemotherapy in oncohematological patients.

Cited by 10 publications

References 17 publications

Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center

Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center

Prevalence of latent tuberculosis in patients with hematological neoplasms in a cancer referral hospital in Mexico City

Evaluation of a Routine Screening Program with Tuberculin Skin Testing on Rates of Detection of Latent Tuberculosis Infection and Prevention of Active Tuberculosis in Patients with Multiple Myeloma at a Canadian Cancer Centre

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