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Hematopoietic Stem Cell Transplantation for Treatment of Patients with Leukemia Concomitant with Active Tuberculosis Infection

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      Abstract

      Background

      Currently, hematopoietic stem cell transplantation is still an essential treatment approach for leukemia. However, patients with leukemia often have weakened immune function, especially more seriously compromised cellular immune response, and appear to be at greater risk for tuberculosis infection during the transplantation process. We aimed to investigate the efficacy and safety of hematopoietic stem cell transplantation for the treatment of patients with leukemia accompanying active tuberculosis infection.

      Material/Methods

      We retrospectively analyzed records of 7 consecutive patients who were diagnosed with leukemia concomitant with active tuberculosis infection and who underwent hematopoietic stem cell transplantation in our hospital from January 2006 to December 2012.

      Results

      Among these 7 patients (4 males and 3 females; median age: 38 years; range: 30–46 years), the mean duration of anti-TB treatment before transplantation was 3 months (range: 2–4.5 months). All patients acquired engraftment, with an implantation rate of 100%. After transplantation, the mean duration of anti-TB treatment was 12 months. All patients had response after receiving anti-TB treatment. One patient died of leukemia relapse 6 months after the transplantation, but no tuberculosis infection-related death was reported.

      Conclusions

      Patients with leukemia concomitant with active tuberculosis infection can be treated with hematopoietic stem cell transplantation if they receive an effective anti-TB treatment regimen. The anti-TB treatment regimen had no effect against hematopoietic stem cell transplantation and was well-tolerated. All post-transplanted patients experienced no relapse of tuberculosis during the immune-suppression period. The findings in the present investigation deserve further in-depth study.

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      Most cited references 11

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      Treatment of Tuberculosis: Guidelines.

       S. S. ABIOLA (2010)
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        Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies

        Background Diseases caused by Mycobacterium tuberculosis (TB) among adult patients with hematological malignancies have rarely been investigated. Methods Adult patients with hematological malignancies at National Taiwan University Hospital between 1996 and 2009 were retrospectively reviewed. Patients with positive serology for HIV were excluded. TB disease is diagnosed by positive culture(s) in the presence of compatible symptoms and signs. The demographics, laboratory and, microbiological features, were analyzed in the context of clinical outcomes. Results Fifty-three of 2984 patients (1.78%) were diagnosed with TB disease. The estimated incidence was 120 per 100,000 adult patients with hematological malignancies. Patients with acute myeloid leukemia had a significantly higher incidence of TB disease than other subtypes of hematological malignancies (2.87% vs. 1.21%, p = 0.002, odds ratio, 2.40; 95% confidence interval, 1.39-4.41). Thirty-eight patients (72%) with non-disseminated pulmonary TB disease presented typically with mediastinal lymphadenopathy (53%), pleural effusion (47%) and fibrocalcific lesions (43%) on chest imaging. The 15 (28%) patients with extra-pulmonary disease had lower rates of defervescence within 72 h of empirical antimicrobial therapy (13% vs 45%, p = 0.03) and a higher 30-day in-hospital mortality (20% vs. 0%, p = 0.004) compared to those with disease confined to the lungs. Conclusions TB disease is not uncommon among patients with hematological malignancies in Taiwan. Patients who received a diagnosis of extra-pulmonary TB suffered higher mortality than those with pulmonary TB alone. Clinicians should consider TB in the differential diagnoses of prolonged fever in patients with hematological malignancies, particularly in regions of high endemicity.
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          Clinical characteristics and treatment responses of tuberculosis in patients with malignancy receiving anticancer chemotherapy.

          The aim of this study was to elucidate the clinical characteristics and treatment responses of tuberculosis developing in patients receiving anticancer chemotherapy. Retrospective case-control study. The Seoul National University Hospital, a tertiary referral hospital in South Korea. From January 1, 2000, to July 31, 2004, patients with tuberculosis detected during the course of anticancer chemotherapy were enrolled as cases. Age- and sex-matched tuberculosis patients without any malignant disease were selected as control subjects. Twenty-four patients and 48 control subjects were enrolled. Their mean +/- SD age was 56.3 +/- 14.3 years, and the male-to-female ratio was 3:1. The most common malignancy was gastric cancer (43%). Lymphoma (17%), lung cancer (8%), and head and neck cancer (8%) were also common. In both groups, the lung was the most common site of tuberculosis involvement (87.8% and 79.2%, retrospectively). The presence of scar tissue suggesting old tuberculosis on radiography was more common in patients with tuberculosis receiving anticancer chemotherapy (66.7% vs 43.8%, p = 0.07). No difference in radiographic severity was observed between groups. A regimen based on first-line antituberculosis drugs was started in all subjects. Frequency of completion of the expected antituberculosis chemotherapy was lower in patients with tuberculosis developing with anticancer chemotherapy (58.3% vs 79.2%, p = 0.02), but it was not different after excluding the loss due to progression of underlying malignancies. Bacteriologic/radiographic responses to treatment and toxicity of antituberculosis medication sufficient to change or stop treatment were not different in both groups. With regard to radiographic and clinical responses to antituberculosis treatment, tuberculosis developing during anticancer chemotherapy is not clinically different from tuberculosis developing in ordinary situations. Findings in this study suggest that anticancer chemotherapy is not an obstacle in treating tuberculosis.
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            Author and article information

            Affiliations
            [1 ]Department of Hematology, 309 Hospital of Chinese People’s Liberation Army, Beijing, China
            [2 ]Department of Clinical Laboratory, 309 Hospital of Chinese People’s Liberation Army, Beijing, China
            Author notes
            Corresponding Author: Yongqing Zhang. e-mail: zhangyongqing0725@ 123456163.com
            [A]

            Study Design

            [B]

            Data Collection

            [C]

            Statistical Analysis

            [D]

            Data Interpretation

            [E]

            Manuscript Preparation

            [F]

            Literature Search

            [G]

            Funds Collection

            [*]

            These 2 authors contributed equally to this study

            Journal
            Med Sci Monit
            Med. Sci. Monit
            Medical Science Monitor
            Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
            International Scientific Literature, Inc.
            1234-1010
            1643-3750
            2014
            30 November 2014
            : 20
            : 2484-2488
            25433702 4260619 10.12659/MSM.891380 891380
            © Med Sci Monit, 2014

            This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License

            Categories
            Clinical Research

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