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

  • Clinical and Epidemiological Study
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Abstract

Purpose

Oncohematological patients undergoing chemotherapy who have latent tuberculosis infection (LTBI) are at a high risk of developing active tuberculosis (TB). The identification and treatment of these patients can prevent LTBI progressing to active TB. This study analyzed the degree of adherence with and safety of the treatment of latent tuberculosis infection (TLTBI) in oncohematological patients undergoing antineoplastic chemotherapy.

Methods

This is a retrospective study of a cohort of oncohematological patients receiving TLTBI and antineoplastic chemotherapy simultaneously, between January 2007 and June 2010. The proportions of toxicity and adherence to TLTBI in these patients were compared with a non-oncohematological control group, matched for age, sex, and year in which the TLTBI was started. In addition, a minimum 2-year follow-up was carried out for all patients.

Results

A total of 105 patients who received TLTBI were included, 21 of whom had received antineoplastic chemotherapy simultaneously. The mean age of the patients was 63 years. There were no significant baseline differences in transaminase values. The percentages of patients completing treatment were 76.2 % in the control group and 71.4 % in the oncohematological group [risk ratio (RR): 1.07, 95 % confidence interval (CI): 0.79–1.43]. The voluntary dropout proportion was similar in both groups (12.3 vs. 11.8 %, RR: 1.05, 95 % CI: 0.25–4.42). Treatment was discontinued because of toxicity in three oncohematological patients and in 11 patients from the control group (RR: 1.14; 95 % CI: 035–3.66). No patient developed TB during the follow-up period.

Conclusion

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

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References

  1. Stefan DC, Kruis AL, Schaaf HS, Wessels G. Tuberculosis in oncology patients. Ann Trop Paediatr. 2008;28:111–6.

    Article  PubMed  CAS  Google Scholar 

  2. Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer. 1974;33:850–8.

    Article  PubMed  CAS  Google Scholar 

  3. Wu CY, Hu HY, Pu CY, et al. Aerodigestive tract, lung and haematological cancers are risk factors for tuberculosis: an 8-year population-based study. Int J Tuberc Lung Dis. 2011;15:125–30.

    PubMed  Google Scholar 

  4. Kamboj M, Sepkowitz KA. The risk of tuberculosis in patients with cancer. Clin Infect Dis. 2006;42:1592–5.

    Article  PubMed  Google Scholar 

  5. Chen CY, Sheng WH, Cheng A, et al. Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies. BMC Infect Dis. 2011;11:324.

    Article  PubMed  Google Scholar 

  6. Silva FA, Matos JO, de Q Mello FC, Nucci M. Risk factors for and attributable mortality from tuberculosis in patients with hematologic malignances. Haematologica. 2005;90:1110–5.

    PubMed  Google Scholar 

  7. Falagas ME, Kouranos VD, Athanassa Z, Kopterides P. Tuberculosis and malignancy. QJM. 2010;103:461–87.

    Article  PubMed  CAS  Google Scholar 

  8. De La Rosa GR, Jacobson KL, Rolston KV, Raad II, Kontoyiannis DP, Safdar A. Mycobacterium tuberculosis at a comprehensive cancer centre: active disease in patients with underlying malignancy during 1990–2000. Clin Microbiol Infect. 2004;10:749–52.

    Article  Google Scholar 

  9. Jasmer RM, Nahid P, Hopewell PC. Clinical practice. Latent tuberculosis infection. N Engl J Med. 2002;347:1860–6.

    Article  PubMed  Google Scholar 

  10. González-Martín J, García-García JM, Anibarro L, et al. Consensus document on the diagnosis, treatment and prevention of tuberculosis. Enferm Infecc Microbiol Clin. 2010;28:297.e1–20.

    Article  Google Scholar 

  11. Carvalho AC, Schumacher RF, Bigoni S, et al. Contact investigation based on serial interferon-gamma release assays (IGRA) in children from the hematology–oncology ward after exposure to a patient with pulmonary tuberculosis. Infection. 2013 (Epub ahead of print). doi:10.1007/s15010-013-0450-y.

  12. [No authors listed]. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep. 2000;49:1–51.

    Google Scholar 

  13. Treatment for latent tuberculosis infection. Core curriculum on tuberculosis: what the clinician should know. Centers for Disease Control and Prevention. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Division of Tuberculosis Elimination. 2011. p. 109–37. http://www.cdc.gov/tb/education/corecurr/pdf/chapter5.pdf

  14. Migliori GB, Zellweger JP, Abubakar I, et al. European union standards for tuberculosis care. Eur Respir J. 2012;39:807–19.

    Article  PubMed  CAS  Google Scholar 

  15. Anibarro L, Casas S, Paz-Esquete J, et al. Treatment completion in latent tuberculosis infection at specialist tuberculosis units in Spain. Int J Tuberc Lung Dis. 2010;14:701–7.

    PubMed  CAS  Google Scholar 

  16. Cardona PJ. A dynamic reinfection hypothesis of latent tuberculosis infection. Infection. 2009;37:80–6.

    Article  PubMed  Google Scholar 

  17. Libshitz HI, Pannu HK, Elting LS, Cooksley CD. Tuberculosis in cancer patients: an update. J Thorac Imaging. 1997;12:41–6.

    Article  PubMed  CAS  Google Scholar 

  18. Chen CY, Sheng WH, Lai CC, et al. Mycobacterial infections in adult patients with hematological malignancy. Eur J Clin Microbiol Infect Dis. 2012;31:1059–66.

    Article  PubMed  Google Scholar 

  19. Pizzo PA. Fever in immunocompromised patients. N Engl J Med. 1999;341:893–900.

    Article  PubMed  CAS  Google Scholar 

  20. Sterling TR, Villarino ME, Borisov AS, et al. Three months of rifapentine and isoniazid for latent tuberculosis infection. N Engl J Med. 2011;365:2155–66.

    Article  PubMed  CAS  Google Scholar 

  21. Kwara A, Herold JS, Machan JT, Carter EJ. Factors associated with failure to complete isoniazid treatment for latent tuberculosis infection in Rhode Island. Chest. 2008;133:862–8.

    Article  PubMed  Google Scholar 

  22. Kunst H, Khan KS. Age-related risk of hepatotoxicity in the treatment of latent tuberculosis infection: a systematic review. Int J Tuberc Lung Dis. 2010;14:1374–81.

    PubMed  CAS  Google Scholar 

  23. Santín Cerezales M, Benítez JD. Diagnosis of tuberculosis infection using interferon-gamma-based assays. Enferm Infecc Microbiol Clin. 2011;29:26–33.

    Article  PubMed  Google Scholar 

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Acknowledgments

We acknowledge the European Union Seventh Framework Programme (FP7/REGPOT-2012-2013.1) under grant agreement BIOCAPS-316265.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Authors and Affiliations

  1. Servicio de Medicina Interna, Unidad de Tuberculosis, Complexo Hospitalario de Pontevedra, 36001, Pontevedra, Galicia, Spain

    E. M. Sánchez-García, R. Gamallo, A. Blanco-Moure, M. A. Viejo & L. Anibarro

  2. Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain

    L. Anibarro

  3. Servicio de Hematología, Complexo Hospitalario de Pontevedra, 36001, Pontevedra, Galicia, Spain

    L. Amador

Authors
  1. E. M. Sánchez-García
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  2. R. Gamallo
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  3. A. Blanco-Moure
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  4. M. A. Viejo
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  5. L. Amador
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  6. L. Anibarro
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Corresponding author

Correspondence to L. Anibarro.

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Sánchez-García, E.M., Gamallo, R., Blanco-Moure, A. et al. Toxicity and adherence to treatment for latent tuberculosis infection in patients with hematologic malignancies. Infection 41, 903–907 (2013). https://doi.org/10.1007/s15010-013-0489-9

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  • DOI: https://doi.org/10.1007/s15010-013-0489-9

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