Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center
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 LTB...
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| Format: | Article |
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MDPI AG
2022-11-01
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| Series: | Current Oncology |
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| Online Access: | https://www.mdpi.com/1718-7729/29/12/731 |
| _version_ | 1797460748007374848 |
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| author | Rbab Taha Sagar Kothari Farid Foroutan Melissa Gitman Vikas Gupta Tram Nguyen Coleman Rotstein |
| author_facet | Rbab Taha Sagar Kothari Farid Foroutan Melissa Gitman Vikas Gupta Tram Nguyen Coleman Rotstein |
| author_sort | Rbab Taha |
| collection | DOAJ |
| description | 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%, <i>p</i> < 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. |
| first_indexed | 2024-03-09T17:09:29Z |
| format | Article |
| id | doaj.art-871d81bf5baa4a069ce5f6620d6e905f |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-09T17:09:29Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-871d81bf5baa4a069ce5f6620d6e905f2023-11-24T14:12:34ZengMDPI AGCurrent Oncology1198-00521718-77292022-11-0129129325933410.3390/curroncol29120731Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer CenterRbab Taha0Sagar Kothari1Farid Foroutan2Melissa Gitman3Vikas Gupta4Tram Nguyen5Coleman Rotstein6Immunocompromised Host Infectious Diseases Service, Ajmera Transplant Center, University Health Network, Toronto, ON M5G 2N2, CanadaImmunocompromised Host Infectious Diseases Service, Ajmera Transplant Center, University Health Network, Toronto, ON M5G 2N2, CanadaTed Rogers Centre for Heart Research, University Health Network, Toronto, ON M5G 2N2, CanadaDepartment of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY 10029, USADepartment of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON M5S 3H2, CanadaDivision of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, CanadaImmunocompromised Host Infectious Diseases Service, Ajmera Transplant Center, University Health Network, Toronto, ON M5G 2N2, CanadaBackground: 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%, <i>p</i> < 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.https://www.mdpi.com/1718-7729/29/12/731latent tuberculosis infectiontuberculin skin testingleukemia |
| spellingShingle | Rbab Taha Sagar Kothari Farid Foroutan Melissa Gitman Vikas Gupta Tram Nguyen Coleman Rotstein Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center Current Oncology latent tuberculosis infection tuberculin skin testing leukemia |
| title | Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center |
| title_full | Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center |
| title_fullStr | Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center |
| title_full_unstemmed | Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center |
| title_short | Implementation of a Routine Screening Program for Latent Tuberculosis Infection among Patients with Acute Leukemia at a Canadian Cancer Center |
| title_sort | implementation of a routine screening program for latent tuberculosis infection among patients with acute leukemia at a canadian cancer center |
| topic | latent tuberculosis infection tuberculin skin testing leukemia |
| url | https://www.mdpi.com/1718-7729/29/12/731 |
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