MANAGEMENT OF LATENT TUBERCULOSIS INFECTION BASED ON T-SPOT.TB ASSAY IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES
Main Article Content
hematologic malignancies, interferon-gamma release assay, latent tuberculosis infection
Background and objective: Patients with latent tuberculosis infection (LTBI) receiving chemotherapy for hematological malignancy (HM) are at high risk of developing active tuberculosis (TB) infection. The aim of this study is to show real-life data and results of the T-SPOT test and preventive isoniazid (INH) therapy in pre-chemotherapy LTBI screening in the HM patient group.
Methods: This retrospective study includes 209 HM patients who had T-SPOT tests between 2016 and 2021 in Sultan 2. Abdulhamid Han Training and Research Hospital in Istanbul, Turkey.
Results: The prevalence of LTBI was 26.8% in 209 patients (n=56). Preventive INH therapy was initiated in 82.1% (n=46) of 56 patients with LTBI. 23.9% (n=11) of the 46 patients who received preventive INH therapy were unable to complete the treatment. Elevated liver enzymes occurred in 4 (8.7%) patients using INH, while gastrointestinal symptoms occurred in 3 (6.5%) patients. Active TB infection emerged in none of the T-SPOT positive or indeterminate individuals but in one HIV (+) patient in the T-SPOT negative group. The cumulative incidence of active TB infection was 0.48%, with a population rate of 478/100.000.
Conclusions: INH treatment was generally well tolerated, and serious drug-related side effects were observed infrequently. Although LTBI cannot be demonstrated in patients with HIV(+) HM who are scheduled for chemotherapy, these patients should be closely monitored for the development of active TB infection.
Keywords: Hematologic malignancies, Interferon-Gamma Release Assays, Latent tuberculosis
2. Cheng MP, Abou Chakra CN, Yansouni CP, Cnossen S, Shrier I, Menzies D, Greenaway C. Risk of Active Tuberculosis in Patients with Cancer: A Systematic Review and Meta-Analysis. Clin Infect Dis. 2017;64:635-644. https://doi.org/ 10.1093/cid/ciw838
3. Trajman A, Steffen RE, Menzies D. Interferon-Gamma Release Assays versus Tuberculin Skin Testing for the Diagnosis of Latent Tuberculosis Infection: An Overview of the Evidence. Pulm Med. 2013;2013:601737. https://doi.org/ 10.1155/2013/601737
4. Tanriverdi Cayci Y, Korkmaz F, Birinci A. Retrospective evaluation of T-Spot. TB test results that sent to our tuberculosis laboratory. Ortadogu Med J. 2017;9:24-27. https://doi.org/10.21601/ ortadogutipdergisi.293217
5. Binay UD, Fincanci M, Fersan E, Karakecili F. Comparison of Tuberculin Skin Test (TST) and T-SPOT.TB Tests for Diagnosis of Latent Tuberculosis Infection (LTBI) in HIV-infected Patients. Mikrobiyol Bul. 2019;53:388-400. https://doi.org/10.5578/mb.68601
6. Sargin G, Sentürk T, Ceylan E, Telli M, Cildag S, Dogan H. TST, QuantiFERON-TB Gold test and T-SPOT.TB test for detecting latent tuberculosis infection in patients with rheumatic disease prior to anti-TNF therapy. Tuberk Toraks. 2018;66:136-143. https://doi.org/10.5578/tt.66444
7. Malone JL, Ijaz K, Lambert L, Rosencrans L, Phillips L, Tomlinson V, Arbise M, Moolenaar RL, Dworkin MS, Simoes EJ. Investigation of healthcare-associated transmission of Mycobacterium tuberculosis among patients with malignancies at three hospitals and at a residential facility. Cancer. 2004;101:2713-2721. https://doi.org/10.1002/ cncr.20698
8. Ganzel C, Silverman B, Chemtob D, Ben Shoham A, Wiener-Well Y. The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study. Leuk Lymphoma. 2019;60:720-5. https://doi.org/10.1080/ 10428194.2018.1499904
9. Niu T, Li J, Jiang M, Yang Y, Liu T. Clinical Research On Hematological Malignancies Complicated With Active Tuberculosis: A Single Center Experience In China. Blood. 2013;122:5592. https://doi.org/10.1182/blood.V122.21.5592.5592
10. Turkish Republic Ministry of Health. Tuberculosis Control Report 2020 in Turkey. Available at: https://hsgm.saglik.gov.tr/tr/tuberküloz-haberler/turkiye-de-verem-savasi.html. Accessed March 01, 2022.
11. Snider DE Jr, Caras GJ, Koplan JP. Preventive therapy with isoniazid. Cost-effectiveness of different durations of therapy. JAMA. 1986;255:1579-1583. https://doi.org/10.1001/ jama.1986.03370120057023
12. Osorio-López EA, Vilar-Compte D, García-Tirado J, Martin-Onraet A. Prevalence of latent tuberculosis in patients with hematological neoplasms in a cancer referral hospital in Mexico City. BMC Infect Dis. 2021;21:1-7. https://doi.org/10.1186/s12879-021-06236-y
13. Rego K, Pereira K, MacDougall J, Cruikshank W. Utility of the T-SPOT®.TB test's borderline category to increase test resolution for results around the cut-off point. Tuberculosis (Edinb) 2018;108:178-185. https://doi.org/10.1016/j.tube.2017.12.005
14. Cheng MP, Kusztos AE, Bold TD, Ho VT, Glotzbecker BE, Hsieh C, Baker MA, Baden LR, Hammond SP, Marty FM. Risk of Latent Tuberculosis Reactivation After Hematopoietic cell Transplantation. Clin Infect Dis. 2019;69:869-872. https://doi.org/10.1093/cid/ciz048.
15. Park JH, Choi EJ, Park HS, Choi SH, Lee SO, Kim YS, Woo JH, Lee JH, Lee JH, Lee KH, Shim TS, Kim SH. Treatment of Latent Tuberculosis Infection Based on the Interferon-gamma Release Assay in Allogeneic Stem Cell Transplant Recipients. Clin Infect Dis. 2020;71:1977-1979. https://doi.org/10.1093/cid/ciaa030
16. Pai M, Zwerling A, Menzies D. Systematic review: T-cell-based assays for the diagnosis of latent tuberculosis infection: an update. Ann Intern Med 2008;149:177-184. https://doi.org/10.7326/0003-4819-149-3-200808050-00241
17. Shangguan Y, Fang H, Wang S, Ji Z, Shi P, Feng X, Xu K. Risk factors for negative T-SPOT.TB assay results in patients with confirmed active tuberculosis: A retrospective study. J Infect Dev Ctries. 2020;14:1288-1295. https://doi.org/10.3855/jidc.12063
18. Beshaw MA, Balcha SA, Lakew AM. Effect of Isoniazid Prophylaxis Therapy on the Prevention of Tuberculosis Incidence and Associated Factors Among HIV Infected Individuals in Northwest Ethiopia: Retrospective Cohort Study. HIV AIDS (Auckl). 2021;13:617-629. https://doi.org/10.2147/ HIV.S301355
19. Mayock RL, MacGregor RR. Diagnosis, prevention and early therapy of tuberculosis. Dis Mon. 1976;22:1-60. https://doi.org/10.1016/s0011-5029(76) 80006-5
20. Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer. 1974;33:850-858. https://doi.org/10.1002/1097-0142(197403)33:3<850::aid-cncr2820330334>3.0.co;2-h.
21. 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;90:1110-1115.
22. Kizza FN, List J, Nkwata AK, Okwera A, Ezeamama AE, Whalen CC, Sekandi JN. Prevalence of latent tuberculosis infection and associated risk factors in an urban African setting. BMC Infect Dis. 2015;15:165. https://doi.org/ 10.1186/s12879-015-0904-1