Abstract
Patients with acute leukemia (AL) are predisposed to develop infections including tuberculosis (TB). The risk is specifically higher in patients from TB endemic areas. Patients (≥12 years) with AL treated between January-2014 to January-2017 who developed TB were reviewed. Patients were classified into three groups: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and acute promyelocytic leukemia (APML) and a systematic analysis of clinical features and outcomes was conducted. Over the study period, 26 patients of AL developed TB. The median time to diagnosis of TB was 8 weeks (0–432 weeks) following the diagnosis of AL and it was comparable between the three leukemia groups. The diagnosis of TB required alteration of anti-leukemia therapy in 26.9% patients and rescheduling in another 42.3% patients. Therapy alteration/rescheduling were more frequent in patients with AML as compared to ALL and APML (p < 0.03, <0.04). Disseminated TB was more common in AML patients (p < 0.016). ATT could be successfully administered in 86.9% patients with improvement of TB. The incidence of ATT induced hepatitis was 34.9%. Mortality was directly attributable to TB in 10% patients. Managing tuberculosis remains a challenge during treatment of acute leukemia. With this analysis, we advocate for a need of early suspicion and evaluation for TB in patients receiving treatment for acute leukemia. Rescheduling and or alteration of anticancer therapy due to TB is associated with significantly higher mortality. Therefore, in carefully selected cases, antileukemia therapy should continue after starting ATT as early as possible.
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References
Global Tuberculosis report (2016) WHO, Geneva. http://www.who.int/tb/publications/global_report/en/. Accessed 26 Jan 2017
Malone JL, Ijaz K, Lambert L, Rosencrans L, Phillips L, Tomlinson V et al (2004) Investigation of healthcare-associated transmission of Mycobacterium tuberculosis among patients with malignancies at three hospitals and at a residential facility. Cancer 101(12):2713–2721
Haidar C, Jeha S (2011) Drug interactions in childhood cancer. Lancet Oncol 12(1):92–99
EPOCRATES. Epocrates online: http://www.epocratess.com. Accessed 25 Jan 2017
Drug checker interaction. Medscape: http://www.medscape.com/druginfo/druginterchecker. Accessed 25 Jan 2017
Iseman MD (2000) Extrapulmonary tuberculosis. A clinicians guide to tuberculosis. Lippincott Williams Wilkins, Philadelphia, 2001, pp 145–197
Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM et al (2016) The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 127(20):2391–2405
Sharma SK, Balamurugan A, Saha PK, Pandey RM, Mehra NK (2002) Evaluation of clinical and immunogenetic risk factors for the development of hepatotoxicity during antituberculosis treatment. Am J Respir Crit Care Med 166(7):916–919
Jones GR, Konsler GK, Dunaway RP, Pusek SN (1996) Infection risk factors in febrile, neutropenic children and adolescents. Pediatr Hematol Oncol 13(3):217–229
Narita M (1993) Polymerase chain reaction for diagnosis of infectious diseases. Acta Paediatrica Japonica Overseas Ed 35(2):89–97
Chen CY, Tang JL, Hsueh PR, Yao M, Huang SY, Chen YC et al (2004) Trends and antimicrobial resistance of pathogens causing bloodstream infections among febrile neutropenic adults with hematological malignancy. J Formosan Med Assoc Taiwan yi zhi 103(7):526–532
Casper C, Singh SP, Rave S, Daley CL, Schecter GS, Riley LW et al (1996) The transcontinental transmission of tuberculosis: a molecular epidemiological assessment. Am J Public Health 86(4):551–553
Kamboj M, Sepkowitz KA (2006) The risk of tuberculosis in patients with cancer. Clin Infect Dis 42(11):1592–1595
Kaplan MH, Armstrong D, Rosen P (1974) Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 33(3):850–858
Feld R, Bodey GP, Groschel D (1976) Mycobacteriosis in patients with malignant disease. Arch Intern Med 136(1):67–70
Choudhry VP (1981) Pulmonary tuberculosis in children with acute lymphatic leukemia. Indian J Pediatr 48(390):117–119
Mishra P, Kumar R, Mahapatra M, Sharma S, Dixit A, Chaterjee T et al (2006) Tuberculosis in acute leukemia: a clinico-hematological profile. Hematology 11(5):335–340
Ostgard LS, Norgaard JM, Sengelov H, Holm MS, Jensen MK, Kallenbach M et al (2014) Impact of chemotherapy delay on short- and long-term survival in younger and older AML patients: a Danish population-based cohort study. Leukemia 28(9):1926–1929
Yakoub-Agha I, Deeg J (2014) Are hypomethylating agents replacing induction-type chemotherapy before allogeneic stem cell transplantation in patients with myelodysplastic syndrome? Biol Blood Marrow Transplant 20(12):1885–1890
Lo-Cocco F, Avvisati G, Vignetti M, Thiede C, Orlando SM, Lacobelli S et al (2013) Retinoic acid and arsenic trioxide for acute promyelocytic leukemia. N Engl J Med 369(2):111–121
Mathews V, George B, Chendamarai E, Lakshmi KM, Desire S, Balasubramanian P et al (2010) Single-agent arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: long-term follow-up data. J Clin Oncol 28(24):3866–3871
de-Medeiros BC, Strapasson E, Pasquini R, de-Medeiros CR (1998) Effect of all-trans retinoic acid on newly diagnosed acute promyelocytic leukemia patients: results of a Brazilian center. Braz J Med Biol Res Revista brasileira de pesquisas medicas e biologicas 31(12):1537–1543
Coburn RJ, England JM, Samson DM, Walford DM, Blowers R et al (1973) Tuberculosis and blood disorders. Br J Haematol 25:793–799
Fu LM (2003) The potential of human neutrophil peptides in tuberculosis therapy. Int J Tuberc Lung Dis 7(11):1027–1032
Chen CY, Sheng WH, Cheng A, Tsay W, Huang SY, Tang JL et al (2011) Clinical characteristics and outcomes of Mycobacterium tuberculosis disease in adult patients with hematological malignancies. BMC Infect Dis 11:324
Nucci M, Nouer SA, Anaissie E (2015) Distinguishing the causes of pulmonary infiltrates in patients with acute leukemia. Clin Lymphoma Myeloma Leuk 15(Suppl):S98–S103
Roy V, Weisdorf D (1997) Mycobacterial infections following bone marrow transplantation: a 20 year retrospective review. Bone Marrow Transplant 19(5):467–470
George B, Mathews V, Srivastava V, Srivastava A, Chandy M (2001) Tuberculosis among allogeneic bone marrow transplant recipients in India. Bone Marrow Transplant 27(9):973–975
Ip MS, Yuen KY, Woo PC, Luk WK, Tsang KW, Lam WK et al (1998) Risk factors for pulmonary tuberculosis in bone marrow transplant recipients. Am J Respir Crit Care Med 158(4):1173–1177
Eom KS, Lee DG, Lee HJ, Cho SY, Choi SM, Choi JK et al (2015) Tuberculosis before hematopoietic stem cell transplantation in patients with hematologic diseases: report of a single-center experience. Transplant Infect Dis 17(1):73–79
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Jain, A., Prakash, G., Singh, C. et al. Analysis of Clinical Profile and Outcome of Tuberculosis in Patients with Acute Leukemia. Indian J Hematol Blood Transfus 34, 430–442 (2018). https://doi.org/10.1007/s12288-017-0875-z
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DOI: https://doi.org/10.1007/s12288-017-0875-z