在造血干细胞移植受者结核再激活：一个流行病国家的先发制人的策略

IF 2 Q3 INFECTIOUS DISEASES

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Pub Date : 2025-09-27 DOI:10.1016/j.jctube.2025.100565

Irma Karen Pellón-Téllez , Omar Eduardo Fernandez-Vargas , Patricia Cornejo-Juárez , Alexandra Martin-Onraet , Luis Felipe Rubalcava-Lara , Rosa Adriana Alvidrez-González , Andrés Bonilla-Salcedo , Luis Valero-Saldaña , Brenda Lizeth Acosta-Maldonado

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引用次数: 0

摘要

结核病（TB）仍然是一个全球性的公共卫生问题，特别是在发展中国家。由于免疫抑制，造血干细胞移植（HSCT）受者患结核病的风险增加。方法回顾性研究（2005-2022）对338例HSCT受者及其供者进行了预防性潜伏性结核感染（LTBI）筛查和治疗策略评估。筛查包括结核菌素皮肤试验（TST）或QuantiFERON-TB Gold （QFT）和肺部影像学检查，阳性病例在HSCT前接受异烟肼（INH）治疗。统计分析比较了HSCT组的TB再激活率、总生存期（OS）和无复发生存期（RFS）。结果在338例患者中，筛查包括325例TST和13例QFT，导致94例（27.8%）患者为LTBI。83例患者完成了INH治疗，其中5例因肝毒性而停止治疗。活动性结核病的累积发病率为0.6%，1例接受INH预防的患者出现LTBI再激活。LTBI状态不影响OS或RFS。我们的研究表明，使用LTBI方案结合TST/QFT和胸部ct扫描，在阳性病例中进行INH，是安全的，是高负担地区HSCT接受者的一种可行选择。

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Tuberculosis reactivation in hematopoietic stem cell transplant recipients: a preemptive strategy in an endemic country

Background

Tuberculosis (TB) remains a global public health issue, particularly in developing countries. Hematopoietic stem cell transplant (HSCT) recipients are at increased risk for TB due to immunosuppression.

Methods

This retrospective study (2005–2022) assessed a preemptive latent tuberculosis infection (LTBI) screening and treatment strategy in 338 HSCT recipients and their donors. Screening included tuberculin skin test (TST) or QuantiFERON-TB Gold (QFT), and pulmonary imaging, with positive cases receiving isoniazid (INH) therapy before HSCT. Statistical analyses compared TB reactivation rates, overall survival (OS), and relapse-free survival (RFS) across HSCT groups.

Results

Of 338 patients, screening involved TST in 325 and QFT in 13 cases, resulting in 94 (27.8%) patients with LTBI. INH therapy was completed by 83 patients, with 5 discontinuing due to hepatotoxicity. The cumulative incidence of active TB was 0.6%, and one patient who received INH prophylaxis developed LTBI reactivation. LTBI status did not affect OS or RFS.

Conclusions

Our study demonstrates that the use of LTBI protocols incorporating TST/QFT and chest CT-scans, followed by INH in positive cases, was safe and is an accessible option among HSCT recipients in high-burden regions.

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来源期刊

Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Medicine-Pulmonary and Respiratory Medicine

CiteScore

4.00

自引率

5.00%

发文量

审稿时长

30 weeks

期刊介绍： Journal of Clinical Tuberculosis and Mycobacterial Diseases aims to provide a forum for clinically relevant articles on all aspects of tuberculosis and other mycobacterial infections, including (but not limited to) epidemiology, clinical investigation, transmission, diagnosis, treatment, drug-resistance and public policy, and encourages the submission of clinical studies, thematic reviews and case reports. Journal of Clinical Tuberculosis and Mycobacterial Diseases is an Open Access publication.