Implementing a Screening and Treatment Protocol for Latent Tuberculosis in Patients with Hematologic Malignancies in a Southern California Medical Centerстатья из журнала
Аннотация: Tuberculosis is caused by the pathogenic species of the Mycobacterium tuberculosis complex. Following a primary tuberculosis infection, adequate T-lymphocyte responses are essential to preventing the progression of disease. Patients with hematologic malignancies are at increased risk for reactivation of latent tuberculosis infection (LTBI) due to T-cell immunodeficiency caused by the disease itself or the chemotherapy used as treatment. Incidence of tuberculosis varies significantly depending on country of birth and underlying hematologic malignancy. The highest rate has been identified among allogeneic hematopoietic stem cell transplant (HSCT) patients, followed by patients with non-Hodgkin lymphoma and patients with Hodgkin's lymphoma. Isoniazid (INH) therapy may be initiated in patients found to have LTBI. INH therapy carries the risk of adverse effects including hepatotoxicity and peripheral neuropathy. INH induced hepatotoxicity occurs in 0.1-0.15% of patients among the general population during preventative therapy. Data on the tolerability of INH in hematologic malignancy patients receiving concomitant chemotherapy is limited. To investigate the incidence of LTBI in patients with hematologic malignancies at UC San Diego Health System. To investigate the safety and tolerability of INH for treatment of latent tuberculosis in patients with hematologic malignancies receiving chemotherapy. This is a prospective, single center study using data collected from an electronic patient database. Recruitment is still on-going; we hope to enroll a total of 100 patients in this study. All patients presenting with hematologic malignancies at the Moores Cancer Center are screened for LTBI as a part of the standard of care using the QuantiFERON®-TB Gold Test (QFT-IT). A value of ≥0.35 IU/mL QFT-IT result is considered positive. Patients with values of 0.35-1 IU/mL will be retested in 3-6 months to confirm positivity. If patients consent to participate, data collection will begin and continued for 9 months if treatment for LTBI is initiated. Data collected: age, gender, race, place of birth, cancer diagnosis, transplant type/conditioning regimen, medication list, PPD result history, history of LTBI and past treatment, QFT-IT result, baseline renal function, liver function tests at baseline and throughout therapy if INH was initiated. Treatment decisions in the cases of a positive QFT-IT is at the discretion of the treating physician. A descriptive analysis including means, medians, ranges and proportions will be calculated.
Год издания: 2015
Авторы: Randy Taplitz, Janine Ann Galasso, Katherine Medley
Издательство: Elsevier BV
Источник: Biology of Blood and Marrow Transplantation
Ключевые слова: Tuberculosis Research and Epidemiology, Mycobacterium research and diagnosis, Pneumocystis jirovecii pneumonia detection and treatment
Открытый доступ: hybrid
Том: 21
Выпуск: 2
Страницы: S259–S259