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.