Tuberculosis after allogeneic hematopoietic stem cell transplantation: a decade nationwide case-control retrospective study in low-incidence country.

Data regarding tuberculosis (TB) in allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients in low areas of incidence is scarce. The objectives were to describe incidence, risk factors, clinical manifestations, treatment and outcome of tuberculosis after Allo-HSCT. We conducted a nationwide multicenter retrospective cohort study of adult Allo-HSCT recipients diagnosed with TB between 2012 and 2023 in France. Patients were identified through the Soci&#xe9;t&#xe9;Francophone de Greffe de Moelle et de Th&#xe9;rapie cellulaire database. Each case was matched with 3 controls. Thirty-five patients were identified. The incidence rate was 60 per 100,000 patient-years. In multivariate analysis, being born in a high-incidence country for TB (OR&#x2009;=&#x2009;19.4 [4.49-135.79], p&#x2009;<&#x2009;0.001) was independently associated with TB. The median time from Allo-HSCT to TB diagnosis was 147 [range 30-7244] days. Extrapulmonary involvement was observed in 82% of cases (28/34). Median duration of anti-tuberculous therapy was 273 [range 10-424] days. Eight patients (25%) presented severe adverse reactions to anti-TB drugs. At the end of follow-up, two TB relapsed (6%). TB attributable mortality was 9% (N&#x2009;=&#x2009;3, among a total of 7 deaths). Overall, our findings showed that TB post Allo-HSCT was rare and severe in low-incidence countries for TB, such as France. LTBI screening should be implemented for transplant candidates born in high-incidence countries for TB.