| Objective To study the incidence, risk factors, clinical manifestation, management and clinical outcome of tuberculosis in allogeneic hematopoietic stem cell transplantation recipientsMethods We retrospectively analyzed 4 cases of tuberculosis from a series of 200 patients undergoing allogeneic hematopoietic stem cell transplantation from June,1997 to December June,2009, with review of the literature.Result Tuberculosis occurred in 4 out of 200 patients undergoing allogeneic hematopoietic stem cell transplantation in our BMT unit, including 3 male and 1 female, aged 15 to 54yr with a median age of 34; patients were transplanted for acute myeloid leukemia (n=1), chronic myeloid leukemia (n=1) and relapsed lymphoma (n=2); Median time to tuberculosis onset after allogeneic hematopoietic stem cell transplantation was 27 months (range 13～35 months); The sites infected with tuberculosis included lungs, pericardium, thoracic cavity, abdominal cavity and testes; among them, tuberculosis occurred in the two sites in 1 case and in three sites in 2 cases. One case of disseminated tuberculosis died of respiratory failure and septic shock before diagnosed, and the remaining 3 cases given routine quadruple anti-tuberculosis treatment are still alive.Conclusion These findings suggest that TB is not a rare complication in the patients after allogeneic hematopoietic stem cell transplantation, and the delay of the diagnosis is attributed to the lack of the typical clinical manifestations. Tuberculosis should be taken into consideration when the differential diagnosis of the infectious complications in allogeneic stem cell transplant recipients. It is reasonable for patients with calcified dense fibrous strands before transplantation and occurrence of graft-versus-host disease post transplantation to receive prophylactic anti-tuberculous treatment. Because early diagnosis and treatment is closely correlated with clinical outcome, transplant physicians should be especially alert to the complication. |
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