Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

Tuberculosis in umbilical cord blood transplant recipients: clinical characteristics and challenges

Bone Marrow Transplantation volume 50, pages 465–468 (2015)Cite this article

Subjects

While umbilical cord blood transplantation (UCBT) provides an alternative donor graft source for patients without HLA matched donors,1 it is associated with delayed immune reconstitution and increased risk of infection.1, 2 Although Mycobacterium tuberculosis (TB) infection is uncommon in UCBT recipients, few available reports3, 4, 5 suggest a more severe clinical course as compared with the TB infections in auto- and allo-SCT recipients.6, 7, 8 Here, we report a case of TB following UCBT and discuss its clinical characteristics and challenges.

A 69-year-old man was admitted to our hospital with a fever 39.2°C and chills on day 50 following UCBT. His history was significant for AML diagnosed in May 2011 with the initial presentation of WBC 83x103/mL, platelet 55x103/mL and 86% blasts. His AML was FLT3 mutation negative but NPM1 mutation positive. He received ‘7+3’ Ara-C plus DNR induction therapy followed by three courses of high-dose Ara-C consolidation. He achieved a CR to induction but relapsed in February 2013 and received re-induction with the FLAG-IDA regimen, achieving a second CR with <5% blasts on a day-14 marrow. Post-remission consolidation consisted of one cycle of decitabine and a cycle of CY. He was conditioned with Flu/Cy/TBI and received a double unit UCBT on 08 August 2013 (Table 1: Patient 6).

Table 1 A summary of reported TB in UCBT recipients
Full size table

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Ballen KK, Gluckman E, Broxmeyer HE . Umbilical cord blood transplantation: the first 25 years and beyond. Blood 2013; 122: 491–498.

    Article  CAS  Google Scholar 

  2. Jacobson CA, Turki AT, McDonough SM, Stevenson KE, Kim HT, Kao G et al. Immune reconstitution after double umbilical cord blood stem cell transplantation: comparison with unrelated peripheral blood stem cell transplantation. Biol Blood Marrow Transplant 2012; 18: 565–574.

    Article  CAS  Google Scholar 

  3. Koya J, Nannya Y, Yoshizato T, Ono K, Seo S, Nakagawa M et al. Disseminated tuberculosis following unrelated cord blood transplantation for refractory peripheral T-cell lymphoma: clinical role of serum procalcitonin levels. J Infect 2011; 62: 237–240.

    Article  CAS  Google Scholar 

  4. Shima T, Yoshimoto G, Miyamoto T, Yoshida S, Kamezaki K, Takenaka K et al. Disseminated tuberculosis following second unrelated cord blood transplantation for acute myelogenous leukemia. Transpl Infect Dis 2009; 11: 75–77.

    Article  CAS  Google Scholar 

  5. Maeda T, Kusumi E, Kami M, Kawabata M, Le Pavoux A, Hara S et al. Disseminated tuberculosis following reduced-intensity cord blood transplantation for adult patients with hematological diseases. Bone Marrow Transplant 2005; 35: 91–97.

    Article  CAS  Google Scholar 

  6. de la Cámara R, Martino R, Granados E, Rodriguez-Salvanés FJ, Rovira M, Cabrera R et al. Tuberculosis after hematopoietic stem cell transplantation: incidence, clinical characteristics and outcome. Spanish group on infectious complications in hematopoietic transplantation. Bone Marrow Transplant 2000; 26: 291–298.

    Article  Google Scholar 

  7. Russo RL, Dulley FL, Suganuma L, França IL, Yasuda MA, Costa SF . Tuberculosis in hematopoietic stem cell transplant patients: case report and review of the literature. Int J Infect Dis 2010; 14: e187–e191.

    Article  Google Scholar 

  8. Ramos JF, Batista MV, Costa SF . Tuberculosis in hematopoietic stem cell transplant recipients. Mediterr J Hematol Infect Dis 2013; 5: e2013061.

    Article  Google Scholar 

  9. De Assis RA, Kerbauy FR, Rodrigues M, Seguro FS, Aranha LF, Fayad L et al. Mycobacterium tuberculosis infection: a rare late complication after cord blood hematopoietic SCT. Bone Marrow Transplant 2009; 43: 667–668.

    Article  CAS  Google Scholar 

  10. Dubey A, Gwal R, Agrawal S . Mycobacterium tuberculosis detection in blood using multiplex nested polymerase chain reaction. Int J Tuberc Lung Dis 2013; 17: 1341–1345.

    Article  CAS  Google Scholar 

  11. Tomblyn M, Chiller T, Einsele H, Gress R, Sepkowitz K, Storek J et al. Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective. Biol Blood Marrow Transplant 2009; 15: 1143–1238.

    Article  CAS  Google Scholar 

  12. Kobashi Y, Mouri K, Obase Y, Fukuda M, Miyashita N, Oka M . Clinical evaluation of QuantiFERON TB-2G test for immunocompromised patients. Eur Respir J 2007; 30: 945–950.

    Article  CAS  Google Scholar 

  13. Menzies D, Pai M, Comstock G . Meta-analysis: new tests for the diagnosis of latent tuberculosis infection: areas of uncertainty and recommendations for research. Ann Intern Med 2007; 146: 340–354.

    Article  Google Scholar 

  14. Kim SH, Lee SO, Park JB, Park IA, Park SJ, Yun SC et al. A prospective longitudinal study evaluating the usefulness of a T-cell-based assay for latent tuberculosis infection in kidney transplant recipients. Am J Transplant 2011; 11: 1927–1935.

    Article  Google Scholar 

  15. Lee YM, Lee SO, Choi SH, Kim YS, Woo JH, Kim DY et al. A prospective longitudinal study evaluating the usefulness of the interferon-gamma releasing assay for predicting active tuberculosis in allogeneic hematopoietic stem cell transplant recipients. J Infect 2014; 69: 165–173.

    Article  Google Scholar 

Download references

Acknowledgements

This work is supported by the NIH/NHLBI grant (WEK); 2U10HL069301-11 (EKW, PI: Wingard), as well as the T32 training grant (1T32CA160040-01A1, JZ is the awardee, PI: Shin).

Author information

Authors and Affiliations

  1. Department of Hematology and Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA

    J Zhang, A Nooka & E K Waller

  2. Department of Pathology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA

    M Mosunjac & A Moon

Authors
  1. J Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M Mosunjac
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A Moon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A Nooka
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E K Waller
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to A Nooka or E K Waller.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, J., Mosunjac, M., Moon, A. et al. Tuberculosis in umbilical cord blood transplant recipients: clinical characteristics and challenges. Bone Marrow Transplant 50, 465–468 (2015). https://doi.org/10.1038/bmt.2014.289

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.289

This article is cited by

Search

Advanced search

Quick links