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Tuberculosis in allogeneic haematopoietic stem cell transplantation: so many unresolved questions!

Bone Marrow Transplantation volume 56, pages 2050–2051 (2021)Cite this article

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The incidence of tuberculosis (TB) infection in allogeneic haematopoietic stem cell transplant (HSCT) recipients is 3–10 times higher than in the general population. However, TB remains a rare infection following HSCT with a median incidence ranging from 0.44% to 2.72% depending on the overall TB epidemiology with regions of low, medium, or high TB burden [1,2,3,4,5,6,7,8]. For unclear reasons, TB is less frequent than expected, even in countries with a high TB incidence, and less frequent than in solid organ transplant [9]. The rarity of TB infection after HSCT probably explains the difficulties in obtaining robust prospective data and in reaching a consensus on how to prevent it.

TB can be due to either reactivation of latent tuberculosis infection (LTBI) or primary infection from TB exposure. LTBI is defined as a state of persistent immune response to stimulation by Mycobacterium tuberculosis antigens diagnosed with a positive immunological test (tuberculin skin test (TST) or interferon gamma-release assays (IGRAs; quantiferon GIT (QTF-GIT) or T-spot TB) with no clinical sign of active TB. People with LTBI are at-risk for developing active TB disease, with a high probability in specific groups of patients, including HSCT candidates. Therefore, the 2018 LTBI guidelines from the World Health Organization recommended that HSCT candidates should be systematically tested and treated for LTBI. However, this stringent stance was based on low–very low-quality evidence due to the lack of data [10].

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Authors and Affiliations

  1. Université de Paris, AP-HP, Hôpital Saint-Louis, Service de Pneumologie, Paris, France

    Anne Bergeron

  2. UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris, France

    Anne Bergeron

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  1. Anne Bergeron
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Correspondence to Anne Bergeron.

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Bergeron, A. Tuberculosis in allogeneic haematopoietic stem cell transplantation: so many unresolved questions!. Bone Marrow Transplant 56, 2050–2051 (2021). https://doi.org/10.1038/s41409-021-01381-z

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