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Analysis of Clinical Profile and Outcome of Tuberculosis in Patients with Acute Leukemia

  • Arihant Jain
  • Gaurav Prakash
  • Charanpreet Singh
  • Deepesh Lad
  • Alka Khadwal
  • Vikas Suri
  • Pankaj Malhotra
  • Savita Kumari
  • Neelam Varma
  • Subhash Varma
Original Article

Abstract

Patients with acute leukemia (AL) are predisposed to develop infections including tuberculosis (TB). The risk is specifically higher in patients from TB endemic areas. Patients (≥12 years) with AL treated between January-2014 to January-2017 who developed TB were reviewed. Patients were classified into three groups: acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML) and acute promyelocytic leukemia (APML) and a systematic analysis of clinical features and outcomes was conducted. Over the study period, 26 patients of AL developed TB. The median time to diagnosis of TB was 8 weeks (0–432 weeks) following the diagnosis of AL and it was comparable between the three leukemia groups. The diagnosis of TB required alteration of anti-leukemia therapy in 26.9% patients and rescheduling in another 42.3% patients. Therapy alteration/rescheduling were more frequent in patients with AML as compared to ALL and APML (p < 0.03, <0.04). Disseminated TB was more common in AML patients (p < 0.016). ATT could be successfully administered in 86.9% patients with improvement of TB. The incidence of ATT induced hepatitis was 34.9%. Mortality was directly attributable to TB in 10% patients. Managing tuberculosis remains a challenge during treatment of acute leukemia. With this analysis, we advocate for a need of early suspicion and evaluation for TB in patients receiving treatment for acute leukemia. Rescheduling and or alteration of anticancer therapy due to TB is associated with significantly higher mortality. Therefore, in carefully selected cases, antileukemia therapy should continue after starting ATT as early as possible.

Keywords

Acute leukemia Tuberculosis Anti tubercular therapy Acid fast bacilli Chemotherapy 

Notes

Funding

It was analysis of patient data base and did not involve any funding.

Compliance with Ethical Standards

Conflict of interest

There are no potential conflict of interest of authors writing this article.

Research Involving Human Participants and/or Animals

This is a retrospective data analysis and does not involve any human or animal intervention or experiment.

Informed Consent

Informed consent was obtained before data analysis from participating subjects.

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Copyright information

© Indian Society of Haematology & Transfusion Medicine 2017

Authors and Affiliations

  1. 1.Department of Internal Medicine, Clinical Hematology Unit and BMTPGIMER ChandigarhChandigarhIndia
  2. 2.Department of HematologyPGIMER ChandigarhChandigarhIndia

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