Contributions
Abstract: PB1890
Type: Publication Only
Background
Aims
To study the clinical manifestations of tuberculosis in patients with acute leukemia, as well as the impact of infection in the management of leukemia
Methods
A hospital database search was done to identify cases of acute leukemia and tuberculosis between a study duration of January 2013 to January 2017. All the medical records of the identified cases were retrieved from the central records department. A systemic analysis of characteristics pertaining to acute leukemia, treatment regimen, chemotherapy response, site of tubercular infection, mode of diagnosis and treatment response to anti-tuberculous therapy was conducted.
Results
A total of 25 patients with acute leukemia were identified who were also diagnosed with tuberculosis. 10 patients had Acute Myeloid Leukemia, 7 had Acute Promyelocytic Leukemia, 5 had Acute Lymphoblastic Leukemia, 2 had Mixed Phenotypic Leukemia while 1 had Myeloid Sarcoma. The mean interval between diagnosis of tuberculosis and acute leukemia was 37.2 weeks, with 2 patients being diagnosed after completion of therapy of acute leukemia and one patient was diagnosed post mortem. The most common organ involved was the lung, which was seen in 80% of patients and 20% of patients had disseminated tuberculosis. The development of tubercular infection led to alteration of therapy for the acute leukemia in 24% of cases, while it was postponed in 44% of cases. In particular, hypomethylating agents were used successfully in two patients with AML as bridge therapy to high dose chemotherapy. 76% of patients were cured of tuberculosis with therapy, while 1 patient expired due to tuberculosis and 3 patients could not receive adequate therapy for tuberculosis. 3 patients went on to undergo HSCT post treatment for tuberculosis, and none had a flare of the disease post transplant.
Conclusion
The presence of tuberculosis infection in patients of acute leukemia has an impact on the overall management of the patient, and strategies such as utilization of hypomethylating agents as bridge therapy may help in successful management of the leukemia. A high index of suspicion is required to suspect and diagnose the presence of tuberculosis as the manifestations are more commonly attributed to fungal infections or to the leukemia per say. These patients usually have a favorable response to anti-tuberculous therapy and the presence of tuberculosis infection does not forego treatment options such as HSCT or high dose chemotherapy for these patients.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Tuberculosis, Leukemia
Abstract: PB1890
Type: Publication Only
Background
Aims
To study the clinical manifestations of tuberculosis in patients with acute leukemia, as well as the impact of infection in the management of leukemia
Methods
A hospital database search was done to identify cases of acute leukemia and tuberculosis between a study duration of January 2013 to January 2017. All the medical records of the identified cases were retrieved from the central records department. A systemic analysis of characteristics pertaining to acute leukemia, treatment regimen, chemotherapy response, site of tubercular infection, mode of diagnosis and treatment response to anti-tuberculous therapy was conducted.
Results
A total of 25 patients with acute leukemia were identified who were also diagnosed with tuberculosis. 10 patients had Acute Myeloid Leukemia, 7 had Acute Promyelocytic Leukemia, 5 had Acute Lymphoblastic Leukemia, 2 had Mixed Phenotypic Leukemia while 1 had Myeloid Sarcoma. The mean interval between diagnosis of tuberculosis and acute leukemia was 37.2 weeks, with 2 patients being diagnosed after completion of therapy of acute leukemia and one patient was diagnosed post mortem. The most common organ involved was the lung, which was seen in 80% of patients and 20% of patients had disseminated tuberculosis. The development of tubercular infection led to alteration of therapy for the acute leukemia in 24% of cases, while it was postponed in 44% of cases. In particular, hypomethylating agents were used successfully in two patients with AML as bridge therapy to high dose chemotherapy. 76% of patients were cured of tuberculosis with therapy, while 1 patient expired due to tuberculosis and 3 patients could not receive adequate therapy for tuberculosis. 3 patients went on to undergo HSCT post treatment for tuberculosis, and none had a flare of the disease post transplant.
Conclusion
The presence of tuberculosis infection in patients of acute leukemia has an impact on the overall management of the patient, and strategies such as utilization of hypomethylating agents as bridge therapy may help in successful management of the leukemia. A high index of suspicion is required to suspect and diagnose the presence of tuberculosis as the manifestations are more commonly attributed to fungal infections or to the leukemia per say. These patients usually have a favorable response to anti-tuberculous therapy and the presence of tuberculosis infection does not forego treatment options such as HSCT or high dose chemotherapy for these patients.
Session topic: 29. Infectious diseases, supportive care
Keyword(s): Tuberculosis, Leukemia