Abstract
Tuberculosis (TB) is rare following hematopoietic cell transplantation (HCT). In this multinational retrospective study, we report the frequency, characteristics, and outcome of TB following HCT performed during 2000–2019. Fifty-two patients (35 (67%) males, 15 (29%) children) from 24 centers developed TB following allogeneic (n = 47) or autologous (n = 5) HCT; with the relative frequency of 0.21% and 0.025%, respectively. Forty (77%) were bacteriologically, 12 (23%) clinically confirmed. The median time from HCT to TB was 135 (range, 16–3225) days. Eighteen (35%) patients with extrapulmonary TB (mainly involving lymph nodes and liver/spleen) were significantly younger, developed TB shorter after HCT, more often had inherited underlying disease, and received immunosuppressive therapy at TB diagnosis as compared to pulmonary TB. Five (22%) of 23 patients with drug-susceptibility testing performed, were resistant to at least one anti-TB drug. Treatment success was achieved in 38/50 (76%) of treated patients. One-year overall survival reached 75.7% and the 1-year cumulative incidence of TB-associated death was 18.1%. Concluding, TB is a rare, albeit severe complication, which can develop any time after HCT, frequently involves extrapulmonary sites, and results in high mortality rates. High proportion of drug-resistant TB warrants routine susceptibility testing.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
We are indebted to all centres participating to the EBMT database, and especially the ones who contributed to this study.
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JDS, JS, MM, AWG designed the study. JDS, DA, IV wrote the manuscript. IV, LW, NK managed data, GT did the statistics. DA, JS, and RC supervised the study. MK, NBA, AC, MA (Mahmoud Aljurf), NK, GO, JP, MG, MP, LLC, AT, AP, MA (Mohsen Al Zahrani), MCA, GB, ACEB, KC, AC, MF, PJ, GK, SDL, SM, JN, FP, KP, JAS, IY, MZ, AWG, RC, LG, MM, JS critically revised the paper and approved the final version.
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This retrospective study was approved by the Infectious Diseases Working Party (IDWP) of the EBMT and was performed in accordance with the Declaration of Helsinki.
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Drozd-Sokołowska, J., Tridello, G., Verheggen, I. et al. Tuberculosis after hematopoietic cell transplantation: retrospective study on behalf of the Infectious Diseases Working Party of the EBMT. Bone Marrow Transplant 60, 603–616 (2025). https://doi.org/10.1038/s41409-025-02530-4
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DOI: https://doi.org/10.1038/s41409-025-02530-4
