title: Risk and impact of tuberculosis in patients with chronic myeloid leukemia: a nationwide population-based study in Taiwan.
abstract: The relationship between chronic myeloid leukemia (CML) and tuberculosis (TB) has not been determined. We conducted a national survey including 1,082 CML patients identified from the Taiwan National Health Insurance database covering a period between 1998 and 2011; the matched non-exposed cohort included 10,820 subjects without CML that were matched for age, sex and comorbidities. The impact of TB was measured by the overall mortality, and the risk factors were identified by a multivariate Cox proportional hazards model. We found the risk of TB was higher in the CML cohort, with an adjusted hazard ratio (aHR) of 3.76 (p = 0.001) for both pulmonary (aHR 3.23, p < 0.001) and extrapulmonary (aHR 9.77, p = 0.001) TB. Specific risk factors were: aged ≥ 60 (aHR 3.24, p = 0.022), being male (aHR 13.49, p = 0.012), receiving stem cell transplantation (aHR 10.50, p = 0.001) and interferon-α therapy (aHR 3.34, p = 0.011). CML patients with TB had a higher mortality rate than those without (aHR 2.04, p = 0.043). We conclude that the incidence of TB is significantly higher in CML patients of male sex, aged ≥ 60, having received either stem cell transplantation or interferon-α treatment. Careful screening strategies for TB should be considered for CML patients with high risk of the infection.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
authors.forename: Ying-Chung
authors.initials: YC
authors.lastname: Hong
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Teng
authors.forename: Man-Hsin
authors.initials: MH
authors.lastname: Hung
authors.forename: Yu-Wen
authors.initials: YW
authors.lastname: Hu
authors.forename: Fan-Chen
authors.initials: FC
authors.lastname: Ku
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Sheng-Hsuan
authors.initials: SH
authors.lastname: Chien
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Tzeon-Jye
authors.initials: TJ
authors.lastname: Chiou
authors.forename: Jyh-Pyng
authors.initials: JP
authors.lastname: Gau
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D016898:Interferon-alpha / Q000627:therapeutic use; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013624:Taiwan; D014376:Tuberculosis / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality
chemical_list: D016898:Interferon-alpha
keywords: BCR-ABL tyrosine kinase inhibitors; chronic myeloid leukemia; extrapulmonary tuberculosis; hematopoietic stem cell transplantation; imatinib; pulmonary tuberculosis