High Tuberculosis density incidence rate in Matched Unrelated Allogeneic stem cell transplantation recipients in the state of São Paulo, Brazil

Abstract

Background: There is limited data regarding Tuberculosis in hematopoietic stem cell transplantation (HSCT), especially in endemic countries. Objectives: We aimed to describe the density incidence rate and standard incidence ratios (SIR) of tuberculosis in matched  unrelated allo-HSCT.   Methods: We conducted a retrospective cohort study including all patients who underwent Matched unrelated allo-HSCT from 2007-2016 in the state of São Paulo, Brazil. Tuberculosis In this population was identified by record linkage between the national HSCT database (REREME)  and  the  São  Paulo  State  Tuberculosis  Control  Program  database. Results Five tuberculosis cases(03 males) were identified and described among 1,223 allo-HSCT. The average age was 25 years, and the estimated time between HSCT and Tuberculosis diagnosis was 376 days. Density incidence rate and standardized incidence ratios(SIR) were compared between matched unrelated donor allo-HSCT and the Tuberculosis database of the São Paulo state (172,925 cases). Considering 2,718 patients/year, the density incidence rate in the allo-HSCT population was 183 cases/100.000 patients/year (SIR:4.9 and 95% CI 1.8-11:), much higher than the average rate for the whole population in  the state  of  São  Paulo for the  same period:  38.8/100.000  inhabitants.   Conclusion; Allo-HSCT patients are highly vulnerable to tuberculosis disease, in our study almost five times higher   than  in  general   population.   Improving  epidemiological   data  and  a  better surveillance system are essential in tackling this critical condition, especially in endemic countries.