1073. Risk of Active Tuberculosis in Patients with Cancer: A Systematic Review and Meta-Analysis
Session: Poster Abstract Session: Infection in Immunocompromised Patients
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Cancer is an important risk factor for developing active tuberculosis (TB) infection.  The magnitude of this risk overall or by type of cancer, however, is not well described or summarized.  Treatment of latent tuberculosis infection (LTBI) would be justified if the risk of developing active TB in patients with cancer was high enough.  We conducted a systematic review and meta-analysis of the risk of developing active TB in patients with cancer to identify groups at high risk who might benefit from LTBI treatment.

Methods: Four electronic databases were searched from 1950 - December 2010 to identify studies in which incidence rates of active TB per year among cancer patients were provided or could be calculated (ie. included number of TB cases and mean or median follow-up time for all study participants).  To adjust for differential exposure to TB, incidence rate ratios (IRR) of active TB for cancer patients as compared to country specific rates of TB in the general population (obtained from the World Health Organization) for each study were calculated.  The data were pooled (overall and cancer-specific) using random effects meta-analysis; and heterogeneity was assessed using the I2 statistic.

Results: A total of 3430 articles were identified, 246 full text articles were reviewed, and 18 studies were included in the final analysis.  The risk of developing TB in cancer patients as compared to the country specific general population overall was high [Incidence Rate Ratio (IRR) 11.6; 95% confidence interval (7.0-19.2); I2 = 79.8].  The relative risk of developing active TB was significant in all types of cancer except for solid tumors; risk for hematologic malignancies [IRR= 29.6 (11.6-75.7); I2 = 61.8], solid tumors  [IRR= 17 (0.7-391)  I2 = 94.1], and stem cell transplants for hematologic malignancies or hematologic disorders [IRR=5.3 (2.6-10.9);  I2 = 70.8]. The large degree of heterogeneity between studies for each of the analyses by cancer type was not reduced by accounting for age group of the studies (adults vs. children) and cancer-type in a meta-regression of all studies.

Conclusion: Patients with all types of cancer have a moderate to high risk of developing active TB.  Therefore, screening for LTBI and offering treatment should be considered in cancer patients.    


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Christina Greenaway, MD, MSc1,2, Mark Palayew, MD2,3, Cedric Yansouni, MD4, Sonya Cnossen, MSc1,2, Amelia Sandoe, MPH1,2, Elizabeth Turner, PhD5, Ian Shrier, MD, PhD1,2 and Richard Menzies, MD, MSc3,6, (1)Lady Davis Inst. for Med. Res., Montreal, QC, Canada, (2)Jewish Gen. Hosp., Montreal, QC, Canada, (3)McGill Univ., Montreal, QC, Canada, (4)McGill Univ. Health Ctr., Montreal, QC, Canada, (5)London Sch. of Hygiene and Tropical Med., London, United Kingdom, (6)Montreal Chest Inst., Montreal, QC, Canada

Disclosures:

C. Greenaway, None

M. Palayew, None

C. Yansouni, None

S. Cnossen, None

A. Sandoe, None

E. Turner, None

I. Shrier, None

R. Menzies, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.