1577. Evaluation of a routine screening program with tuberculin skin testing on rates of detection of latent tuberculosis infection and prevention of active tuberculosis in patients with multiple myeloma at a Canadian cancer center
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Background: Due to chemotherapy induced T-cell dysfunction, patients being treated for multiple myeloma (MM) are at high risk for reactivation of LTBI, however, the optimal screening strategy in this patient population has not been well described. The objective of this study was to assess the number of patients treated for LTBI both before and after the introduction of a consistent tuberculosis skin test (TST) screening program for patients with MM at our cancer center.

Methods: We carried out a retrospective observational study of adult patients treated at our cancer hospital for MM with autologous hematopoietic stem cell transplantation and who also had a TST results available from January 1, 2013 – December 31 2014. Baseline demographic characteristics, results of TST and LTBI therapy were collected. This cohort was compared to a pre-intervention cohort of sporadically tested patients from January 1, 2008 – December 31, 2009.

Results: During the post-intervention period, 170 patients with MM had a TST. At the time of TST, 113 (66.4%) patients had a lymphocyte count ≥1.0 x109/L. 14 patients (8.2%) had positive results. There were also 16 patients with radiographic evidence of prior granulomatous disease on either CXR or chest CT In these 16 patients, 12 (75%) with positive radiographic findings had negative TST results. Notably, 7//12 (58.3%) had a lymphocyte count ≤1.0 x 109/L at the time of testing. Eleven patients with positive TST results and 2 with positive radiographic results alone were treated for LTBI. There was one case of active TB diagnosed in a patient with a negative TST. There were no TSTs performed in the pre-intervention cohort and no cases of active TB were documented.

Conclusion: A significant portion of our MM patients may benefit from LTBI therapy. A targeted program combining evaluation of host risk factors, imaging findings and screening tests would optimize LTBI diagnosis and management and may be effective in preventing the development of active TB.

Melissa Gitman, MD, MPH, Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, new york, NY, James Vu, Bsc, Immunocompromised Hosts Infectious Diseases Service, University Health Network, Toronto, ON, Canada, Tram Nguyen, MSN, University Health Network, University of Toronto, toronto, ON, Canada, Coleman Rotstein, MD, FSHEA, University of Toronto, Toronto, ON, Canada and Christine Chen, MD, MHPE, Medical Oncology, University Health Network, University of Toronto, toronto, ON, Canada

Disclosures:

M. Gitman, None

J. Vu, None

T. Nguyen, None

C. Rotstein, None

C. Chen, None

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