From the Research
Patients with Acute Lymphoblastic Leukemia (ALL) and a positive QuantiFERON test should be treated with prophylaxis to prevent the reactivation of latent tuberculosis infection (LTBI). The decision to treat is based on the risk of progression to active TB disease, which is higher in immunosuppressed individuals, such as those with ALL. According to the most recent study 1, patients with ALL who tested positive for LTBI using the QuantiFERON test were started on prophylaxis with isoniazid 300 mg daily, and none of them developed active TB during the 46 months of observation. Key factors to consider when deciding to treat LTBI in patients with ALL include:
- Recent TB exposure
- Immunocompromised status due to chemotherapy or other factors
- Radiographic evidence of prior untreated TB
- Young age or recent conversion to positive QuantiFERON test Standard treatment regimens for LTBI include isoniazid 300mg daily for 6-9 months, rifampin 600mg daily for 4 months, or the combination of isoniazid 900mg plus rifapentine 900mg weekly for 12 weeks (3HP regimen) 1. In the context of ALL, the benefits of treating LTBI likely outweigh the risks, given the high risk of reactivation and the potential for severe consequences in immunocompromised individuals. Therefore, treatment with prophylaxis is recommended for patients with ALL and a positive QuantiFERON test.