From the Research
Treatment of latent tuberculosis infection in leukemic patients should prioritize the use of rifampin 600mg daily for 4 months, due to its higher treatment completion rates and lower risk of hepatotoxicity compared to isoniazid regimens, as evidenced by a population-based study published in 2020 1. The choice of treatment regimen for latent tuberculosis infection (LTBI) in leukemic patients is crucial, given their immunocompromised state and increased risk of progression to active TB.
- Key considerations in selecting a treatment regimen include efficacy, safety, and treatment completion rates.
- Alternative regimens, such as a combination of isoniazid 300mg plus rifapentine 900mg weekly for 12 weeks (3HP regimen), may also be considered, but the 4-month rifampin regimen has been shown to have a more favorable safety profile and higher treatment completion rates in a general population study 1. Before initiating treatment, baseline liver function tests should be obtained, and patients should be monitored monthly for hepatotoxicity, which is more common in this population.
- For leukemic patients undergoing chemotherapy, LTBI treatment should ideally begin before or between chemotherapy cycles when possible, but should not delay essential cancer treatment.
- Pyridoxine (vitamin B6) 25-50mg daily should be administered with isoniazid to prevent peripheral neuropathy, although this may not be necessary with rifampin regimens. Drug interactions are a significant concern, particularly with rifampin, which can affect metabolism of many chemotherapeutic agents and immunosuppressants, so medication regimens should be carefully reviewed 2. Treatment completion is crucial as leukemic patients have a higher risk of progression to active TB due to their compromised immune function, with the highest risk occurring during periods of profound neutropenia or lymphopenia.
- A study published in 2011 found that a 3-month regimen of rifapentine and isoniazid had similar efficacy to a 9-month regimen of isoniazid, with higher treatment completion rates and less hepatotoxicity 3.
- However, the most recent and highest-quality evidence supports the use of rifampin 600mg daily for 4 months as the preferred regimen for LTBI treatment in leukemic patients, due to its favorable safety profile and high treatment completion rates 1.