Association of tuberculosis in patients with chronic myeloid leukemia: a treatment proposal based on literature review

ABSTRACT

Introduction: Chronic Myeloid leukemia (CML) is one of the first hematological malignancy linked with genetic alterations and have a targeted therapy with Tyrosine Kinase Inhibitors. However, there are certain unanswered questions and many unmet needs which limit its treatment. Concurrent Mycobacterium Tuberculosis (Mtb) infection is one of those significant factors. Tuberculosis (TB) is a highly prevalent disease in association with diabetes mellitus, malignancy, poor socioeconomic environment, HIV, and other immunosuppressive conditions in developed and developing countries. Anti-TB medications can affect other drug’s pharmacokinetics by altering liver enzymes metabolism and poses treatment challenge with CML medications.

Areas covered: The authors performed a rigorous literature review between 2000 and 2020 using PubMed and Google Scholar, with the main focus on all articles addressing the topic of TB in CML. Authors highlighted the need to improve clinical diagnosis and to define management strategy for this dilemma.

Expert opinion: In the current era, there are no clear guidelines or recommendations in the literature that address this problem. The aim of this review was to collect and carefully analyze the literature to highlight the need for comprehensive guidelines and propose an algorithm for better management of TB in patients with CML.

KEYWORDS:

• Chronic myeloid leukemia (CML)
• tuberculosis (TB)
• mycobacterium tuberculosis
• anti- TB medications
• tyrosine kinase inhibitors (TKI)
• treatment

Article highlights

• Tuberculosis (TB) infection in Chronic Myeloid Leukemia (CML) patients creates a dilemma for treatment due to alteration in pharmacokinetics of TKIs by anti- Tb medications.

• This aspect poses a challenge to achieve clinical remission in CML patients as well as proper TB treatment.

• Inadequate treatment in such clinical scenarios increases mortality in the patients.

• Currently, there is lack of clinical guidelines to provide a solution in such condition. Based on keen literature review, we propose that both conditions can be treated with adjustment of TKIs dosage or anti-medication class switch based on clinical remission and cautious patient follow-up.

• TB screening is also mandated in special cases of CML patients in order to provide optimum management for cure purposes.

• Our review is based on previous literature search and clinical recommendations need further randomized clinical trials and research studies in order to support this evidence.

Acknowledgments

Open Access funding provided by the Qatar National Library.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The paper has been funded by Qatar National Library.