Risk of tuberculosis in patients with solid cancers and haematological malignancies: a systematic review and meta-analysis

There is uncertainty regarding whether patients with cancer should be screened for latent tuberculosis infection (LTBI). We performed a systematic review and meta-analysis to estimate the relative incidence of tuberculosis (TB) in cancer.We searched MEDLINE and Embase for studies published before December 21, 2016. We included studies that evaluated the incidence of TB in patients with solid cancers and haematological malignancies relative to a reference group (study control or general population). A pooled estimate of the incidence rate ratio (IRR) was obtained using standard meta-analysis methods.The search strategy identified 13 unique studies including 921 464 patients with cancer. The IRR of TB for adult patients with cancer was 2.61 (95% CI 2.12-3.22; I2=91%). In haematological cancers, the IRR was 3.53 (95% CI 1.63-7.64; I2=96%); and in solid cancers in adults, it was 2.25 (95% CI 1.96-2.58; I2=91%). The highest IRR was found in children with haematological malignancies or solid cancers (IRR 16.82, 95% CI 8.81-32.12; I2=79%).Considering the limited duration of maximum immunosuppression in cancer and reduced cumulative lifetime risk of TB because of reduced life expectancy, children, but not adults, appear to be at a sufficient level of risk to warrant systematic screening for LTBI.