Efficacy of Isoniazid Prophylaxis in Pediatric Patients at High Risk for LTBI Undergoing Hematopoietic Stem Cell Transplantation
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By
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Uet Yu
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Jiaming Yu
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Xindan Lian
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Yu Liu
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Xiaodong Wang
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Qian Zhang
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Chunjing Wang
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Chunlan Yang
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Yue Li
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Xiaohui Zhou
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Xiaoling Zhang
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Sixi Liu
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February 2, 2026
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Clinical Scorecard: Efficacy of Isoniazid Prophylaxis in Pediatric Patients at High Risk for LTBI Undergoing Hematopoietic Stem Cell Transplantation
At a Glance
| Category | Detail |
|---|
| Condition | Latent Tuberculosis Infection (LTBI) in pediatric HSCT recipients |
| Key Mechanisms | Immunosuppression post-HSCT increases TB reactivation risk |
| Target Population | Pediatric patients undergoing hematopoietic stem cell transplantation |
| Care Setting | Pediatric hematology/oncology units |
Key Highlights
- TB incidence in HSCT recipients is 10–40 times higher than the general population.
- Isoniazid (INH) prophylaxis significantly reduces post-HSCT TB reactivation.
- Effective TB risk stratification is essential for optimizing prophylaxis.
Guideline-Based Recommendations
Diagnosis
- Utilize IGRA tests and radiological assessments for TB risk stratification.
- Follow WHO guidelines for diagnosing active TB.
Management
- Administer INH at 5-10 mg/kg/d starting 5-7 days post-HSCT for high-risk patients.
Monitoring & Follow-up
- Conduct weekly follow-ups for the first three months post-HSCT, biweekly for the next three months, and monthly thereafter.
Risks
- Monitor for drug-related toxicities, particularly hepatic and renal functions.
Patient & Prescribing Data
689 pediatric HSCT recipients, with 69 classified as LTBI high-risk.
INH prophylaxis is well-tolerated with careful monitoring for adverse effects.
Clinical Best Practices
- Implement thorough pre-HSCT evaluations including IGRA and radiological assessments.
- Ensure multidisciplinary approaches for TB diagnosis in suspected cases.
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