Should patients starting cyclophosphamide be screened routinely for latent tuberculosis (TB)?

Yes, I think patients starting Cyclophosphamide should be screened routinely for latent TB since CYC is a strong immunosuppressant and increases the risk of TB reactivation. The issue is that CYC is often being considered for life or organ-threatening situations, for which it may not be ideal to wait 4-6 weeks while the patient starts treatment for latent TB if the test is positive. I think in those situations, concurrent treatment for TB while CYC is being started is a way to go, rather than delaying CYC induction.

I certainly believe that latent TB could reactivate due to a multitude of immunosuppressive drugs, including TNF inhibitors. Drugs such as cyclophosphamide, azathioprine, mycophenolate mofetil, and corticosteroids could pose a greater risk.