Role of bi‐weekly serum galactomannan screening for the diagnosis of invasive aspergillosis in haematological cancer patients

Abstract

Invasive aspergillosis (IA) is a life-threatening infection affecting haematological cancer patients with chemotherapy-induced neutropenia. The diagnosis of IA often relies on the detection of galactomannan (GM) in serum or bronchoalveolar lavage fluid (BAL). Bi-weekly serum GM screening has been proposed for a pre-emptive therapeutic approach of IA in patients not receiving mold-active prophylaxis. We have analysed all IA cases among patients with haematological malignancies and prolonged chemotherapy-induced neutropenia (>14 days) in our institution over a 10-year period (2007-2017). Serum GM was measured twice weekly and mold-active prophylaxis was not routinely administered. Thirty IA cases were observed and a positive serum GM was the first indicator of IA in 10 (33%) of them, which represents a need of approximately 500 GM tests for the detection of a single IA case. In the other 20 (67%) cases, suggestive chest CT lesion was the first sign of IA and bronchoscopy was required in 15 (50%) cases with negative serum GM for establishing the diagnosis of probable/proven IA. A positive serum GM was associated with a worse prognosis (57% 12-week survival vs 100% among serum GM-negative patients, P = .006), irrespective of the timing of GM positivity compared to CT. We concluded that bi-weekly serum GM screening demonstrated limited benefit in this population.

Galactomannan antigen detection as a screening tool for early diagnosis of invasive aspergillosis: Experience of Turkish adult patients

“…IA was diagnosed in 30 out of 268 patients, and a positive serum GM was the first indicator of IA in 10 (33%) patients. A total of 500 GM antigen tests were required to diagnose one IA case based on GM antigen screening, costing $15,000 in this setting (23). Cost and logistics are other important issues to use GM antigen screening as an effective tool for the early diagnosis of IA.…”

The pathogenicity ofAspergillus fumigatus, drug resistance, and nanoparticle delivery

“…A new commercial A. fumigatus IgM antibody assay (Dynamiker) for the diagnosis of IA did not offer any promising results over current diagnostic methods (Yao et al 2017). Even though serum galactomannan screening is the most efficient microbiology marker of IA, a preemptive bi-weekly monitoring in cancer patients did not result in any significant benefits (Couchepin et al 2018).…”

Pulmonary aspergillosis: diagnosis and treatment

“…In haematologic cancer patients, the yield of direct exam and cultures for Aspergillus detection is notoriously low (around 20% and 50%, respectively) [24][25][26]. Nonculture methods, in particular GM or PCR in serum or BAL, are the cornerstone of IPA diagnosis and are in more than 50% of cases the only mycological markers of IPA [8,12,25,27].…”

“…An algorithm for the diagnostic work-up of IPA in high-risk haematologic cancer patients is presented in figure 2 . Patients with a positive serum GM have a worse prognosis, because of more advanced disease, which suggests that clinicians should have low threshold to perform chest CT for early detection of IPA [ 24 ].…”