Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Abstract

Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non-BCT centers (7%; IQR 5–10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.

Invasive fungal disease in children with acute myeloid leukaemia: An Australian multicentre 10‐year review

“…The early onset of IFD observed in our study is in keeping with recent adult data demonstrating high prevalence of IFD early in AML therapy, consistent with the inherent immunodeficiency associated with the AML disease process 33 . A role for baseline computerised tomography (CT) imaging for early detection of IFD in adult patients with de novo AML has been proposed 33 ; however, early imaging is not considered standard practice at present at adult centres 34 . Our findings of high prevalence of IFD in the period immediately following AML diagnosis suggest a broad systems based approach is required to identify patients at highest risk of IFD, implement prophylaxis from the start of treatment and facilitate timely diagnostic testing to minimise time to initiation of appropriate antifungal therapy.…”

Role of pre‐transplant chest high‐resolution computed tomography and serum galactomannan index in predicting post‐transplant invasive pulmonary aspergillosis in allogeneic hematopoietic cell transplant recipients

“…The median IPA incidence rate did not differ between centers that did baseline CT (9%) and those which did not (7%). 16 The incidence of pre-HCT chest CT abnormalities is to the tune of 13.6%-55% 6-11 (Table 2). Our study had a 38% incidence.…”

Invasive Fungal Infections at Presentation of Untreated Hematologic Malignancies: Rare and Elusive

“…In a subgroup analysis of newly diagnosed HM (AML) patients, 10% (11 of 107) had IPA identified on baseline chest CT and positive Aspergillus galactomannan (GM) in bronchoalveolar lavage (BAL) fluid [ 11 , 12 ]. Most of these patients (8 of 11) were not neutropenic and (6 of 11) lacked symptoms [ 13 ]. Due to a lack of patient-level information, these 11 patients were not included in our review.…”

“…Due to a lack of patient-level information, these 11 patients were not included in our review. In a web-based survey study, authors found a 9% IPA rate detected by baseline chest CT in high-risk HM patients compared with a 7% median IPA rate detected in high-risk HM patients at centers that did not use baseline chest CT [ 13 ]. Data for rates of IPA on baseline CT for newly diagnosed AML were not available.…”