Galactomannan, a Surrogate Marker for Outcome in Invasive Aspergillosis: Finally Coming of Age

Abstract

Detection of galactomannan has become widely available for diagnosing invasive aspergillosis. The test characteristics, using the Platelia™ enzyme-immunoassay, have been well described. This assay could potentially also be useful for the early evaluation of the efficacy of antifungal therapy and for predicting the outcome in terms of response and survival. In this systematic review, we assessed the available evidence for the use of serum galactomannan at baseline as a prognostic marker, and the predictive value of serum galactomannan kinetics after initiation of antifungal therapy. Overall, serum galactomannan at baseline and galactomannan kinetics appear to be good predictors of therapy response and survival. However, breakpoints for predicting therapy failure and validation in different patient populations are still lacking.

Diagnosing Invasive Pulmonary Aspergillosis in Hematology Patients: a Retrospective Multicenter Evaluation of a Novel Lateral Flow Device

“…The quantitative and qualitative results of the LFD on BALf were not predictive of outcome in multivariate Cox regression. This is not unexpected, as similar results were seen with GM testing on BALf (18). This is likely the result of differences in BALf sampling techniques, which are not standardized between physicians and can even differ between procedures by the same physician.…”

The early diagnostic value of serum galactomannan antigen test combined with chest computed tomography for invasive pulmonary aspergillosis in pediatric patients after hematopoietic stem cell transplantation

“…11 In pediatric recipients with IPA, GM is measurable in peripheral blood. 15,16 In addition, Aspergillus GM which released into the blood circulation did not persist but will be cleared quickly. In previous studies, the patients who accepted HSCT, the sensitivity, and specificity of serum GM testing were 68% and 77%.…”

“…Firstly, the effective antifungal therapy has been shown to reduce GM levels, which lead to false-negative. 15,16 In addition, Aspergillus GM which released into the blood circulation did not persist but will be cleared quickly. Lastly, the patients were not seriously ill. Based on these data, prospective monitoring and serial screening of GM twice weekly in children after HSCT should be considered for early diagnosis of IPA.…”

Diagnosis of invasive fungal diseases in haematology and oncology: 2018 update of the recommendations of the infectious diseases working party of the German society for hematology and medical oncology (AGIHO)

“…The current cut‐off optical density index for positivity is 0.5 in serum and 0.5‐1.0 for BAL . The GM assay may actually be positive prior to clinical suspicion of an infection and may also be useful in monitoring the therapeutic response [A].…”

“…81 The current cut-off optical density index for positivity is 0.5 in serum and 0.5-1.0 for BAL. 80,82,83 The GM assay may actually . 75,90 Either daily or twice weekly GM screening, or a intensive work-up with GM for 3 days after 96 hours persisting fever together with clinical and radiological examinations has been found effective.…”