A comprehensive diagnostic approach improves the diagnostic accuracy of invasive fungal disease in adult haemato-oncology patients undergoing HSCT or high-dose chemotherapy- results of the King’s Prospective Aspergillosis Study (NCT00816088)

Ref ID: 18549

Author:

M.M. Ceesay (1), L. Berry (2), S.R. Desai (2), J. Cleverly (3),
C.C. Kibbler (3), J. Wade (2), M. Smith (2), G.J. Mufti (2),
A. Pagliuca (2)

Author address:

(1)Kings College Hospital and South London Healthcare NHS
Trust (London, UK); (2)Kings College Hospital (London, UK);
(3)Royal Free Hampstead NHS Trust (London, UK)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Invasive fungal disease (IFD) is a diffi cult diagnosis. For clinical trials the revised EORTC/MSG criteria is useful but there
is little data on its usefulness in clinical practice. The aim of
this study was to evaluate the ’real world’ incidence of IFD in
patients undergoing HSCT or high dose chemotherapy using
EORTC/MSG diagnostic tools. Patients were recruited prospectively between December 2008 and May 2010 and followed for at least 4 months after chemotherapy/HSCT. During
admission twice weekly galactomannan (GM) and beta-Dglucan (BDG) was performed and neutropenic sepsis unresponsive to antimicrobials triggered diagnostic work-up with
computed tomography (CT). The CT scans were reviewed
independently by two chest radiologists and all cases were
independently verifi ed before assigning EORTC status. All
patients had antifungal prophylaxis during the period of neutropenia or continuing immunosuppression. Two hundred and
three patients were recruited [123 male, 80 female; median
age 54y (range 19-73); median follow-up 194 days (range
12-647)]. The underlying diagnoses were: acute leukaemia
62 (myeloid 55, lymphoid 7), chronic leukaemia 4 (myeloid 3,
lymphoid 1), MDS/MPD 33, aplastic anaemia 19, lymphoma
37 (non-Hodgkin’s 29, Hodgkin’s 8), multiple myeloma 45,
and others 3. Main treatments received were: HSCT 165
(81%) [allogeneic 94, cord 5, autologous 66], chemotherapy
28 (14%), and immunosuppressive therapy (IST) 8 (4%). The
total number of treatments received during study period was
263 (allografts 106, chemotherapy 77, autografts 67, IST
13). The patients were heavily pre-treated; 85% had at least
one prior therapy with a median of 5 cycles of therapy/patient (range 1-17). There were 44 (21%) cases of IFD in 40
patients: proven 14 (Aspergillus fumigatus 2, Fusarium spp 1,
mould IFD 5, non-candida albican spp 5, Pneumocystis jirovecii 1), probable 30. Invasive pulmonary aspergillosis was
the commonest presentation (82%). The treatment-specifi c
incidences were 17% (18/104), 12% (21/177), 7% (2/29), and
4% (3/72) for allogeneic HSCT, chemotherapy, immunosuppressive therapy, and autologous HSCT respectively. Median time
to diagnosis of IFD was 42 days (range 3 to 524) from index
chemotherapy or HSCT. Using galactomannan (GM) or betaD-glucan (BDG) alone (plus host and CT scan evidence) the
apparent incidence of IFD would be 13% and 17% respectively.
Our fi ndings demonstrate that a multi-diagnostic approach is
necessary in order to improve diagnostic accuracy of IFD.

Abstract Number: P465

Conference Year: 2012

Link to conference website: NULL

New link: NULL


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