Galactomannan-driven diagnostic strategy of invasive aspergillosis in patients with graft-versus-host disease after allogeneic haematopoietic stem cell transplantation – good correlation between serum and bronchoalveolar lavage galactomannan testi

Ref ID: 18575

Author:

L. Gil (1), A. Mol (1), A. Czyz (1), A. Lojko-Dankowska (1),
A. Nowicki (1), M. Matuszak (1), J. Styczynski (2),
M. Komarnicki (1)

Author address:

(1)University of Medical Sciences (Poznan, PL); (2)Collegium
Medicum, Nicolaus Copernicus University (Bydgoszcz, PL)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Invasive aspergillosis (IA) is a serious complication in pts with
graft versus host disease (GVHD) after allogeneic SCT and the
outcome of this condition depends on early diagnosis and treatment initiation. Current diagnostic strategy is however tailored
mainly for neutropenic patients. Aim of the study was to asses
the effi cacy of galactomannan (GM)-based diagnostic strategy in SCT recipients after granulocyte recovery and treated
because of GVHD.
Material and methods: 81 pts (median age 34; range 15-67)
undergoing alloSCT because of hematologic diseases (AML/
MDS 41, CML/MPD 14, NHL/HD 13, ALL 9, SAA 4) were prospectively analyzed. Pts were transplanted with PB (55) or
BM (26) stem cells from related (59) or unrelated donor (22).
After hematologic recovery all pts were monitored with onceweekly serum GM test up to 100 days or longer in case of
GVHD. High resolution chest computed tomography (HRCT)
and bronchoscopy with lavage (BAL) were performed in case of
positive serum GM test ( ≥ 0.5 in two consecutive samples), persistent fever or pulmonary infi ltrates. GM test was additionally
performed in BAL with a result ≥ 0.5 regarded as positive. The
diagnosis of IA was made according to EORTC/MSG criteria.
Results: Documented IA was diagnosed in 16 (19.8%) patients
(2 proven, 14 probable) and possible in 13 (16%). Median
time to diagnosis of documented IA was 76d (r; 23-515). All
but one cases of IA were diagnosed in patients with GVHD S209
grade 2-4: 15/37 (40.5%) vs. 1/44 (2.3%), P = 0.00005,
OR = 29. GM serum test was positive in all 16 pts and correlated with GM in BAL detected in 15 pts (r = 0.8, P < 0.001). HRCT revealed typical changes in 10 pts; endobronchial biopsy confi rmed IA (A. fumigatus) in 2 pts. The cumulative risk of development IA was 0.25 ± 0.05 at 1 yr. All patients with documented IA were treated with voriconazole. In 12 weeks follow-up 8 (50%) patients died because of IA. Probability of 1 yr survival after IA was 0.36 ± 0.12, while among non-IA patients 0.69 ± 0.06 (P = 0.001). Overall risk of death due to IA was 0.124 ± 0.042 at 1 yr. The mean survival after IA occurrence was 407 d (95%CI = 193-621 d). Conclusions: In alloSCT setting, IA frequently occurs after neutrophil recovery in patients treated because of GVHD. Strategy based on GM screening, HRCT and bronchoscopy allows early diagnosis of IA and early preemptive or targeted therapy in this group of pts, leading to survival in to 50% of patients with IA. GM in BAL correlates with GM serum testing.

Abstract Number: P720

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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