Serum GGalactomannan screening for the diagnosis of invasive pulmonary aspergillosis in children after haematopoietic stem cell transplantation and high-risk leukaemia

Ref ID: 18623

Author:

I. Zaidman (1), R. Gefen (1), Y. Shachor-Meyouhas (1), I. Avidor (2),
I. Kassis (1)

Author address:

(1)Meyer Children’s Hospital (Haifa, IL); (2)Rambam Medical
Centre (Haifa, IL)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Objectives: Invasive Fungal Infections (IFI) constitutes a substantial source of morbidity and mortality among immunocompromised patients. Morbidity and mortality among patients
following HSCT is high. Rapid diagnosis and early treatment
of IFI are crucial, yet, limited by other complications of HSCT
and the need for invasive procedures mainly to identify IPA.
Our study was designed to investigate the impact of
serial Serum Galactomannan Assay (GMA) on the diagnosis
of IPA.
Methods: Children with high risk leukemia or following HSCT
were included. Serum samples for GMA (Platela, Aspergillus
EIA, Biorad, France) were taken twice weekly from patients at
high risk for IFI over 10 months (February-November 2010).
Results over 0.5 were considered positive. Patients suspected
to have IA were stratifi ed as possible, probable and defi nite
according to recent consensus (Clinical Infectious Diseases
2008; 46:1813-21).
Results: 27 patients were included. Median age was 11( range
1-21 years). 306 samples were processed. Of 22 HSCT children 15 were after allogeneic and 7 patients after autologous
bone marrow transplantation. 5 patients had high risk leukemia. 20 patients had prolonged period of screening from 1 to 7
months. In 7 children only 1-3 samples were obtained.
GMA was negative in 14 patients; none was suspected to
have IA. 13 patients had 1-4 positive GMA. Four of these 13
children (30%) had criteria of possible IPA and due to positive
GMA results were upgraded to the category of probable IPA
and started early antifungal treatment. However in 9/13 (70 %)
of patients the test was considered false positive without any
sign of IA. In our group, 6 of 13 patients (60%) showed positive Galactomannan index during high dose chemotherapy or
irradiation as well as during infusion of stem cells; another 40%
had positive index during Piperacillin-tazobactam treatment,
engraftment period and other viral infection (EBV and HHV-6).
Conclusion: GMA may have an important role in the follow up
for high risk patients and support early evaluation and treatment for IA. Negative predictive value is high among children.
False positive rate is high. The cost benefi t of early detection
versus. over diagnosis and performing more specifi c tests in
children should be further evaluated.

Abstract Number: P802

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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