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.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)