GM EIA is approved for early diagnosis of invasive aspergillosis in high risk patients. We assessed the utility of serial GM EIA for diagnosis and guidance for antifungal therapy in a cohort of pediatric BMT patients. METHODS: From July 2006 through June 2008, 65 pediatric patientss received allogeneic BMT at MSKCC. Standard antifungal prophylaxis consisted of fluconazole. Pts with history of pre-transplant IFI, on corticosteroids, GVHD or prolonged neutropenia received mold- active prophylaxis (MAP) with voriconazole or micafungin. Pts were monitored prospectively hy serial GM. Work-up for invasive fungal infections (IFl) and choice of antifungal therapy was at the discretion of the physician. EORTC/MSG criteria were used for IFI diagnosis. The impact of GM result on clinical management was assessed by an independent reviewer. RESULTS: 63 patients had 1,887 GM (median 27, range 8-54). Mean age 8.1 years; 69% hematologic malignancy; 58% peripheral stem cells; 69% unrelated donor; 63 % T-cell depleted, 17% pts had presumed aspergillosis pre-transplant Nine (14%) pts developed acute GVHD (grade 2-4). Thirty-seven (57%) and 26(40%) pts were on MAP at I and 6 months post transplant. Six (9.2%) pts were treated for 1FT; (Possible 3, probable based on GM 2, definite 1), All patients treated for IF had been on MAP. Overall GM monitoring lead to change in management in 1 patient. The number of GM needed to diagnose 1 case of IA was >600 at a cost of 160,000$. CONCLUSIONS: 1) In our pediatric cohort GM did not have an impact on earlier diagnosis or management of IFI. 2) The financial burden of monitoring fungal burden was 510,000 US dollars; More than 600 GM were performed to diagnose a single case of IA by GM. 2) The utility of GM needs to be reconsidered in clinical settings with high use of mold active therapy.
Full conference title:
17th International Society for Human and Animal Mycology
- ISHAM 17th (2009)