Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients - 05/01/22
, Tatsuo Oyake c, Hiroki Yamaguchi d, Shin-ichiro Fujiwara b, Akinao Okamoto e, Hiroyuki Fujita f, Yoshio Saburi g, Kazuo Tamura hfor the
Japan Febrile Neutropenia Study Group
Highlights |
• | A post-hoc analysis of a prospective randomized controlled trial (n = 413) was performed. |
• | Afebrile screening of fungal biomarkers in low-risk treatment is not useful. |
• | Fungal biomarker monitoring is useful in high-risk treatment. |
• | Chest CT scans in cases of persistent fever, recurrent fever and positive biomarkers are essential. |
• | Chest CT should be reevaluated in persistent fever lasting for 7 days or longer. |
Summary |
Objectives |
By using data from the CEDMIC trial (n = 413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients.
Methods |
IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly.
Results |
The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4–6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4–6 days.
Conclusions |
Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.
Le texte complet de cet article est disponible en PDF.Keywords : Invasive fungal disease, Aspergillus galactomannan, (1→3)-β-D-glucan, Computed tomography, Positive predictive value
Plan
Vol 84 - N° 1
P. 80-86 - janvier 2022 Retour au numéro
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