Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients

Published:October 25, 2021DOI:https://doi.org/10.1016/j.jinf.2021.10.018

      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.

      Keywords

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