Diagnostic and treatment strategy of invasive aspergillosis based on galactomannan screenning – prospective analysis of 268 patients after hematopoietic stem cell transplantation

Background: The outcome of invasive aspergillosis (IA) after hematopoietic
stem cell transplantation (HSCT) depends on early diagnosis and treatment initiation. The aim of the study was to assess the efficacy of Aspergillus' antigen galactomannan-based diagnostic and treatment strategy in HSCT recipients.
Material/Methods: A total of 268 patients (median age 42; range 18-68) undergoing autologous (181) or allogeneic (87) HSCT were prospectively analyzed. All patients were monitored with twice-weekly serum galactomannan (GM) test. High resolution thoracic tomography (HRCT) and bronchoscopy with lavage were performed in case of positive GM test, persistent fever or pulmonary infiltrates. The diagnosis of IA was made according to EORTC/MSG criteria.
Results: Among patients after allogeneic HSCT documented IA was diagnosed in 17 (19.5%) patients (4 proven, 13 probable) and possible in 13 (15%). Median time to diagnosis of documented IA was 69 (range; 10-515) days. After autologous HSCT documented IA was established in 12 (6.5%) patients (5 proven, 7 probable) and possible in 48 (25.5%). Median time to diagnosis of documented IA in this group was 15 (range; 8-38) days. All patients with documented IA were treated with voriconazole. In 12 weeks follow up 11 (38%) patients died because of IA. In case of possible IA, amphotericin B or caspofungin were used. In this group 4 patients died due to confirmed bacterial infection. In summary: IA represents serious infectious complication both after allogeneic and autologous HSCT. Strategy based on GM screening, HRCT and bronchoscopy allows early diagnosis of IA and early pre-emptive or targeted therapy.

Keywords: fungal infections, Stem Cell Transplantation