Blood Res.  2017 Dec;52(4):300-306. 10.5045/br.2017.52.4.300.

The limited role of serum galactomannan assay in screening for invasive pulmonary aspergillosis in allogeneic stem cell transplantation recipients on micafungin prophylaxis: a retrospective study

Affiliations
  • 1Department of Internal Medicine, Seoul National University, College of Medicine, Seoul, Korea. wbpark1@snu.ac.kr, ihkimmd@snu.ac.kr
  • 2Cancer Research Institute, Seoul National University, College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
We evaluated the outcomes of serum galactomannan (GM) assay for the screening of invasive pulmonary aspergillosis (IPA) in allogeneic hematopoietic stem cell transplantation (alloHSCT) recipients while on primary antifungal prophylaxis (PAP).
METHODS
This study included patients with hematologic disorders who underwent alloHSCT from January 2013 to November 2015. Patients received routine PAP with fluconazole before 2014 and micafungin after 2014; serum GM tests were performed and retrospectively analyzed. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of serum GM tests for detection of probable/proven IPA were evaluated. The serial change of serum GM levels was illustrated on a time series plot.
RESULTS
A total of 136 alloHSCT recipients at Seoul National University Hospital were included in the study. Fluconazole was administered in 72 patients for PAP, while micafungin was administered in the remaining 64 patients. The overall sensitivity, specificity, and NPV of serum GM assays were 95.8% (95% confidence interval [CI] 78.9-99.9%), 93.8% (95% CI 91.7-95.5%), and 99.8% (95% CI 99.1-100.0%), respectively. However, the PPV of GM tests was relatively low at 35.4% (95% CI 23.9-48.2%). The serial change in serum GM levels differed according to the antifungal agents used. With effective PAP using micafungin, serial serum GM levels showed zero order kinetics during the neutropenic period.
CONCLUSION
Although the serum GM assay is a sensitive and specific test for detecting IPA in alloHSCT recipients, its role for routine surveillance in an era of effective PAP with micafungin is limited.

Keyword

Hematology; Stem cell transplantation; Galactomannan; Invasive pulmonary aspergillosis; Antifungal prophylaxis

MeSH Terms

Antifungal Agents
Fluconazole
Hematology
Hematopoietic Stem Cell Transplantation
Humans
Invasive Pulmonary Aspergillosis*
Kinetics
Mass Screening*
Retrospective Studies*
Sensitivity and Specificity
Seoul
Stem Cell Transplantation*
Stem Cells*
Antifungal Agents
Fluconazole

Figure

  • Fig. 1 Classification of a total of 698 serum galactomannan tests. A total of 423 tests were performed using fluconazole as PAP, while micafungin was administered when the remaining 275 tests were performed. Each serum GM assays were further divided according to goal of the assay: routine surveillance and diagnostic workup for infection.

  • Fig. 2 Time series plots of serum galactomannan optical density (OD) index under (A) fluconazole prophylaxis and (B) micafungin prophylaxis.


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