The Diagnosis of Invasive Aspergillosis Using Screening Detection of Aspergillus Galactomannan After Hematopoietic Stem Cell Transplant.

Abstract

Early detection of invasive aspergillosis (IA) in hematopoietic stem cell transplant (HSCT) patients is crucial and requires early initiation of antifungal therapy. One method that has been suggested as a means for early detection of aspergillosis is serum Aspergillus galactomannan (GM) detection. However, there have been few formal evaluations of the performance of GM screening for early detection of aspergillosis. We performed a retrospective cohort study at the Fred Hutch Cancer Center (FHCC) that revealed a false positive serum GM result in 105/169 (62.1%) HSCT patients who screened positive between 2006 - 2010. Among all positive GM results, logistic regression analysis showed that the presence of acute gut graft vs. host disease (AGVHD) at the time of screening was not associated with a higher likelihood of a false positive result (odds ratio 1.29; 95% confidence interval 0.69, 2.45; p=0.4) compared to patients without AGVHD. These findings support the FHCC's decision in 2011 that led to the cessation of routine GM screening for invasive aspergillosis. Additionally, the results do not indicate that the screening performs better in patients without AGVHD. These data highlight the need for more specific diagnostic approaches for the early detection of IA in this vulnerable patient population.