Adherence to, and Outcomes of, a Galactomannan Screening Protocol in High-Risk Hematology Patients

Abstract

Background A twice-weekly galactomannan (gm) screening protocol was implemented in high-risk hematology

Cost-Effectiveness of Serum Galactomannan Surveillance during Mould-Active Antifungal Prophylaxis

“…Our analysis revealed that the use of empirical antifungal treatment was a key driver in the cost-effectiveness of GM surveillance. Clinical studies have shown benefits of routine GM surveillance in terms of reduced cost and the prescription of antifungal treatment, but not in mortality rates [8,10,12]. This was made possible through serial GM surveillance as a trigger to guide further investigation and initiation of antifungal treatment as opposed to empirical prescription applied in prolonged neutropenic fevers unresolved by board-spectrum antibiotics [13].…”

“…There was not any significant trend in survival benefits from the use of a biomarker diagnostic approach as with previous studies. Based on a cohort study of haematological patients receiving fluconazole prophylaxis, GM surveillance led to improved clinical success-defined as patients not using antifungal agents 6 weeks after the end of the episode or the day before subsequent cycles of chemotherapy [8]. The model did not include the cost of adverse events or management of the underlying malignancies because these costs were assumed to be similar in all treatment groups.…”

“…To overcome these challenges, diagnostic-driven strategies using serological biomarkers, in particular, the Aspergillus galactomannan (GM) antigen, have been developed to aid the timely diagnosis of IA and guide management decisions including the initiation of therapy [7]. Serial surveillance of serum GM has been a strategy to trigger antifungal treatment and has been shown to reduce the prescription of empiric antifungal therapy [8][9][10][11][12]. Maertens and colleagues assayed the GM antigen index daily in 88 high-risk haematological patients.…”

Six-year experience with GM test in hematological patients in a public Brazilian tertiary hospital

“…Delay in starting treatment is often associated with increased mortality. 5 , 6 , 7 , 8 These fungal infections present diagnostic challenges associated with traditional culture and histological examination methods. The diagnosis is based on the combination of the patient's risk factors, clinical symptoms and signs, culture, histopathological exams, and detection of antigenic components of the fungus, such as Galactomannan (GM).…”

“…GM testing is available in many hospitals, but there are still questions about the role it plays in decision-making related to antifungal treatment in high-risk IFI/IA patients. 6 , 12 , 13 , 14 …”