Clinical Utility of the Galactomannan Assay as a Screening Tool for Invasive Aspergillosis Following Allogeneic Hematopoietic Stem Cell Transplant

Abstract

Care Alliance. Clinical information was obtained from the institutional database. Multiple linear regression was used to analyze the patient and transplant characteristics that are associated with total costs. Results: Median age was 50 years (range 21 to 69 years), and 62% patients were male. Seventy eight percent transplants were for acute leukemia/MDS. Reasons for second transplant were graft failure (25%), relapse of original disease (65%) and other causes e.g. secondary MDS/aplasia (10%). 73% of relapsed patients were in remission at the time of the second transplant. Non-myeloablative conditioning was more common in the second allografts (75%) than in first allografts (30%) and a higher proportion of second allografts were from unrelated donors (76% vs. 43%). In the first 100 days, relapse occurred in 25% patients and 64% experienced $ grade II acute GVHD. Survival was 78% at 100 days and 49% at one year after transplant. Regimen related toxicity accounted for 75% of deaths within the first 100 days. The median total cost in 2010 dollars was $137,600 ($4,500 -$434,200) for the first 100 days, with approximately $135,600 (0 -$432,200) for inpatient and $4,100 (0 -$17,200) for outpatient costs. The median length of hospital stay was 22 days (range 0 to 77 days). Myeloablative conditioning, unrelated donors and pulmonary complications post-transplant were significant predictors of higher costs for the second transplants.