Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing

Garnica, Márcia; Sinhorelo, Aline; Madeira, Laura Bernardo; Portugal, Rodrigo de Souza; Nucci, Márcio

doi:10.1016/j.bjid.2016.04.007

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…They have reported that the c-D-index cutoff value of ≥5,500 is a sensitive predictor of IFI [ 7 ]. This original report was followed by further studies in this area [ 20 , 21 ]. In both reports, a 9–10-day period of prolonged neutropenia was associated with a high risk of IFI.…”

Section: Discussionmentioning

confidence: 99%

“…Some advances have been made in the sensitive and accurate diagnosis of infections [ 23 ]. The development of these medical techniques and procedures will establish an easier approach to empirical and presumptive diagnosis-driven antimicrobial therapy [ 20 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In these situations, the D-index is an alternative approach to enable early treatment of underdiagnosed infection before the infection is proven or the patient becomes critically ill. Evidence is growing that the D-index is a useful and convenient tool for predicting IFIs [ 20 ]. Pediatric analysis [ 16 ] and regimen-related analysis [ 29 ] are also available from clinical trials.…”

Section: Discussionmentioning

confidence: 99%

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c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

et al. 2022

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Acute myeloid leukemia (AML) often requires long-term intensive chemotherapy for its cure. During chemotherapy, the patient always experiences neutropenia with readings below 500 cells/μL; this is often accompanied by pyrexia with a temperature of more than 101°F. This combination of neutropenia and fever is called febrile neutropenia (FN). A tool to sum up the daily severity of a patient’s neutropenia, the “D-index,” has been validated in some specific clinical settings. In this study, we examined whether the D-index is a useful predictor of the onset of FN. We recruited consecutive patients treated with induction and consolidation chemotherapy for newly diagnosed AML. We gathered all the FN events and their clinical background data retrospectively. Patients’ background, such as pre-existing conditions and disease status before the treatment, were analyzed using multivariate methods. All FN events during chemotherapy were evaluated for infection focus and causative organism. A total cohort of 51 cases (25 women, 26 men; median age 51 years, range 18–74) was analyzed. They displayed 171 neutropenic events (115 FN and 56 afebrile episodes) during chemotherapy, and complete neutropenic events were used in this study. Sensitivity and specificity analysis showed that the most useful cutoff value to predict the onset of FN was a cumulative D-index at day 11 (c-D11-index) of 718. The cumulative incidence of FN during chemotherapy was significantly higher in the group with c-D11-index ≥710 (80%) than in the group with c-D11-index <710 (39%) (P < 0.0001). Through multivariate analysis, the presence of diabetes mellitus and the c-D11-index were extracted as contributing factors to the onset of FN (P = 0.0087 and 0.0002, respectively). In conclusion, we can predict that AML patients receiving chemotherapy will experience the complication of FN when the c-D-index at day 11 is >710, with an odds ratio of 2.1.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

et al. 2022

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“…Because of the inappropriate conditions for AML treatment, higher incidence of bacterial and fungal infections is frequently reported. These inappropriate conditions could be associated to the tropical climate, lack of enough beds in rooms with positive-pressure laminar flow, and difficulties in the access to the workup for invasive mold disease [48]. Neutropenic fever (NF) is a very common complication during induction therapy and even after consolidation.…”

Section: Barriers To Access To Therapy In Developing Countriesmentioning

confidence: 99%

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

Meillón-Garcı́a

Demichelis‐Gómez

2020

Curr Oncol Rep

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Purpose of Review Acute myeloid leukemia (AML) is a costly disease, and its impact is greater in developing countries (DC). We will review the current concept of what are DC, compare the differences in the epidemiology and economic burden of this disease between developed and DC, and finally, analyze the barriers and possible solutions that DC should implement to achieve better results. Recent Findings DC is a frequently misunderstood name. The way we use to measure human development is changing, and multidimension metrics better define what are DC. With this in mind, we show the differences in the AML epidemiology and the impact of economic burden in DC. We analyze the barriers to access therapy from a clinician point of view, to show that most DC shared similar challenges but with a diverse healthcare structure. Finally, we provide several possible solutions for a more integrated and timely treatment that allows better results not only in terms of survival but with a better quality of life. Summary The economic burden of AML treatment in DC is high, and the results are poor. It is crucial to face this challenge and propose new treatment approaches to achieve better results.

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“…In a follow-up prospective study among 29 patients with acute leukemia undergoing remission-chemotherapy, the investigators utilized the D-index and galactomannan screening to stratify patients as low (<3000), intermediate (3000–5800), and high risk (>5800) for IMD [87]. Although a positive galactomannan result or clinical symptoms triggered a diagnostic workup in similar numbers of patients irrespective of the D-index risk stratification (58–73%), patients in the low risk D-index group were less likely to receive antifungal therapy (17% vs. 54–67%) and no cases of IMD were diagnosed in the low risk group versus 67% and 45% of the patients classified as high and moderate risk, respectively.…”

Section: Risk Models For Invasive Mold Diseasementioning

confidence: 99%

Development and Applications of Prognostic Risk Models in the Management of Invasive Mold Disease

Stanzani

Lewis

2018

JoF

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Prognostic models or risk scores are frequently used to aid individualize risk assessment for diseases with multiple, complex risk factors and diagnostic challenges. However, relatively little attention has been paid to the development of risk models for invasive mold diseases encountered in patients with hematological malignancies, despite a large body of epidemiological research. Herein we review recent studies that have described the development of prognostic models for mold disease, summarize our experience with the development and clinical use of one such model (BOSCORE), and discuss the potential impact of prognostic risk scores for individualized therapy, diagnostic and antifungal stewardship, as well as clinical and epidemiological research.

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Diagnostic-driven antifungal therapy in neutropenic patients using the D-index and serial serum galactomannan testing

Abstract: A risk stratification using D-index was a useful instrument to be incorporated in invasive mold disease diagnostic approach, resulting in a more comprehensive antifungal treatment strategy, and to guide an earlier start of treatment in afebrile patients under very high risk.

Cited by 8 publications

References 26 publications

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

c-D-index at day 11 can predict febrile neutropenia during chemotherapy in acute myeloid leukemia

Access to Therapy for Acute Myeloid Leukemia in the Developing World: Barriers and Solutions

Development and Applications of Prognostic Risk Models in the Management of Invasive Mold Disease

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