Galactomannan and Computed Tomography-Based Preemptive Antifungal Therapy in Neutropenic Patients at High Risk for Invasive Fungal Infection: A Prospective Feasibility Study

Maertens, Johan; Theunissen, Koen; Verhoef, Gregor; Verschakelen, Johny; Lagrou, Katrien; Verbeken, Eric; Wilmer, Alexander; Verhaegen, Jan; Boogaerts, Marc; Eldere, Johan Van

doi:10.1086/496927

Cited by 544 publications

(431 citation statements)

References 42 publications

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“…These patients are admitted to the hospital during their period at high risk, and GM monitoring is recommended every 3-4 days. 11,12 A diagnosis-driven strategy that incorporates prospective GM monitoring should be combined with highresolution computed tomography imaging, and appropriate clinical and microbiological evaluation. 11,12 A single positive GM index of X0.7 or two consecutive samples of X0.5 should prompt a diagnostic work-up.…”

Section: Galactomannan (Gm)mentioning

confidence: 99%

“…11,12 A diagnosis-driven strategy that incorporates prospective GM monitoring should be combined with highresolution computed tomography imaging, and appropriate clinical and microbiological evaluation. 11,12 A single positive GM index of X0.7 or two consecutive samples of X0.5 should prompt a diagnostic work-up. 13 GM monitoring can be continued after antifungal therapy has been initiated.…”

Section: Galactomannan (Gm)mentioning

confidence: 99%

See 1 more Smart Citation

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

Marchetti

Lamoth

Mikulska

et al. 2011

Bone Marrow Transplant

245

178

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Section: Galactomannan (Gm)mentioning

confidence: 99%

Section: Galactomannan (Gm)mentioning

confidence: 99%

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

Marchetti

Lamoth

Mikulska

et al. 2011

Bone Marrow Transplant

245

178

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“…This strategy has been evaluated in patients with hematologic malignancies undergoing intensive chemotherapy, but not in allogeneic HSCT recipients. A pilot trial showed a substantial decrease in the use of antifungal drugs compared with the empiric strategy [18]. More recently, a randomized, prospective trial comparing pre-emptive and empiric strategies, mostly in patients with acute leukemia and neutropenia, showed that the former strategy led to increased diagnosis of IFI, no increased mortality, and decreased antifungal drug cost [19].…”

Section: Pre-emptive Therapymentioning

confidence: 99%

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Chandrasekar

Ramesh

2009

Expert Review of Anti-infective Therapy

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“…26 Only patients with ≥ 2 positive serum galactomannan assays or CT and or bronchoscopic evidence for mould infection received antifungal therapy. A total of 41 of 117 febrile neutropenic episodes (35%) had persistent neutropenic fever; however, only 9 patients (22% of the 41 persistent neutropenic fevers; 8% of the original febrile neutropenic episodes) satisfied the pre-defined criteria for antifungal therapy-a 78% relative risk reduction in antifungal therapy use.…”

Section: Pre-emptive Antifungal Therapymentioning

confidence: 99%

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

Bow¹

2006

Hematology

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Improvements in anticancer treatments, the ability to modify myelosuppression profiles, greater duration and intensity of immunosuppression, and the variety of available antimicrobial therapies have influenced the spectrum of pathogens associated with invasive fungal infection complicating treatment of hematological malignancies and hematopoietic stem cell transplantation. The approaches to the management of these infections encompass strategies of prevention for all those at risk, pre-emptive therapy based upon surrogates of infection before the onset of clinical disease, empirical therapy for patients with clinical evidence of early disease, and directed or targeted therapy for infected patients with established disease. Chemoprophylaxis is effective if applied to the highest risk patients over the duration of the risk. Pre-emptive strategies, while promising, have yet to be validated and linked to reliably predictive nonmicrobiological diagnostic techniques. Empirical antifungal therapy, as it is currently applied, now seems questionable. Patients with probable or proven invasive fungal infection still have suboptimal outcomes despite the availability of promising anti-fungal agents. Strategies examining the concept of dose-intensity and combination regimens require careful study and cannot yet be regarded as an acceptable standard of practice. Changing Epidemiology of Invasive Fungal Infection in Hematological Malignancies and Stem Cell TransplantsInterest in the field of medical mycology has expanded considerably as the numbers of immuno-and myelo-suppressed patients susceptible to opportunistic invasive fungal infections (IFI) increase. While the majority (95-97%) of invasive yeast infections are due to five species, predominantly Candida albicans, followed by C. tropicalis, C. glabrata, C. parapsilosis, and C. krusei, emerging importance of infections due to non-albicans Candida spp. including C. glabrata, C. parapsilosis, and C. krusei in high-risk cancer patients is noteworthy. 1 The remaining 3% to 5% of pathogens include other non-albicans Candida spp.. and non-Candida yeasts such as Trichosporon spp., Cryptococcus spp., Blastoschizomyces spp., and Malassezia spp.. 2,3 The risks for IFI among hematopoietic stem cell transplants (HSCT) increases as the disparity of the donor:recipient pair (autologous HSCT, 0.6%; matched related donor HSCT, 3.7%; mismatched related or unrelated donor HSCT, 5.9%, P < 0.0001). 4 The changing character of the HSCT populations together with effective antiCandida agents contribute to a changing spectrum of opportunistic mycoses. In a comparison of transplant patients with IFI to a more general population of patients at risk, the proportion of Candida infections decreased by approximately 45% (77% to 42%); however, that due to Aspergillus spp. has more than doubled (13% to 29%) and that due to other environmental moulds including Fusarium spp., Scedosporium spp., the zygomycetes, and the less com-

show abstract

Galactomannan and Computed Tomography-Based Preemptive Antifungal Therapy in Neutropenic Patients at High Risk for Invasive Fungal Infection: A Prospective Feasibility Study

Abstract: Preemptive therapy based on enzyme immunoassay and HRCT reduced the exposure to expensive and potentially toxic drugs and offered effective antifungal control, but it failed to detect non-Aspergillus IFI.

Cited by 544 publications

References 42 publications

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

ECIL recommendations for the use of biological markers for the diagnosis of invasive fungal diseases in leukemic patients and hematopoietic SCT recipients

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Of Yeasts and Hyphae: A Hematologist’s Approach to Antifungal Therapy

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