Invasive pulmonary aspergillosis treatment duration in haematology patients in Europe: An EFISG, IDWP‐EBMT, EORTC‐IDG and SEIFEM survey

Abstract

Summary Invasive pulmonary aspergillosis (IPA) optimal duration of antifungal treatment is not known. In a joint effort, four international scientific societies/groups performed a survey to capture current practices in European haematology centres regarding management of IPA. We conducted a cross‐sectional internet‐based questionnaire survey in 2017 to assess practices in sixteen European countries concerning IPA management in haematology patients including tools to evaluate treatment response, duration and discontinuation. The following four groups/societies were involved in the project: European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG), Infectious Diseases Working Party‐European Society for Blood and Bone Marrow Transplantation (IDWP‐EBMT), European Organisation for Research and Treatment‐Infectious Disease group (EORTC‐IDG) and Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM). A total of 112 physicians from 14/16 countries answered the survey. Galactomannan antigen was available in serum and bronchoalveolar lavage in most centres (106/112 [95%] and 97/112 [87%], respectively), quantitative Aspergillus PCR in 27/112 (24%) centres, β‐D‐glucan in 24/112 (21%) and positron emission tomography in 50/112 (45%). Treatment duration differed between haematological malignancies, with a median duration of 6 weeks [IQR 3‐12] for patients with AML, 11 [4‐12] for patients with allogenic stem cell transplantation and GvHD and 6 [3‐12] for patients with lymphoproliferative disease. Treatment duration significantly differed according to country. Essential IPA biomarkers are not available in all European countries, and treatment duration is highly variable according to country. It will be important to provide guidelines to help with IPA treatment cessation with algorithms according to biomarker availability.

Physicians' knowledge of invasive fungal disease in China

“…The physicians from the various departments also had different perspectives on the treatment course for IA, which is supported by a research in Europe. 14 The present study also found that a large minority of Chinese physicians was not aware of the recommended criteria for discontinuing IC therapy. Indeed, poor compliance with IC treatment guidelines in clinical practice has been reported in Europe 28 ; further research is merited to establish whether similar issues exist in China.…”

“…The guidelines for the diagnosis and treatment of IFD are constantly updated, resulting in changes in diagnosis and treatment patterns. Previous studies have explored the management of IFD by physicians in different regions of the world, [12][13][14]…”

Choice and duration of antifungal prophylaxis and treatment in high-risk haematology patients

“…type of mould infection, extent of infection) and response to therapy [73]. A recent European survey has illustrated that practice varies greatly for invasive aspergillosis [74]. Almost all centres rely on computed tomography (CT)-scan to guide duration of therapy [74].…”

“…A recent European survey has illustrated that practice varies greatly for invasive aspergillosis [74]. Almost all centres rely on computed tomography (CT)-scan to guide duration of therapy [74]. Other tools, which are sometimes used in this indication are FDG-PET/CT (given its potential to differentiate active infection from nonactive lesions [75]) and biomarkers (commonly, serum galactomannan [74,76]).…”

Beta-D-Glucan in Patients with Haematological Malignancies

“…However, the availability of BDG is much more limited than that of GM, as shown in a recent survey on the treatment of IA in haematology patents in Europe [3]. While GM was available in serum and bronchoalveolar lavage in most of the 112 included centres (95% and 87%, respectively), BDG was available only in 21%.…”