359. Baseline Serum Aspergillus Galactomannan Index Among Aspergillus Species in Hematologic Malignancies Patients With Invasive Pulmonary Aspergillosis

Abstract

BackgroundMost of the information regarding serum Aspergillus galactomannan (sAGM) index in patients with invasive pulmonary aspergillosis (IPA) and hematological malignancies (HM) is derived by infections caused by Aspergillus fumigatus, the predominant Aspergillus species causing IPA. It is unclear if differences exist in sAGM in IPA caused by non-fumigatus Aspergillus species.MethodsWe analyzed all consecutive patients with proven or probable culture-documented IPA (EORTC/MSG criteria) at MD Anderson Cancer Center (2006–2017) who had an sAGM obtain within a week of IPA diagnosis (day −6 to day 0 of fungal culture). The sAGM result was categorized as either undetectable (GM = 0), negative (0.0 > GM < 0.5) or ≥ than a 0.5 index value. Baseline demographic characteristics and 42-day crude mortality after the diagnosis of IPA were collected.ResultsWe identified 72 (proven in 4, probable in 68) patients with culture-documented IPA. Most common HM was AML in 34 (47.2%) patients and CLL in 15 (20.8%) patients. Most (47/72, 65, 2%) patients developed IPA despite mold-active antifungals. Forty-three (60%) patients had A. fumigatus, 19 (26%) A. terreus, and 10 (14%) A. flavus. Mortality at 42 day was 22.2% (16/72) patients. Serum AGM at the baseline was undetectable in only one (2%) Aspergillus fumigatus IPA. Serum AGM positivity was seen in 28 (65%), 10 (53%), and five (50%), among the Aspergillus fumigatus, terreus, and flavus species, respectively (P = 0.52), with a median sAGM level of 1.32 (0.50–9.36), 0.87 (0.50–9.70), and 1.11 (0.57–8.58), respectively, P = 0.99. There were not significant differences in baseline neutropenia, extent of lung involvement by chest CT, prior mold-active antifungal use, prior SCT as well as 42-day mortality among patients with IPA caused by each of the three Aspergillus species.ConclusionIn the setting of common prior mold-active antifungal use, we found no apparent differences in sAGM among Aspergillus species causing IPA in HM patients. Mortality was comparable and worse in patients with high baseline sAGM levels.Disclosures D. P. Kontoyiannis, Merck: Consultant, Research support and Speaker honorarium. Pfizer: Consultant, Research support. Astellas: Consultant, Research support and Speaker honorarium. Gilead: Speaker’s Bureau, Speaker honorarium. F2G Inc.: Speaker’s Bureau, Speaker honorarium. Cidara Inc.: Speaker’s Bureau, Speaker honorarium. Jazz Pharmaceuticals: Speaker’s Bureau, Speaker honorarium.