A Prospective Multicenter Cohort Surveillance Study of Invasive Aspergillosis in Patients with Hematologic Malignancies in Greece: Impact of the Revised EORTC/MSGERC 2020 Criteria.

Konstantinos Korantanis,Christoforos Roumpakis,Maria Pagoni,Helen Sambatakou,Panagiotis Tsirigotis,Stamatis Karakatsanis,Maria Siopi,Nikolaos V. Sipsas,Joseph Meletiadis

doi:10.3390/jof7010027

Abstract

Data concerning the incidence of invasive aspergillosis (IA) in high-risk patients in Greece are scarce, while the impact of the revised 2020 EORTC/MSGERC consensus criteria definitions on the reported incidence rate of IA remains unknown. A total of 93 adult hematology patients were screened for IA for six months in four tertiary care Greek hospitals. Serial serum specimens (n = 240) the sample was considered negative by PCR were collected twice-weekly and tested for galactomannan (GM) and Aspergillus DNA (PCR) detection. IA was defined according to both the 2008 EORTC/MSG and the 2020 EORTC/MSGERC consensus criteria. Based on the 2008 EORTC/MSG criteria, the incidence rates of probable and possible IA was 9/93 (10%) and 24/93 (26%), respectively, while no proven IA was documented. Acute myeloid leukemia was the most (67%) common underlying disease with most (82%) patients being on antifungal prophylaxis/treatment. Based on the new 2020 EORTC/MSGERC criteria, 2/9 (22%) of probable and 1/24 (4%) of possible cases should be reclassified as possible and probable, respectively. The episodes of probable IA were reduced by 33% when GM alone and 11% when GM + PCR were used as mycological criterion. The incidence rate of IA in hematology patients was 10%. Application of the 2020 EORTC/MSGERC updated criteria results in a reduction in the classification of probable IA particularly when PCR is not available.

Highlights

Over the last decades, advances in the treatment of hematologic malignancies have been paralleled by a growing prevalence and changing epidemiology of invasive aspergillosis (IA) in hematology patients [1,2,3]
48/93 (52%) hematology patients enrolled in the study were men of median age 51 (18–83, 27) years
Our findings show that the key contributing factor to this reduction in the classification is the adaption of the increased by twofold GM index cut-off value from 0.5 to 1, which was partially compensated by the incorporation of Aspergillus polymerase chain reaction (PCR) in the mycological criteria (≥2 consecutive PCR+ tests)

Summary

Introduction

Advances in the treatment of hematologic malignancies have been paralleled by a growing prevalence and changing epidemiology of invasive aspergillosis (IA) in hematology patients [1,2,3]. It is noteworthy that the reported epidemiology of IA in patients with hematologic malignancies depends on the local approach to diagnosing IA as more systemic testing and combination of multiple biomarkers to achieve adequate sensitivity have shown to increase its detection [7,8]. Only a few hospital-based microbiological laboratories in Greece have currently reported diagnostic capacity for invasive fungal infections relying on serological and/or molecular assays, while having the capacity does not translate into routine testing due to lack of funding [14]

Methods

Results

Discussion

Conclusion