Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients.

Jannik Stemler ,Enrico Schalk ,Nina Khanna ,Elizabeth De Kort ,Methee Chayakulkeeree ,Juergen Prattes ,Nael Alakel ,Rodrigo Martino‐Bufarull ,Jutta Auberger ,Andreas H Groll ,Pere Soler‐Palacín ,Martin Schmidt‐Hieber ,Peter Bojko ,Barbora Weinbergerová ,Aline El Zakhem ,Athina Pyrpasopoulou ,Jarmo Oksi ,C Bruns ,Márcio Nucci ,A O Mager ,José Cozzi ,Michelle Ananda‐Rajah ,Michael Koldehoff ,Neeraj Sidharthan ,Hamdı Akan ,Oliver A Cornely ,Werner Rabitsch ,Francesco Marchesi ,Larissa Henze ,Livio Pagano ,Marcos Hernandez Jimenez ,Bob Phillips ,Dong Gun Lee ,Sibylle C Mellinghoff ,Christopher H Heath ,Pranatharthi H Chandrasekar ,Souha S Kanj ,Anat Stern ,Philipp Köehler

doi:10.3390/jof6010036

Abstract

Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5–15%) and non-BCT centers (7%; IQR 5–10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.

Highlights

Invasive aspergillosis (IA) typically affects high-risk hematology patients, in particular those with acute leukemia or the recipients of hematopoietic cell transplantation (HCT) [1]
Other timepoints for follow-up CT were indicated in 14.1% (n = 13) (Figure 4). In this web-based survey study, 142 participants from 43 countries contributed to assessing current chest imaging use in high-risk hematology patients
For detection of invasive pulmonary aspergillosis (IPA) in neutropenic patients, it is still broadly used as a frontline investigation [19,20]

Summary

Introduction

Invasive aspergillosis (IA) typically affects high-risk hematology patients, in particular those with acute leukemia or the recipients of hematopoietic cell transplantation (HCT) [1]. The incidence of probable or proven IA in these patients ranges from 2%, while on posaconazole prophylaxis to 11.2%. Without mold-directed prophylaxis [2,3]. The overall and attributable mortality are high reaching up to. Invasive pulmonary aspergillosis (IPA) is associated with even higher mortality up to 75%, and it has been shown to negatively impact the long-term survival of leukemia patients [6,7]. Diagnosis and treatment are crucial in the management of IPA to improve patient outcome [8,9]. IA is still a frequently missed diagnosis in hematological patients [10]

Methods

Results

Conclusion