Abstract
Detection of galactomannan has become widely available for diagnosing invasive aspergillosis. The test characteristics, using the Platelia™ enzyme-immunoassay, have been well described. This assay could potentially also be useful for the early evaluation of the efficacy of antifungal therapy and for predicting the outcome in terms of response and survival. In this systematic review, we assessed the available evidence for the use of serum galactomannan at baseline as a prognostic marker, and the predictive value of serum galactomannan kinetics after initiation of antifungal therapy. Overall, serum galactomannan at baseline and galactomannan kinetics appear to be good predictors of therapy response and survival. However, breakpoints for predicting therapy failure and validation in different patient populations are still lacking.
Highlights
Invasive aspergillosis (IA) is a potentially life-threatening disease, occurring mostly in severely immunocompromised patients such as those with acute myeloid leukemia, those with prolonged neutropenia due to myelotoxic therapy, or following allogeneic hematopoietic cell transplantation or solid organ transplantation, and is estimated to affect around 200,000 patients per year (Brown et al, 2012)
This finding was confirmed in animal models, where a concentration-dependent effect on serum GM (sGM) detection was shown for triazoles, polyenes, and investigational drugs such as the orotomides (Petraitiene et al, 2001; Petraitis et al, 2016; Kimura et al, 2017; Negri et al, 2017)
We identified 21 studies that looked at GM kinetics as predictor of response and survival
Summary
Invasive aspergillosis (IA) is a potentially life-threatening disease, occurring mostly in severely immunocompromised patients such as those with acute myeloid leukemia, those with prolonged neutropenia due to myelotoxic therapy, or following allogeneic hematopoietic cell transplantation or solid organ transplantation, and is estimated to affect around 200,000 patients per year (Brown et al, 2012). Serum Galactomannan as Prognostic Marker (Mennink-Kersten et al, 2004) This assay is approved by the US Food and Drug Administration, commercially available, and has been incorporated as a microbiological criterion in the European Organization for Research and Treatment of Cancer-Mycosis Study Group consensus definitions of invasive fungal disease (Pauw et al, 2008). Due to the relative large size of GM, the antigen cannot freely diffuse from the alveoli through the endothelial lining of the pulmonary capillaries; angio-invasion is required to reach the circulation This was confirmed in an in vitro model of human alveoli, in which GM only appeared in the bloodstream after invasive growth of Aspergillus through the TABLE 1 | A summarized overview of diagnostic tests in invasive aspergillosis
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