Invasive Pulmonary Aspergillosis in Patients with Haematological Malignancies and Hematopoietic Stem Cell Transplantation:a Single-Center Study.

Denis Niyazi,Rumyana Markovska,Temenuga Stoeva,Svilena Atanasova,Ilina Micheva

doi:10.3897/folmed.63.e65248

Abstract

The aim of this study was to evaluate the clinical significance of Aspergillus Galactomannan antigen (GM) test for the diagnosis of invasive pulmonary aspergillosis (IPA) in patient with hematological malignancies, including patients undergoing hematopoietic stem cell transplantation (HSCT). Between January 2016 and June 2019, ninety patients were tested for GM. A total of 134 blood and 19 bronchoalveolar lavage (BAL) samples were analyzed using Platelia Aspergillus Ag Enzyme-Immuno Assay (Bio-Rad Laboratories). The median age of patients was 63 years (range 25-81). Fifty-six patients (62.2%) were male. All patients were allocated into five groups on the basis of their GM results. A positive GM antigen test was detected in 16 patients (17.7%). Of these, ten had positive serum samples (group I). After re-testing, 1 patient from group I gave a negative result. Five patients with negative serum samples gave positive BAL results (group II). One patient had positive both serum and BAL samples (group III). Fifteen GM positive patients (9 from group I, group II, and III) were categorized as probable IPA. Thirty-six patients (40%) negative for GM (group IV) were considered with a possible IPA. IPA was excluded in 38 patients (42.2%) (group V). Anti-mould therapy was initiated in all 15 patients who were considered to be cases with probable IPA. IPA was the immediate cause of death in 3 cases (25%). Our results demonstrated the clinical applicability of the GM test for screening of IPA in high-risk patients with hematological malignancies and HSCT.

Highlights

Patients with hematological malignancies and those with hematopoietic stem cell transplantation (HSCT) are at high risk of developing severe, life-threatening infections with mortality rates as high as 55%.1Invasive pulmonary aspergillosis (IPA) is one of the most important infectious complications with frequency of 12% in individuals with hematological malignancies and between 2% and 8% after autologous and allogeneic stemcell transplantation
invasive pulmonary aspergillosis (IPA) was the immediate cause of death in 3 cases (25%), all with acute leukemia
A large-scale retrospective multi-center study[16] conducted to characterize better the invasive mycotic infections in patients with hematological malignancies without HSCT demonstrated that the highest rate (94% of cases) of IPA was observed in patients with acute leukemia

Summary

Introduction

Invasive pulmonary aspergillosis (IPA) is one of the most important infectious complications with frequency of 12% in individuals with hematological malignancies and between 2% and 8% after autologous and allogeneic stemcell transplantation. Depending on the underlying disease, the IPA-associated mortality may reach as high as 88%.2. The aspergillosis is an exogenous mycotic infection caused by the widespread fungi belonging to the genus Aspergillus with A. fumigatus, A. flavus, A. niger, and A. terreus being the most clinically important species.[3] The infections associated with Aspergillus spp. can vary from local skin infections to severe infections with high mortality such as IPA.[4,5] Very rarely, these moulds can cause invasive diseases in immunocompetent individuals.[3,6]

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