DIAGNOSTIC UTILITY OF ADDING SERUM GALACTOMANNAN TEST TO STANDARD TECHNIQUES OF DIAGNOSING INVASIVE FUNGAL INFECTION IN PATIENTS OF ACUTE LEUKEMIA WITH NEUTROPENIA
(Abstract release date: 05/21/15)
EHA Library. Singh P. 06/12/15; 102893; PB1802
Disclosure(s): BLK Superspeciality HospitalHemato-Oncology & BMT
Dr. Pawan Kumar Singh
Contributions
Contributions
Abstract
Abstract: PB1802
Type: Publication Only
Background
Invasive fungal infection (IFI) (esp. Invasive Aspergillosis) is very common in patients of acute leukemia undergoing induction chemotherapy. Case fatality rates are approximately 50-60% in various studies. It is usually diagnosed as probable case based on CT, as per EORTC/MSG criteria. Serial Galactomannan (GM) monitoring can be helpful in diagnosing IFI early.
Aims
Methods
Prospective single centre cohort study which included 100 patients of acute leukemia with neutropenia. Weekly GM levels were done with CT chest done as and when clinically indicated. Results of GM levels were compared with CT positivity at any time point during the phase of neutropenia. GM levels were also assessed to predict the survival.
Results
Patients of acute leukemia with neutropenia (mean age 24?8 years, 62% males) were followed for a period of 1 month of which 37% patients expired with median day of expiry 40 days. ALL and AML patients were 34 and 66%, respectively with fever being most common (92%) presenting symptom. 49% patients had evidence of fungal pneumonia on the basis of CT chest with median day of positivity was 12 days (IQR 3-16 days). 74% patients had GM positive value at any time point out of which 20% had persistent GM index positive. Highest value of GM index was 0.701 at day 14 correlating with nadir ANC of 30/cumm at day 14. GM levels were positive in 43%, 63%, 69% and 54% patients at day 0, 7, 14 and 21, respectively. The median GM levels at day 7 (0.8 vs 0.4; p=0.001), 14 (0.87 vs 0.49; p=0.00) and 21 (0.92 vs 0.46; p=0.00) were higher in CT positive group as compared to CT negative group. There was a significant negative correlation between ANC and GM levels (p=0.007). High GM levels at day 7 (p value = 0.018) and day 14 (p value <0.001) were predictor of development of invasive fungal infection on 1st or 2nd CT. Low GM levels at day 14 (1 vs 0.63; p <0.001) and post induction CR status (98% vs 8%; p<0.001) were significantly associated with better survival.
Summary
High GM levels at day 7 were predictor of development of invasive fungal infection on CT. High GM levels negatively correlates with the degree of neutropenia. Low GM levels at day 14 and post induction CR is associated with better survival.
Keyword(s): Acute leukemia, Fungal infection
Session topic: Publication Only
Type: Publication Only
Background
Invasive fungal infection (IFI) (esp. Invasive Aspergillosis) is very common in patients of acute leukemia undergoing induction chemotherapy. Case fatality rates are approximately 50-60% in various studies. It is usually diagnosed as probable case based on CT, as per EORTC/MSG criteria. Serial Galactomannan (GM) monitoring can be helpful in diagnosing IFI early.
Aims
To study the diagnostic & prognostic significance of weekly Serum Galactomannan level monitoring and the development of invasive fungal infection based on radiological imaging.
Methods
Prospective single centre cohort study which included 100 patients of acute leukemia with neutropenia. Weekly GM levels were done with CT chest done as and when clinically indicated. Results of GM levels were compared with CT positivity at any time point during the phase of neutropenia. GM levels were also assessed to predict the survival.
Results
Patients of acute leukemia with neutropenia (mean age 24?8 years, 62% males) were followed for a period of 1 month of which 37% patients expired with median day of expiry 40 days. ALL and AML patients were 34 and 66%, respectively with fever being most common (92%) presenting symptom. 49% patients had evidence of fungal pneumonia on the basis of CT chest with median day of positivity was 12 days (IQR 3-16 days). 74% patients had GM positive value at any time point out of which 20% had persistent GM index positive. Highest value of GM index was 0.701 at day 14 correlating with nadir ANC of 30/cumm at day 14. GM levels were positive in 43%, 63%, 69% and 54% patients at day 0, 7, 14 and 21, respectively. The median GM levels at day 7 (0.8 vs 0.4; p=0.001), 14 (0.87 vs 0.49; p=0.00) and 21 (0.92 vs 0.46; p=0.00) were higher in CT positive group as compared to CT negative group. There was a significant negative correlation between ANC and GM levels (p=0.007). High GM levels at day 7 (p value = 0.018) and day 14 (p value <0.001) were predictor of development of invasive fungal infection on 1st or 2nd CT. Low GM levels at day 14 (1 vs 0.63; p <0.001) and post induction CR status (98% vs 8%; p<0.001) were significantly associated with better survival.
Summary
High GM levels at day 7 were predictor of development of invasive fungal infection on CT. High GM levels negatively correlates with the degree of neutropenia. Low GM levels at day 14 and post induction CR is associated with better survival.
Keyword(s): Acute leukemia, Fungal infection
Session topic: Publication Only
Abstract: PB1802
Type: Publication Only
Background
Invasive fungal infection (IFI) (esp. Invasive Aspergillosis) is very common in patients of acute leukemia undergoing induction chemotherapy. Case fatality rates are approximately 50-60% in various studies. It is usually diagnosed as probable case based on CT, as per EORTC/MSG criteria. Serial Galactomannan (GM) monitoring can be helpful in diagnosing IFI early.
Aims
Methods
Prospective single centre cohort study which included 100 patients of acute leukemia with neutropenia. Weekly GM levels were done with CT chest done as and when clinically indicated. Results of GM levels were compared with CT positivity at any time point during the phase of neutropenia. GM levels were also assessed to predict the survival.
Results
Patients of acute leukemia with neutropenia (mean age 24?8 years, 62% males) were followed for a period of 1 month of which 37% patients expired with median day of expiry 40 days. ALL and AML patients were 34 and 66%, respectively with fever being most common (92%) presenting symptom. 49% patients had evidence of fungal pneumonia on the basis of CT chest with median day of positivity was 12 days (IQR 3-16 days). 74% patients had GM positive value at any time point out of which 20% had persistent GM index positive. Highest value of GM index was 0.701 at day 14 correlating with nadir ANC of 30/cumm at day 14. GM levels were positive in 43%, 63%, 69% and 54% patients at day 0, 7, 14 and 21, respectively. The median GM levels at day 7 (0.8 vs 0.4; p=0.001), 14 (0.87 vs 0.49; p=0.00) and 21 (0.92 vs 0.46; p=0.00) were higher in CT positive group as compared to CT negative group. There was a significant negative correlation between ANC and GM levels (p=0.007). High GM levels at day 7 (p value = 0.018) and day 14 (p value <0.001) were predictor of development of invasive fungal infection on 1st or 2nd CT. Low GM levels at day 14 (1 vs 0.63; p <0.001) and post induction CR status (98% vs 8%; p<0.001) were significantly associated with better survival.
Summary
High GM levels at day 7 were predictor of development of invasive fungal infection on CT. High GM levels negatively correlates with the degree of neutropenia. Low GM levels at day 14 and post induction CR is associated with better survival.
Keyword(s): Acute leukemia, Fungal infection
Session topic: Publication Only
Type: Publication Only
Background
Invasive fungal infection (IFI) (esp. Invasive Aspergillosis) is very common in patients of acute leukemia undergoing induction chemotherapy. Case fatality rates are approximately 50-60% in various studies. It is usually diagnosed as probable case based on CT, as per EORTC/MSG criteria. Serial Galactomannan (GM) monitoring can be helpful in diagnosing IFI early.
Aims
To study the diagnostic & prognostic significance of weekly Serum Galactomannan level monitoring and the development of invasive fungal infection based on radiological imaging.
Methods
Prospective single centre cohort study which included 100 patients of acute leukemia with neutropenia. Weekly GM levels were done with CT chest done as and when clinically indicated. Results of GM levels were compared with CT positivity at any time point during the phase of neutropenia. GM levels were also assessed to predict the survival.
Results
Patients of acute leukemia with neutropenia (mean age 24?8 years, 62% males) were followed for a period of 1 month of which 37% patients expired with median day of expiry 40 days. ALL and AML patients were 34 and 66%, respectively with fever being most common (92%) presenting symptom. 49% patients had evidence of fungal pneumonia on the basis of CT chest with median day of positivity was 12 days (IQR 3-16 days). 74% patients had GM positive value at any time point out of which 20% had persistent GM index positive. Highest value of GM index was 0.701 at day 14 correlating with nadir ANC of 30/cumm at day 14. GM levels were positive in 43%, 63%, 69% and 54% patients at day 0, 7, 14 and 21, respectively. The median GM levels at day 7 (0.8 vs 0.4; p=0.001), 14 (0.87 vs 0.49; p=0.00) and 21 (0.92 vs 0.46; p=0.00) were higher in CT positive group as compared to CT negative group. There was a significant negative correlation between ANC and GM levels (p=0.007). High GM levels at day 7 (p value = 0.018) and day 14 (p value <0.001) were predictor of development of invasive fungal infection on 1st or 2nd CT. Low GM levels at day 14 (1 vs 0.63; p <0.001) and post induction CR status (98% vs 8%; p<0.001) were significantly associated with better survival.
Summary
High GM levels at day 7 were predictor of development of invasive fungal infection on CT. High GM levels negatively correlates with the degree of neutropenia. Low GM levels at day 14 and post induction CR is associated with better survival.
Keyword(s): Acute leukemia, Fungal infection
Session topic: Publication Only
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