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Clin Infect Dis. 2015 Feb 1;60(3):405-14. doi: 10.1093/cid/ciu833. Epub 2014 Oct 21.

Serum galactomannan versus a combination of galactomannan and polymerase chain reaction-based Aspergillus DNA detection for early therapy of invasive aspergillosis in high-risk hematological patients: a randomized controlled trial.

Author information

1
Unit of Infectious Diseases, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid.
2
Department of Hematology, Hospital Universitario de Salamanca.
3
Department of Hematology, Fundación Jiménez Díaz, Madrid.
4
Department of Infectious Diseases.
5
Department of Hematology, Hospital Universitari Vall d'Hebron, Barcelona.
6
Department of Clinical Hematology, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona.
7
Department of Hematology and Medical Oncology, Hospital Clínico Universitario-INCLIVA, Valencia.
8
Department of Hematology, Institut Català d'Oncologia, Hospital Josep Trueta, Girona.
9
Department of Hematology, Hospital Universitario Morales Meseguer, Murcia.
10
Department of Hematology, Hospital Clínico Universitario San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid.
11
Department of Hematology, Complexo Hospitalario Universitario A Coruña.
12
Department of Hematology, Hospital Universitario Central de Asturias, Oviedo.
13
Department of Hematology, Hospital Clínico Universitario de Zaragoza.
14
Department of Hematology, Hospital Universitario Ramón y Cajal, Madrid.
15
Department of Hematology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona.
16
Department of Hematology, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla.
17
Department of Mycology, Spanish National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain.

Abstract

BACKGROUND:

The benefit of the combination of serum galactomannan (GM) assay and polymerase chain reaction (PCR)-based detection of serum Aspergillus DNA for the early diagnosis and therapy of invasive aspergillosis (IA) in high-risk hematological patients remains unclear.

METHODS:

We performed an open-label, controlled, parallel-group randomized trial in 13 Spanish centers. Adult patients with acute myeloid leukemia and myelodysplastic syndrome on induction therapy or allogeneic hematopoietic stem cell transplant recipients were randomized (1:1 ratio) to 1 of 2 arms: "GM-PCR group" (the results of serial serum GM and PCR assays were provided to treating physicians) and "GM group" (only the results of serum GM were informed). Positivity in either assay prompted thoracic computed tomography scan and initiation of antifungal therapy. No antimold prophylaxis was permitted.

RESULTS:

Overall, 219 patients underwent randomization (105 in the GM-PCR group and 114 in the GM group). The cumulative incidence of "proven" or "probable" IA (primary study outcome) was lower in the GM-PCR group (4.2% vs 13.1%; odds ratio, 0.29 [95% confidence interval, .09-.91]). The median interval from the start of monitoring to the diagnosis of IA was lower in the GM-PCR group (13 vs 20 days; P = .022), as well as the use of empirical antifungal therapy (16.7% vs 29.0%; P = .038). Patients in the GM-PCR group had higher proven or probable IA-free survival (P = .027).

CONCLUSIONS:

A combined monitoring strategy based on serum GM and Aspergillus DNA was associated with an earlier diagnosis and a lower incidence of IA in high-risk hematological patients. Clinical Trials Registration. NCT01742026.

KEYWORDS:

PCR; clinical trial; galactomannan; invasive aspergillosis; monitoring

PMID:
25336623
DOI:
10.1093/cid/ciu833
[Indexed for MEDLINE]

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