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Impact of neutropenia evaluated in terms of the D‐index on invasive fungal disease while on empiric or preemptive antifungal treatment strategy in the early phase after allogeneic hematopoietic stem cell transplantation
Author(s) -
Kimura Shunichi,
Nakamura Yuhei,
Kawamura Masakatsu,
Takeshita Junko,
Kawamura Shunto,
Yoshino Nozomu,
Misaki Yukiko,
Yoshimura Kazuki,
Matsumi Shimpei,
Gomyo Ayumi,
Akahoshi Yu,
Tamaki Masaharu,
Kusuda Machiko,
Kameda Kazuaki,
Wada Hidenori,
Sato Miki,
TerasakoSaito Kiriko,
Tanihara Aki,
Nakasone Hideki,
Kako Shinichi,
Kanda Yoshinobu
Publication year - 2020
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.13409
Subject(s) - neutropenia , medicine , receiver operating characteristic , hematopoietic stem cell transplantation , area under the curve , transplantation , youden's j statistic , gastroenterology , immunology , chemotherapy
Background We retrospectively evaluated the association between the D‐index, which reflects both the depth and duration of neutropenia, and proven/probable invasive fungal disease (IFD) early after allogeneic hematopoietic stem cell transplantation (HSCT) at our center (n = 394). Methods The D‐index was defined as the area over the neutrophil curve during neutropenia. The cumulative D‐index from the start of neutropenia until the development of infection (c‐D‐index) was also evaluated as a real‐time assessment of neutropenia. Results There were 19 cases of early proven/probable IFD before and within 1 week after engraftment. Fifteen cases (78.9%) were seen as breakthrough infection while on empiric (n = 7), preemptive (n = 4) or prophylactic (n = 4) antifungal administration with mold‐active agents. The c‐D‐index and lower performance status were identified as independent significant predictive factors for IFD. A receiver operating characteristic (ROC) curve analysis showed that the D‐index and c‐D‐index were more accurate than the simple duration of neutropenia and as accurate as the duration of profound neutropenia for predicting IFD. The sensitivity, specificity, and positive and negative predictive values of the c‐D‐index using an appropriate cutoff (CO) value (10 644) determined by ROC curve analysis were 73.1%, 63.2%, 9.1%, and 97.9%, respectively. The advantage of the c‐D‐index to cumulative days of neutropenia in terms of positive and negative predictive values seemed to be small. Conclusions The appropriate CO value for the c‐D‐index for predicting IFD was as high as 10 644 in allogeneic HSCT with a more frequent use of empiric antifungal therapy. The c‐D‐index is useful for assessing the risk of breakthrough IFD.