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Role of pre‐transplant chest high‐resolution computed tomography and serum galactomannan index in predicting post‐transplant invasive pulmonary aspergillosis in allogeneic hematopoietic cell transplant recipients
Author(s) -
Sharma Rintu,
Singh Charanpreet,
Khadwal Alka,
Prakash Gaurav,
Malhotra Pankaj,
Jain Arihant,
Jandial Aditya,
Suri Vikas,
Muthu Valliappan,
Prabhakar Nidhi,
Gorsi Ujjwal,
Chakrabarti Arunaloke,
Varma Subhash,
Lad Deepesh P.
Publication year - 2021
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.13632
Subject(s) - medicine , galactomannan , high resolution computed tomography , aspergillosis , chest pain , gastroenterology , radiology , surgery , lung , immunology
The role of pre‐HCT chest high‐resolution computed tomography (HRCT) and serum galactomannan index (GMI) in predicting the post‐allogeneic hematopoietic cell transplant (HCT) invasive pulmonary aspergillosis (IPA) is debatable. Methods This was a single‐center, prospective study from 2014 to 2019. The primary objective was to study if pre‐HCT chest HRCT and serum GMI predicted IPA post‐HCT. The secondary objective was day +100 mortality. All consecutive, consenting patients of ≥12 years of age undergoing allo‐HCT were included and had pre‐HCT chest HRCT and serum GMI. All patients received mold active antifungal prophylaxis. The EORTC/MSG criteria were used for the diagnosis of IPA. Results A total of 82 patients with median age 27 years (12‐59 years) were included. The underlying diagnoses included hematological malignancies (79%) and aplastic anemia (21%). Fifteen percent of patients was treated for prior history of probable IPA (>6 weeks before HCT). Pre‐HCT chest HRCT satisfied EORTC clinical criteria in 24% patients. Serum GMI ≥0.5 was seen in 27% of patients. Post‐HCT probable IPA was seen in 24% of patients. There were more patients with pre‐HCT chest HRCT findings satisfying EORTC clinical criteria (45% vs. 18%, P = .014) and GMI ≥0.5 (45% vs. 21%, P = .03) in the group with post‐HCT IPA compared to those without IPA. There was higher day+100 mortality in patients with post‐HCT IPA (55% vs. 18%, P = .001). Conclusions The presence of EORTC clinical criteria on pre‐HCT chest HRCT, serum GMI ≥0.5, and prior history of IPA predicted post‐HCT IPA.