title: Serum galactomannan-based early detection of invasive aspergillosis in hematology patients receiving effective antimold prophylaxis.
abstract: BACKGROUND
  There is a practical need to investigate the performance of the serum galactomannan (GM) assay in hematology patients with a potentially low pretest risk of invasive aspergillosis following effective antimold prophylaxis.
  
  
  METHODS
  We present a 4-year study with 262 unselected consecutive high-risk episodes, prospectively managed with posaconazole primary prophylaxis and a uniform diagnostic algorithm, including biweekly serum GM quantification for early detection of invasive aspergillosis.
  
  
  RESULTS
  A total of 2972 serum GM tests were performed (median, 11 per episode [range, 3-30]); the vast majority were negative (96.7% of tests and 83.6% of episodes). The incidence of breakthrough invasive aspergillosis was 1.9% (5/262), all with true-positive GM test results. Our study identified 30 false-positive GM evaluable episodes (85.7%; 13.8% of all evaluable episodes), validating with real-life data the low positive predictive value of the assay in this setting (12%). In 26 of these 30 episodes (86.7%), the false-positive result(s) occurred in tests performed as preemptive surveillance only. Conversely, in evaluable cases with positive GM tests and a clinical suspicion of invasive fungal disease, the performance of diagnostic-driven GM tests improved, with a positive predictive value of 89.6%.
  
  
  CONCLUSIONS
  The low pretest risk of invasive aspergillosis in the context of effective antimold prophylaxis renders serum GM surveillance of asymptomatic patients unreliable, as all results would be either negative or false positive. The test remains useful to diagnose patients with a clinical suspicion of invasive fungal disease, calling for a more efficient copositioning of effective prophylaxis and GM testing in this clinical setting.
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Duarte
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez-Ortega
authors.affiliation: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid.
authors.forename: Isabel
authors.initials: I
authors.lastname: Cuesta
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Patiño
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Alberto
authors.initials: A
authors.lastname: Fernández de Sevilla
authors.affiliation: Department of Hematology, Catalan Institute of Oncology, Hospital Duran i Reynals, Barcelona.
authors.forename: Carlota
authors.initials: C
authors.lastname: Gudiol
authors.affiliation: Department of Microbiology, Hospital Universitario de Bellvitge, Barcelona, Spain.
authors.forename: Josefina
authors.initials: J
authors.lastname: Ayats
authors.affiliation: Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid.
authors.forename: Manuel
authors.initials: M
authors.lastname: Cuenca-Estrella
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D000946:Antigens, Fungal / Q000097:blood; D001228:Aspergillosis / Q000097:blood* / Q000188:drug therapy*; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000097:blood*; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D000946:Antigens, Fungal; D008351:Mannans; D014230:Triazoles; C012990:galactomannan; C101425:posaconazole; D005690:Galactose
keywords: antifungal prophylaxis; invasive aspergillosis; posaconazole; preemptive antifungal strategy; serum galactomannan assay