False-positive Aspergillus galactomannan and its kinetics in allogeneic hematopoietic stem cell transplantation.
OBJECTIVE
We evaluated the incidence of and risk factors for false-positive Aspergillus galactomannan (GM) antigenemia in allogeneic hematopoietic stem cell transplantation (HSCT). We also focused on the GM index value and its kinetics.


METHODS
Patients who underwent their first allogeneic HSCT at our center between June 2007 and December 2012 were included (n = 172). Episodes of positive GM tests were classified as either "true-positive", which fulfilled the EORTC criteria for proven or probable invasive aspergillosis (IA), or "false-positive", which was not accompanied by clinical findings. The remaining cases were regarded as "inconclusive".


RESULTS
The one-year cumulative incidences of IA and positive GM tests were 10.1% and 48.1%, respectively. Among 148 episodes of positive GM tests, 97(65.5%), 23(15.5%), and 28(19.0%) were classified as false-positive, true-positive and inconclusive, respectively. In the first episodes of positive GM tests in each patient (false-positive = 67, others = 30), an increase in the GM value in the first two measurements, neutropenia, and use of anti-mold agents at positive GM episode were associated with a significantly lower possibility of false-positive results according to a multivariate analysis.


CONCLUSIONS
A false-positive GM test was frequently seen after allogeneic HSCT. An increase in the GM value may increase its positive predictive value.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Shun-Ichi
S
Kimura
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Yu
Y
Akahoshi
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Hirofumi
H
Nakano
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Naonori
N
Harada
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Kazuaki
K
Kameda
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Tomotaka
T
Ugai
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Hidenori
H
Wada
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Ryoko
R
Yamasaki
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Yuko
Y
Ishihara
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Koji
K
Kawamura
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Kana
K
Sakamoto
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Masahiro
M
Ashizawa
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Miki
M
Sato
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Kiriko
K
Terasako-Saito
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Hideki
H
Nakasone
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Misato
M
Kikuchi
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Rie
R
Yamazaki
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Junya
J
Kanda
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Shinichi
S
Kako
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Aki
A
Tanihara
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan.
Junji
J
Nishida
Division of Hematology, Saitama Medical Center, Jichi Medical University, Japan. Electronic address: ycanda-tky@umin.ac.jp.
Yoshinobu
Y
Kanda
D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy; D001230:Aspergillus / Q000737:chemistry / Q000302:isolation & purification / Q000472:pathogenicity; D004797:Enzyme-Linked Immunosorbent Assay; D005189:False Positive Reactions; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007700:Kinetics; D008297:Male; D008351:Mannans / Q000032:analysis*; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
D008351:Mannans; C012990:galactomannan; D005690:Galactose
Allogeneic hematopoietic stem cell transplantation; Aspergillus galactomannan; False-positive; Kinetics of Aspergillus galactomannan