title: Changes of serum aspergillus galactomannan during hematopoietic stem cell transplantation in children with prior invasive aspergillosis.
abstract: BACKGROUND
  Invasive aspergillosis (IA) has recently increased and has a high mortality rate in immunocompromised patients. IA before hematopoietic stem cell transplantation (HSCT) is not uncommon, but how to cope with it is very tough. The serum aspergillus galactomannan antigen (GM) is a helpful marker for diagnosis of IA, and a serial follow-up of GM levels is important to evaluate the response of treatment. However, data on the changes of GM during HSCT are very limited.
  
  
  METHODS
  Patient 1 was a 2-year-old female with severe aplastic anemia. A typical lung lesion in the computed tomography of the chest with elevated GM levels was noted, and probable IA was diagnosed. After a combination treatment of voriconazole and caspofungin, the GM levels decreased. Although of significant improvement, the pulmonary lesion in the chest X-ray did not disappear before HSCT. The GM levels increased when she received the conditioning regimen during HSCT. The GM levels remained high during the use of steroids for the graft-versus-host disease and declined gradually after tapering off steroids and cyclosporine. Patient 2 was a 12-year-old female with severe aplastic anemia. Voriconazole was administered after the diagnosis of a probable IA. The pulmonary lesions in the chest X-ray disappeared before HSCT. The GM levels flared up during the administration of conditioning regimen and declined after neutrophil engraftment. At present, the two patients were cured of the disease without requiring surgical resection of their pulmonary IA.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report about the changes of GM during HSCT in patients with prior IA. With appropriate antifungal therapy and restoration of patient's immunity, IA can be cured without surgical resection. Further studies are warranted.
authors.affiliation: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. tefu.weng@gmail.com.
authors.forename: Te-Fu
authors.initials: TF
authors.lastname: Weng
authors.affiliation: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. d5284@mail.cmuh.org.tw.|School of post-baccalaureate Chinese medicine, College of Chinese Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. d5284@mail.cmuh.org.tw.
authors.forename: Kang-Hsi
authors.initials: KH
authors.lastname: Wu
authors.affiliation: Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fuxing St., Guishan District, Taoyuan City, 333, Taiwan. popo333@hotmail.com.tw.|College of Medicine, Chang Gung University, No. 5, Fuxing St., Guishan District, Taoyuan City, 333, Taiwan. popo333@hotmail.com.tw.
authors.forename: Han-Ping
authors.initials: HP
authors.lastname: Wu
authors.affiliation: Division of Pediatric Hematology-Oncology, Children's Hospital, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. m8201033@hotmail.com.|Department of Biotechnology and Bioinformatics, Asia University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan. m8201033@hotmail.com.
authors.forename: Ching-Tien
authors.initials: CT
authors.lastname: Peng
authors.affiliation: Department of Pediatrics, Chung Shan Medical University Hospital, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, 402, Taiwan. chaoyuhua@yahoo.com.tw.|School of Medicine, Chung Shan Medical University, No. 110, Sec. 1, Chien-Kuo N. Road, Taichung, 402, Taiwan. chaoyuhua@yahoo.com.tw.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Chao
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy; D002648:Child; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005690:Galactose / Q000031:analogs & derivatives; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007223:Infant; D008351:Mannans / Q000097:blood*; D014057:Tomography, X-Ray Computed
chemical_list: D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose