Serum Galactomannan Versus a Combination of Galactomannan and Polymerase Chain Reaction–Based Aspergillus DNA Detection for Early Therapy of Invasive Aspergillosis in High-Risk Hematological Patients: A Randomized Controlled Trial. (21st October 2014)

• Record Type: Journal Article
• Authors: Aguado, José María; Vázquez, Lourdes; Fernández-Ruiz, Mario; Villaescusa, Teresa; Ruiz-Camps, Isabel; Barba, Pere; Silva, Jose T.; Batlle, Montserrat; Solano, Carlos; Gallardo, David; Heras, Inmaculada; Polo, Marta; Varela, Rosario; Vallejo, Carlos; Olave, Teresa; López-Jiménez, Javier; Rovira, Montserrat; Parody, Rocío; Cuenca-Estrella, Manuel; Zarzuela, Marta Polo; Candel González, Francisco J.; Amador, Paloma Merino; Mediavilla, Joaquín Díaz; Camps, Isabel Ruiz; Barba, Pere; Castillo, Nerea; Martín, María Teresa; Soriano, Jordi Andreu; Fernando, Inmaculada Heras; Castilla-Llorente, Cristina; Cesteros, Rosa; Rodríguez Mondéjar, María Remedios; Vázquez, Lourdes; Villaescusa, Teresa; Caballero, Dolores; García, José Elías; García, Inmaculada García; de la Mano González, Sara; Fernandez García-Hierro, Jose María; Solano, Carlos; Tormo, Mar; Navarro, David; Angel Molla, Miguel; Vallejo, Carlos; González, Ana J.; González, Soledad; González, Ana Pilar; Palomo, Pilar; Porras, Rocío Parody; Batlle, Montserrat; Gallardo, David; Guardia Sánchez, Ramón; Rosario Varela, María; Olave Rubio, María Teresa; Jiménez, Javier López; Tarrats, Montserrat Rovira; Grande, María Suárez-Lledó; Fernández-Avilés, Francesc; Aguado, José María; Fernández-Ruiz, Mario; Silva, Jose Tiago; Cuenca-Estrella, Manuel; Buitrago, María José; Amador, Teresa Merino; Bernal-Martínez, Leticia;
• Is Part Of: Clinical infectious diseases. Volume 60:Number 3(2014:Aug. 01)
• Page Start: 405
• Page End: 414
• Publication Date: 2014-10-21
• Subjects: invasive aspergillosis -- PCR -- galactomannan -- monitoring -- clinical trial; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciu833
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : In this randomized trial, a combined monitoring strategy based on serum galactomannan and detection of Aspergillus DNA by real-time polymerase chain reaction followed by early antifungal therapy reduced the incidence of invasive aspergillosis in high-risk patients not receiving antimold prophylaxis. Abstract: Background. The benefit of the combination of serum galactomannan (GM) assay and polymerase chain reaction (PCR)–based detection of serum Aspergillus DNA for the early diagnosis and therapy of invasive aspergillosis (IA) in high-risk hematological patients remains unclear. Methods. We performed an open-label, controlled, parallel-group randomized trial in 13 Spanish centers. Adult patients with acute myeloid leukemia and myelodysplastic syndrome on induction therapy or allogeneic hematopoietic stem cell transplant recipients were randomized (1:1 ratio) to 1 of 2 arms: "GM-PCR group" (the results of serial serum GM and PCR assays were provided to treating physicians) and "GM group" (only the results of serum GM were informed). Positivity in either assay prompted thoracic computed tomography scan and initiation of antifungal therapy. No antimold prophylaxis was permitted. Results. Overall, 219 patients underwent randomization (105 in the GM-PCR group and 114 in the GM group). The cumulative incidence of "proven" or "probable" IA (primary study outcome) was lower in the GM-PCR group (4.2% vs 13.1%; odds ratio, 0.29 [95% confidence interval, .09–.91]). The median interval from the start of monitoring to the diagnosis of IA was lower in the GM-PCR group (13 vs 20 days; P = .022), as well as the use of empirical antifungal therapy (16.7% vs 29.0%; P = .038). Patients in the GM-PCR group had higher proven or probable IA–free survival ( P = .027). Conclusions. A combined monitoring strategy based on serum GM and Aspergillus DNA was associated with an earlier diagnosis and a lower incidence of IA in high-risk hematological patients. Clinical Trials Registration. NCT01742026.