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Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis
Posaconazole prophylaxis has demonstrated efficacy in the prevention of invasive aspergillosis during prolonged neutropenia following acute myeloid leukemia induction chemotherapy. Antifungal treatment decreases serum galactomannan enzyme immunoassay diagnostic accuracy that could delay the diagnosi...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Impact Journals LLC
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003556/ https://www.ncbi.nlm.nih.gov/pubmed/29928481 http://dx.doi.org/10.18632/oncotarget.25477 |
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author | Calmettes, Claire Gabriel, Frederic Blanchard, Elodie Servant, Vincent Bouchet, Stéphane Kabore, Nathanael Forcade, Edouard Leroyer, Camille Bidet, Audrey Latrabe, Valérie Leguay, Thibaut Vigouroux, Stephane Tabrizi, Reza Breilh, Dominique Accoceberry, Isabelle de Lara, Manuel Tunon Pigneux, Arnaud Milpied, Noel Dumas, Pierre-Yves |
author_facet | Calmettes, Claire Gabriel, Frederic Blanchard, Elodie Servant, Vincent Bouchet, Stéphane Kabore, Nathanael Forcade, Edouard Leroyer, Camille Bidet, Audrey Latrabe, Valérie Leguay, Thibaut Vigouroux, Stephane Tabrizi, Reza Breilh, Dominique Accoceberry, Isabelle de Lara, Manuel Tunon Pigneux, Arnaud Milpied, Noel Dumas, Pierre-Yves |
author_sort | Calmettes, Claire |
collection | PubMed |
description | Posaconazole prophylaxis has demonstrated efficacy in the prevention of invasive aspergillosis during prolonged neutropenia following acute myeloid leukemia induction chemotherapy. Antifungal treatment decreases serum galactomannan enzyme immunoassay diagnostic accuracy that could delay the diagnosis and treatment. We retrospectively studied patients with acute myeloid leukemia who underwent intensive chemotherapy and antifungal prophylaxis by posaconazole oral suspension. Clinical, radiological, microbiological features and treatment response of patients with invasive aspergillosis that occurred despite posaconazole prophylaxis were analyzed. Diagnostic accuracy of serum galactomannan assay according to posaconazole plasma concentrations has been performed. A total of 288 patients with acute myeloid leukemia, treated by induction chemotherapy, who received posaconazole prophylaxis for more than five days were included in the present study. The incidence of invasive aspergillosis was 8% with 12 (4.2%), 8 (2.8%) and 3 (1%), possible, probable and proven invasive aspergillosis, respectively. Posaconazole plasma concentration was available for 258 patients. Median duration of posaconazole treatment was 17 days, and median posaconazole plasma concentration was 0.5 mg/L. None of patients with invasive aspergillosis and posaconazole concentration ≥ 0.5 mg/L had a serum galactomannan positive test. Sensitivity of serum galactomannan assay to detect probable and proven invasive aspergillosis was 81.8%. Decreasing the cut-off value for serum galactomannan optical density index from 0.5 to 0.3 increased sensitivity to 90.9%. In a homogenous cohort of acute myeloid leukemia patients during induction chemotherapy, increasing the posaconazole concentration decreases the sensitivity of serum galactomannan assay. |
format | Online Article Text |
id | pubmed-6003556 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Impact Journals LLC |
record_format | MEDLINE/PubMed |
spelling | pubmed-60035562018-06-20 Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis Calmettes, Claire Gabriel, Frederic Blanchard, Elodie Servant, Vincent Bouchet, Stéphane Kabore, Nathanael Forcade, Edouard Leroyer, Camille Bidet, Audrey Latrabe, Valérie Leguay, Thibaut Vigouroux, Stephane Tabrizi, Reza Breilh, Dominique Accoceberry, Isabelle de Lara, Manuel Tunon Pigneux, Arnaud Milpied, Noel Dumas, Pierre-Yves Oncotarget Research Paper Posaconazole prophylaxis has demonstrated efficacy in the prevention of invasive aspergillosis during prolonged neutropenia following acute myeloid leukemia induction chemotherapy. Antifungal treatment decreases serum galactomannan enzyme immunoassay diagnostic accuracy that could delay the diagnosis and treatment. We retrospectively studied patients with acute myeloid leukemia who underwent intensive chemotherapy and antifungal prophylaxis by posaconazole oral suspension. Clinical, radiological, microbiological features and treatment response of patients with invasive aspergillosis that occurred despite posaconazole prophylaxis were analyzed. Diagnostic accuracy of serum galactomannan assay according to posaconazole plasma concentrations has been performed. A total of 288 patients with acute myeloid leukemia, treated by induction chemotherapy, who received posaconazole prophylaxis for more than five days were included in the present study. The incidence of invasive aspergillosis was 8% with 12 (4.2%), 8 (2.8%) and 3 (1%), possible, probable and proven invasive aspergillosis, respectively. Posaconazole plasma concentration was available for 258 patients. Median duration of posaconazole treatment was 17 days, and median posaconazole plasma concentration was 0.5 mg/L. None of patients with invasive aspergillosis and posaconazole concentration ≥ 0.5 mg/L had a serum galactomannan positive test. Sensitivity of serum galactomannan assay to detect probable and proven invasive aspergillosis was 81.8%. Decreasing the cut-off value for serum galactomannan optical density index from 0.5 to 0.3 increased sensitivity to 90.9%. In a homogenous cohort of acute myeloid leukemia patients during induction chemotherapy, increasing the posaconazole concentration decreases the sensitivity of serum galactomannan assay. Impact Journals LLC 2018-06-01 /pmc/articles/PMC6003556/ /pubmed/29928481 http://dx.doi.org/10.18632/oncotarget.25477 Text en Copyright: © 2018 Calmettes et al. http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License 3.0 (http://creativecommons.org/licenses/by/3.0/) (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Paper Calmettes, Claire Gabriel, Frederic Blanchard, Elodie Servant, Vincent Bouchet, Stéphane Kabore, Nathanael Forcade, Edouard Leroyer, Camille Bidet, Audrey Latrabe, Valérie Leguay, Thibaut Vigouroux, Stephane Tabrizi, Reza Breilh, Dominique Accoceberry, Isabelle de Lara, Manuel Tunon Pigneux, Arnaud Milpied, Noel Dumas, Pierre-Yves Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title | Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title_full | Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title_fullStr | Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title_full_unstemmed | Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title_short | Breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
title_sort | breakthrough invasive aspergillosis and diagnostic accuracy of serum galactomannan enzyme immune assay during acute myeloid leukemia induction chemotherapy with posaconazole prophylaxis |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6003556/ https://www.ncbi.nlm.nih.gov/pubmed/29928481 http://dx.doi.org/10.18632/oncotarget.25477 |
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