Introducing biomarkers for invasive fungal disease in haemato-oncology patients: a single-centre experience

OBJECTIVES: Biomarkers for invasive fungal disease (IFD) have been shown to reduce antifungal prescriptions in neutropaenic haemato-oncology patients. Our study aimed to assess the real-life impacts of introducing a novel biomarker-based pathway, incorporating serum galactomannan and Aspergillus PCR, for pyrexial haemato-oncology admissions. METHODS: Patients with neutropaenic fever were identified prospectively after introduction of the new pathway from 2013-2015. A historical group of neutropaenic patients who had blood cultures taken from 2009-2012 was generated for comparison. Clinical details including demographics, underlying diagnosis, investigations, radiology and antimicrobial treatment were obtained. RESULTS: Prospective data from 308 patients was compared to retrospective data from 302 patients. The proportion of patients prescribed an antifungal medication was unchanged by the pathway (p=0.79), but the pattern was different with more patients receiving targeted antifungals (p=0.04). A negative serum galactomannan test was not sufficient evidence to withhold therapy with 17.2% of those episodes felt to have possible or probable IFD by EORTC/MSG criteria. There was no difference in 30-day mortality (p=0.21) or 1-year mortality (p=0.57) following introduction of the pathway. CONCLUSIONS: Biomarkers can be used safely as part of a multidisciplinary approach to the diagnosis of IFD in neutropaenic haemato-oncology patients. Whilst they do not necessarily result in antifungal therapy being withheld, they can allow more confident diagnosis of IFD and more specific antifungal therapy in selected cases.