Journal Article

Utility of CT assessment in hematology patients with invasive aspergillosis: a post-hoc analysis of phase 3 data

Aram, Jalal A., Patterson, Thomas F., Jin, Jie, Lou, Yin-jun, Wu, Depei, Meng, Haitao, Zhang, Xian’an, Liu, Yang, Yan, Jean Li, Chen, Xiaochen, Pan, Sisi, Schwartz, Ilan S.

2019

Overview

Background Pulmonary computed tomography (CT) scans are commonly used as part of the clinical criteria in diagnostic workup of invasive fungal diseases like invasive aspergillosis, and may identify radiographic abnormalities, such as halo signs or air-crescent signs. We assessed the diagnostic utility of CT assessment in patients with hematologic malignancies or those who had undergone allogeneic hematopoietic stem cell transplantation in whom invasive aspergillosis was suspected. Methods This post-hoc analysis assessed data from a prospective, multicenter, international trial of voriconazole (with and without anidulafungin) in patients with suspected invasive aspergillosis (IA; proven, probable, or possible, using 2008 European Organisation for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria) [NCT00531479]. Eligible patients received at least one baseline lung CT scan. Results Of 395 patients included in this post-hoc analysis, 240 patients (60.8%) had ‘confirmed’ proven (9/240, 3.8%) or probable (231/240, 96.3%) invasive aspergillosis (cIA) and 155 patients (39.2%) had ‘non-confirmed’ invasive aspergillosis (all nIA; all possible IA (de Pauw et al., Clin Infect Dis 46:1813–21, 2008)). Mean age was 52.3 and 50.5 years, 56.3 and 60.0% of patients were male, and most patients were white (71.7 and 71.0%) in the cIA and nIA populations, respectively. Median baseline galactomannan was 1.4 (cIA) and 0.2 (nIA), mean Karnofsky score was 65.3 (cIA) and 66.8 (nIA), and mean baseline platelet count was 48.0 (cIA) and 314.1 (nIA). Pulmonary nodules (46.8% of all patients), bilateral lung lesions (37.5%), unilateral lung lesions (28.4%), and consolidation (24.8%) were the most common radiographic abnormalities. Ground-glass attenuation (cIA: 24.2%; nIA: 11.6%; P  < 0.01) and pulmonary nodules (cIA: 52.5%; nIA: 38.1%; P < 0.01) were associated with cIA. Other chest CT scan abnormalities (including halo signs and air-crescent signs) at baseline in patients with hematologic malignancy or hematopoietic stem cell transplantation, and suspected IA, were not associated with cIA. Conclusions These findings highlight the limitations in the sensitivity of chest CT scans for the diagnosis of IA, and reinforce the importance of incorporating other available clinical data to guide management decisions on individual patients, including whether empirical treatment is reasonable, pending full evaluation. Trial registration NCT00531479 (First posted on ClinicalTrials.gov on September 18, 2007)

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abnormalities / Adult / Allergies / Allergy / Anidulafungin - therapeutic use / Antibiotics / Antifungal agents / Antifungal treatment / Aspergillosis / Attenuation / Bacterial and fungal diseases / Blood cancer / CAT scans / Chest / Communicable diseases / Complications and side effects / Computed tomography / Computed tomography scans / Diagnosis / Diagnostic imaging / Diagnostic systems / Empirical analysis / Female / Fungal diseases / Fungal infections / Fungi / Hematologic diseases / Hematologic Neoplasms - microbiology / Hematologic Neoplasms - mortality / Hematology / Hematopoietic stem cell transplant / Hematopoietic stem cell transplantation / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic stem cells / Humans / Immunocompromised host / Infections / Infectious Diseases / Internal Medicine / Invasive aspergillosis / Invasive Pulmonary Aspergillosis - diagnostic imaging / Invasive Pulmonary Aspergillosis - drug therapy / Invasive Pulmonary Aspergillosis - mortality / Invasiveness / Karnofsky Performance Status / Lesions / Lung - microbiology / Lung - pathology / Lung diseases / Lung nodules / Lungs / Male / Malignancy / Mannans - blood / Medical examination / Medical imaging / Medical Microbiology / Medical research / Medicine / Medicine & Public Health / Middle Aged / Mortality / Mycoses / Neutropenia / Nodules / Parasitology / Patients / Platelet Count / Population / Prospective Studies / Pulmonary aspergillosis / Radiographic abnormalities / Research Article / Risk factors / Signs / Stem cell transplantation / Stem cells / Surgery / Tomography / Tomography, X-Ray Computed - methods / Transplantation / Tropical Medicine / Voriconazole / Voriconazole - therapeutic use