Annals of Oncology Advance Access originally published online on January 27, 2008
Annals of Oncology 2008 19(5):984-989; doi:10.1093/annonc/mdm571
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Aspergillus galactomannan testing in patients with long-term neutropenia: implications for clinical management
1 Department of Hematology and Oncology, Charité Campus Benjamin Franklin, Berlin
2 Institute of Microbiology and Hygiene, Campus Charité Mitte, Berlin, Germany
* Correspondence to: Dr O. Penack, Department of Hematology and Oncology, Charité Campus Benjamin Franklin, Hindenburgdamm 30, D-12200 Berlin, Germany. Tel: +49-30-844523337; Fax: +49-30-84454468; E-mail: olaf.penack{at}charite.de
We carried out a prospective study on galactomannan enzyme immuno assay (GEI) (PlateliaTM Aspergillus EIA, Bio-Rad) testing for diagnosis of invasive aspergillosis (IA) in serum and broncho-alveolar lavage (BAL) in 200 patients with hematological malignancies and profound neutropenia. The incidence of proven and probable IA was 6% and 5.5%, respectively. In patients with fever or pneumonia, a single-positive GEI test result (galactomannan index 
0.5) had excellent specificity (100%). Sensitivity was relatively low (40%) at onset of fever, but increased to 94.7% after 6 days of fever. In patients with infiltrates in chest X-ray or computed tomography scan (n = 48), GEI testing in BAL had a favorable diagnostic accuracy as compared with GEI testing in serum (sensitivity100% versus 71%). Our findings indicate that antifungal therapy should be started immediately at onset of fever in neutropenic patients with positive GEI tests. In patients with fever refractory to broad-spectrum antibiotics (6 days of fever), the high diagnostic accuracy makes GEI testing a valuable diagnostic tool and questions the common strategy to carry out antifungal treatment irrespective of diagnostic testing in this situation. Our data also show that GEI testing in BAL can be useful for early diagnosis of IA in patients with hematological malignancies and pulmonary infiltrates.
Key words: antigen, Aspergillus, galactomannan, infection, neutropenia
Present address: Department of Immunology and Medicine, Memorial Sloan-Kettering Cancer Center, Zuckerman Building, 14th Floor, Room Z-1419, 1275 York Avenue, New York, NY 10021, USA Received for publication September 4, 2007. Revision received November 26, 2007. Accepted for publication November 27, 2007.
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