Baseline chest computed tomography for diagnosis of invasive aspergillosis in patients with acute myeloid leukaemia treated with intensive chemotherapy: A retrospective single-centre cohort study.

acute myeloid leukaemia computed tomography invasive pulmonary aspergillosis screening

Journal

Mycoses
ISSN: 1439-0507
Titre abrégé: Mycoses
Pays: Germany
ID NLM: 8805008

Informations de publication

Date de publication:
Mar 2024
Historique:
revised: 11 12 2023
received: 01 08 2023
accepted: 01 03 2024
medline: 13 3 2024
pubmed: 13 3 2024
entrez: 13 3 2024
Statut: ppublish

Résumé

Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy. Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions. Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024). Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.

Sections du résumé

BACKGROUND BACKGROUND
Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy.
METHODS METHODS
Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions.
RESULTS RESULTS
Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024).
CONCLUSION CONCLUSIONS
Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.

Identifiants

pubmed: 38477367
doi: 10.1111/myc.13715
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e13715

Informations de copyright

© 2024 The Authors. Mycoses published by Wiley-VCH GmbH.

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Auteurs

Emilie Janssens (E)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.

Sammy Huygens (S)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.
Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.

Ine Moors (I)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.

Anke Delie (A)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.

Tessa Kerre (T)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.

Yannick Vande Weygaerde (Y)

Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.

Eva Van Braeckel (E)

Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
Respiratory Infection and Defense lab (RIDL), Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.

Jerina Boelens (J)

Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.

Lieve Morbée (L)

Department of Radiology, Ghent University Hospital, Ghent, Belgium.

Alexander Schauwvlieghe (A)

Department of Hematology, Ghent University Hospital, Ghent, Belgium.
Department of Hematology, AZ Sint-Jan, Bruges, Belgium.

Classifications MeSH