移植前胸部高分辨率 CT 和血清半乳甘露聚糖指数在预测异基因造血细胞移植受者移植后侵袭性肺曲霉病中的作用。
Role of pre-transplant chest high-resolution computed tomography and serum galactomannan index in predicting post-transplant invasive pulmonary aspergillosis in allogeneic hematopoietic cell transplant recipients.
机构信息
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
Transpl Infect Dis. 2021 Aug;23(4):e13632. doi: 10.1111/tid.13632. Epub 2021 May 22.
INTRODUCTION
The role of pre-HCT chest high-resolution computed tomography (HRCT) and serum galactomannan index (GMI) in predicting the post-allogeneic hematopoietic cell transplant (HCT) invasive pulmonary aspergillosis (IPA) is debatable.
METHODS
This was a single-center, prospective study from 2014 to 2019. The primary objective was to study if pre-HCT chest HRCT and serum GMI predicted IPA post-HCT. The secondary objective was day +100 mortality. All consecutive, consenting patients of ≥12 years of age undergoing allo-HCT were included and had pre-HCT chest HRCT and serum GMI. All patients received mold active antifungal prophylaxis. The EORTC/MSG criteria were used for the diagnosis of IPA.
RESULTS
A total of 82 patients with median age 27 years (12-59 years) were included. The underlying diagnoses included hematological malignancies (79%) and aplastic anemia (21%). Fifteen percent of patients was treated for prior history of probable IPA (>6 weeks before HCT). Pre-HCT chest HRCT satisfied EORTC clinical criteria in 24% patients. Serum GMI ≥0.5 was seen in 27% of patients. Post-HCT probable IPA was seen in 24% of patients. There were more patients with pre-HCT chest HRCT findings satisfying EORTC clinical criteria (45% vs. 18%, P = .014) and GMI ≥0.5 (45% vs. 21%, P = .03) in the group with post-HCT IPA compared to those without IPA. There was higher day+100 mortality in patients with post-HCT IPA (55% vs. 18%, P = .001).
CONCLUSIONS
The presence of EORTC clinical criteria on pre-HCT chest HRCT, serum GMI ≥0.5, and prior history of IPA predicted post-HCT IPA.
简介
异体造血细胞移植（HCT）前胸部高分辨率计算机断层扫描（HRCT）和血清半乳甘露聚糖指数（GMI）在预测异基因 HCT 后侵袭性肺曲霉病（IPA）中的作用存在争议。
方法
这是一项 2014 年至 2019 年进行的单中心前瞻性研究。主要目的是研究 HCT 前胸部 HRCT 和血清 GMI 是否预测 HCT 后 IPA。次要目标是第 100 天死亡率。所有连续同意接受 allo-HCT 的年龄≥12 岁的患者均纳入研究，并进行 HCT 前胸部 HRCT 和血清 GMI 检查。所有患者均接受了 mold 活性抗真菌预防。EORTC/MSG 标准用于 IPA 的诊断。
结果
共纳入 82 例中位年龄为 27 岁（12-59 岁）的患者。基础诊断包括血液系统恶性肿瘤（79%）和再生障碍性贫血（21%）。15%的患者因 HCT 前 6 周内有疑似 IPA 的病史而接受治疗。24%的患者 HCT 前胸部 HRCT 满足 EORTC 临床标准。27%的患者血清 GMI≥0.5。24%的患者出现 HCT 后疑似 IPA。与无 IPA 的患者相比，HCT 后 IPA 组有更多的患者满足 EORTC 临床标准（45%比 18%，P=0.014）和 GMI≥0.5（45%比 21%，P=0.03）。HCT 后 IPA 患者的第 100 天死亡率更高（55%比 18%，P=0.001）。
结论
HCT 前胸部 HRCT 上存在 EORTC 临床标准、血清 GMI≥0.5 和 IPA 既往史可预测 HCT 后 IPA。
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