Wehbe Saliba, Chaftari Anne-Marie, Hachem Ray, Dagher Hiba, Haddad Andrea, Philip Ann, Jiang Ying, Zakhour Ramia, Bakht Peter, Shrestha Jishna, Lamie Peter, Sherchan Robin, Makhoul Jennifer, Chaftari Patrick, Raad Issam I
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Division of Infectious Diseases, Department of Pediatrics, McGovern Medical School at UTHealth, Houston, TX 77030, USA.
J Fungi (Basel). 2025 May 3;11(5):355. doi: 10.3390/jof11050355.
Invasive aspergillosis (IA) is a life-threatening fungal infection that primarily affects immunocompromised individuals and has high morbidity and mortality rates, necessitating timely diagnosis and treatment. This study aimed to evaluate the prognostic utility of serum and bronchoalveolar lavage (BAL) fluid galactomannan levels, as well as galactomannan kinetics, in patients with IA. : We retrospectively reviewed the medical records of patients who were diagnosed with proven or probable IA from March 2016 to April 2024 at a tertiary cancer center. The collected data included patient characteristics, baseline and peak galactomannan levels in serum and BAL fluid, galactomannan trends, and clinical outcomes. Subgroup analyses were performed to assess the prognostic value of dual-source galactomannan positivity (positive serum and BAL fluid galactomannan levels). Elevated baseline serum galactomannan levels independently predicted treatment non-response ( = 0.039) and 12-week all-cause mortality ( < 0.001). Peak serum and BAL fluid galactomannan levels were strongly associated with poor clinical outcomes ( < 0.01). Compared to single-source galactomannan positivity, dual-source galactomannan positivity was linked to reduced treatment response (22% vs. 43%, = 0.01) and higher IA-attributable mortality (52% vs. 27%, = 0.002). Patients with neutropenia had poorer outcomes compared to patients without neutropenia, but neutrophil recovery dramatically improved survival (25% vs. 69% mortality, < 0.0001). Early galactomannan kinetics and malignancy type had limited prognostic value. Our findings highlight the potential role of galactomannan as a key biomarker for early prognostication for IA. The strong association between galactomannan levels and clinical outcomes suggests its utility in identifying high-risk patients who may benefit from more aggressive management. Further studies are needed to introduce a nuanced and context-specific use of galactomannan into clinical practice and assess its role as a prognostic biomarker.
侵袭性曲霉病（IA）是一种危及生命的真菌感染，主要影响免疫功能低下的个体，发病率和死亡率很高，因此需要及时诊断和治疗。本研究旨在评估血清和支气管肺泡灌洗（BAL）液中半乳甘露聚糖水平以及半乳甘露聚糖动力学在IA患者中的预后价值。我们回顾性分析了2016年3月至2024年4月在一家三级癌症中心被诊断为确诊或疑似IA的患者的病历。收集的数据包括患者特征、血清和BAL液中的基线和峰值半乳甘露聚糖水平、半乳甘露聚糖趋势以及临床结局。进行亚组分析以评估双源半乳甘露聚糖阳性（血清和BAL液半乳甘露聚糖水平均为阳性）的预后价值。基线血清半乳甘露聚糖水平升高独立预测治疗无反应（P = 0.039）和12周全因死亡率（P < 0.001）。血清和BAL液半乳甘露聚糖峰值水平与不良临床结局密切相关（P < 0.01）。与单源半乳甘露聚糖阳性相比，双源半乳甘露聚糖阳性与治疗反应降低相关（22%对43%，P = 0.01），且IA归因死亡率更高（52%对27%，P = 0.002）。与无中性粒细胞减少症的患者相比，中性粒细胞减少症患者的结局较差，但中性粒细胞恢复显著改善了生存率（死亡率25%对69%，P < 0.0001）。早期半乳甘露聚糖动力学和恶性肿瘤类型的预后价值有限。我们的研究结果突出了半乳甘露聚糖作为IA早期预后关键生物标志物的潜在作用。半乳甘露聚糖水平与临床结局之间的密切关联表明其在识别可能从更积极治疗中获益的高危患者方面的效用。需要进一步研究将半乳甘露聚糖的细微差别和根据具体情况的使用引入临床实践，并评估其作为预后生物标志物的作用。
