359. Baseline serum Aspergillus galactomannan index among Aspergillus species in hematologic malignancies patients with invasive pulmonary aspergillosis
Session: Poster Abstract Session: Fungal Disease: Management and Outcomes
Thursday, October 4, 2018
Room: S Poster Hall
Background: Most of the information regarding serum Aspergillus galactomannan (sAGM) index in patients (pts) with invasive pulmonary aspergillosis (IPA) and hematological malignancies (HM) is derived by infections caused by Aspergillus fumigatus, the predominant Aspergillus species causing IPA. It is unclear if differences exist in sAGM in IPA caused by non-fumigatus Aspergillus species.

Methods: We analyzed all consecutive pts with proven or probable culture-documented IPA (EORTC/MSG criteria) at MD Anderson Cancer Center (2006-2017) who had a sAGM obtain within a week of IPA diagnosis (day -6 to day 0 of fungal culture). sAGM result was categorized as either undetectable (GM=0), negative (0.0>GM<0.5) or ≥ than a 0.5 index value. Baseline demographic characteristics and 42 day crude mortality after the diagnosis of IPA were collected

Results: We identified 72 (proven in 4, probable in 68) pts with culture-documented IPA. Most common HM was AML in 34 (47.2%) pts and CLL in 15 (20.8%) pts. Most (47/72, 65, 2%) pts developed IPA despite mold-active antifungals. Forty three (60%) pts had A. fumigatus, 19 (26%) A. terreus, and 10 (14%) A. flavus. Mortality at 42 day was 22.2% (16/72) pts. Serum AGM at the baseline was undetectable in only one (2%) Aspergillus fumigatus IPA. Serum AGM positivity was seen in 28 (65%), 10 (53%), and 5 (50%), among the Aspergillus fumigatus, terreus, and flavus species respectively (p=0.52), with a median sAGM level of 1.32 (0.50-9.36), 0.87 (0.50-9.70), and 1.11 (0.57-8.58) respectively (p=0.99). There were not significant differences in baseline neutropenia, extent of lung involvement by chest CT, prior mold-active antifungal use, prior SCT as well as 42 day mortality among pts with IPA caused by each of the three Aspergillus species.

Conclusion: In the setting of common prior mold-active antifungal use, we found no apparent differences in sAGM among Aspergillus species causing IPA in HM pts. Mortality was comparable and worse in pts with high baseline sAGM levels.

Eleni Magira, MD PhD, Department of Infectious Disease, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX; First Department of Critical Care Medicine, Medical School of National and Kapodistrian University of Athens, Athens, Greece, Ying Jiang, MS, Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, Sang Taek Heo, M.D. PhD., Internal Medicine, Jeju National University School of Medicine, Jeju Special-Governing Province, Korea, Republic of (South), Jeffrey Tarrand, MD, Department of Microbiology, The University of Texas MD Anderson Cancer Center, Houston, TX and Dimitrios P. Kontoyiannis, MD, ScD, PhD (Hon), FACP, FIDSA, FECMM, FAAM, Department of Infectious Diseases Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

E. Magira, None

Y. Jiang, None

S. T. Heo, None

J. Tarrand, None

D. P. Kontoyiannis, Merck: Consultant , Research support and Speaker honorarium . Pfizer: Consultant , Research support . Astellas: Consultant , Research support and Speaker honorarium . Gilead: Speaker's Bureau , Speaker honorarium . F2G Inc: Speaker's Bureau , Speaker honorarium . Cidara Inc: Speaker's Bureau , Speaker honorarium . Jazz Pharmaceuticals: Speaker's Bureau , Speaker honorarium .

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