Probable Invasive Aspergillosis without Prespecified Radiologic Findings: Proposal for Inclusion of a New Category of Aspergillosis and Implications for Studying Novel Therapies
Abstract
BACKGROUND: The European Organization for Research and Treatment of Cancer (EORTC) and the Mycosis Study Group (MSG) definition of invasive aspergillosis used in clinical trials lacks sensitivity. We hypothesize that giving lower weight to the prespecified radiologic findings in patients with a positive serum galactomannan index test result will improve the definition's diagnostic sensitivity. METHODS: The medical records of 121 patients with 125 cases of invasive aspergillosis treated at a referral cancer institute from January 2003 through December 2009 were reviewed. Aspergillosis was diagnosed as EORTC-MSG proven or probable (controls, 83) or probable invasive aspergillosis without prespecified radiologic criteria (cases, 42). The latter differed from the former by the inclusion of patients whose pulmonary infiltrates, although well described in invasive aspergillosis, do not fulfill EORTC-MSG invasive aspergillosis requirements. The host, clinical, and mycologic characteristics and survival of cases and controls served as end points. RESULTS: A total of 114 (91%) of 125 patients had multiple myeloma. Patients had a median age was 65 years (range, 26-81 years), and 74 were male. All had received antineoplastic therapy, including stem cell transplantation (58 [46%]). Aspergillosis involved lungs (88 patients), sinuses (9 patients), or both (28 patients). Except for higher median baseline platelet count and shorter duration of neutropenia among cases, there were no statistically significant differences between groups on all predefined end points, including 4-, 6-, and 12-week survival. Eleven of 26 cases were reclassified as controls on the basis of subsequent imaging. CONCLUSIONS: Except for less well-circumscribed consolidations, the host, clinical, radiologic, and mycologic characteristics and outcome of patients with probable invasive aspergillosis but without prespecified radiologic criteria are similar to those with EORTC-MSG invasive aspergillosis. Enrolling such patients in clinical trials of novel therapies will increase the pool of eligible study participants and improve trial speed and efficiency.
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Clinical and radiologic presentation of IPA in the expanding group of nonneutropenic patients who develop infection is atypical, including cases with tree-in-bud opacities or diffuse ground glass appearance in CT.
“Nonetheless, clinical and radiologic presentation of IPA in the expanding group of nonneutropenic patients who develop infection is atypical, including cases with tree-in-bud opacities or diffuse ground glass appearance in CT (95).”
From Aspergillus fumigatus and Aspergillosis in 2019 (2019) · cites this paper as [95]
A large proportion of IPA cases still are not detected by existing criteria, especially in nonneutropenic patients who possess atypical clinical and radiographic features of infection.
“However, a large proportion of IPA cases still are not detected by existing criteria, especially in nonneutropenic patients who possess atypical clinical and radiographic features of infection (95–97).”
From Aspergillus fumigatus and Aspergillosis in 2019 (2019) · cites this paper as [95]
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- Authors
- Nucci, M., Nouér, S. A., Grazziutti, M., Kumar, N. S., Barlogie, B., & Anaissie, E.
- Affiliations
- Hospital Universitário Clementino Fraga Filho (BR)
- University of Arkansas for Medical Sciences (US)
- Corresponding author
- Anaissie, Elias
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2010-12
- Volume
- 51
- Issue
- 11
- Pages
- 1273-1280
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W2144686332
- Cited by
- 112
- References
- 33
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 1 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 5 · 2019: 8 · 2018: 5 · 2017: 5 · 2016: 13 · 2015: 8 · 2014: 6 · 2013: 9 · 2012: 20
- FWCI
- 8.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Infectious Diseases (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Fungal and yeast genetics research
- Keywords
- invasive aspergillosis, diagnostic sensitivity, serum galactomannan, pulmonary infiltrates, multiple myeloma, stem cell transplantation, antineoplastic therapy, survival, inclusion and exclusion criteria
- MeSH terms
- Adult, Aged, Aged, 80 and over, Aspergillosis, Aspergillus, Female, Galactose, Humans, Lung, Male, Mannans, Middle Aged, Paranasal Sinuses, Radiography, Retrospective Studies, Survival Analysis, Treatment Outcome
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