Long-Term Kinetics of Serum Galactomannan during Treatment of Complicated Invasive Pulmonary Aspergillosis

Abstract

Several studies have evaluated the serum galactomannan (GM) antigen assay in pediatric patients, and there is convincing evidence for its usefulness as a diagnostic tool for invasive Aspergillus infections in patients with acute leukemias or post allogeneic hematopoietic cell transplantation (HCT). Less is known about the utility of the assay in monitoring responses to treatment in patients with established invasive aspergillosis (IA). Here, we present the long-term kinetics of serum galactomannan in two severely immunocompromised adolescents with invasive pulmonary aspergillosis (IPA) who were cured after complicated clinical courses. We also review the utility of the GM antigen assay in serum as a prognostic tool around the time of diagnosis of IA and as a biomarker to monitor disease activity in patients with established IA and assess responses to systemic antifungal therapy.

Keywords: antigen; aspergillosis; cancer; children; galactomannan; kinetics; leukemia; monitoring; transplantation; treatment.

Figure 1

Kinetics of the GM serum antigen index over time in patient 1. (A) GM kinetics over time, key clinical events, and corresponding neutrophil and CD4+ T-lymphocyte counts. (B) Corresponding pulmonary CT imaging findings in the left lung: (a) 8 August; (b) 2 September; (c) 10 October; and (d) 21 March.

Figure 2

Kinetics of the GM serum antigen index over time in patient 2. (A) GM kinetics over time, key clinical events, and corresponding neutrophil and CD4+ T-lymphocyte counts. (B) Corresponding CT imaging findings in the left lung: (a) April 23; (b) June 14; (c) August 22 (section with the new lesions in the right lung copied on top of the section of the left lung); and (d) June 19.