Galactomannan, β-D-Glucan, and Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis

TY - JOUR

T1 - Galactomannan, β-D-Glucan, and Polymerase Chain Reaction-Based Assays for the Diagnosis of Invasive Fungal Disease in Pediatric Cancer and Hematopoietic Stem Cell Transplantation

T2 - A Systematic Review and Meta-Analysis

AU - Lehrnbecher, Thomas

AU - Robinson, Paula D

AU - Fisher, Brian T

AU - Castagnola, Elio

AU - Groll, Andreas H

AU - Steinbach, William J

AU - Zaoutis, Theoklis E

AU - Negeri, Zelalem F

AU - Beyene, Joseph

AU - Phillips, Bob

AU - Sung, Lillian

N1 - © The Authors, 2016. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details. Embargo period: 12 months.

PY - 2016/11/15

Y1 - 2016/11/15

N2 - We systematically reviewed and analyzed the available data for galactomannan (GM), beta-D-glucan (BG), and polymerase-chain reaction (PCR)-based assays to detect invasive fungal disease (IFD) in pediatric cancer or hematopoietic stem cell transplantation (HSCT) patients when used as screening tools during immunosuppression or as diagnostic tests in patients presenting with symptoms such as fever during neutropenia (FN). Out of 1,532 studies screened, 25 studies reported on GM (n=19), BG (n=3) and PCR (n=11). All fungal biomarkers demonstrated highly variable sensitivity, specificity and positive predictive values, and these were generally poor in both clinical settings. GM negative predictive values were high, ranging from 85-100% for screening and 70-100% in the diagnostic setting, but failure to identify non-Aspergillus molds limits its usefulness. Future work could focus on the usefulness of combinations of fungal biomarkers in pediatric cancer and HSCT.

AB - We systematically reviewed and analyzed the available data for galactomannan (GM), beta-D-glucan (BG), and polymerase-chain reaction (PCR)-based assays to detect invasive fungal disease (IFD) in pediatric cancer or hematopoietic stem cell transplantation (HSCT) patients when used as screening tools during immunosuppression or as diagnostic tests in patients presenting with symptoms such as fever during neutropenia (FN). Out of 1,532 studies screened, 25 studies reported on GM (n=19), BG (n=3) and PCR (n=11). All fungal biomarkers demonstrated highly variable sensitivity, specificity and positive predictive values, and these were generally poor in both clinical settings. GM negative predictive values were high, ranging from 85-100% for screening and 70-100% in the diagnostic setting, but failure to identify non-Aspergillus molds limits its usefulness. Future work could focus on the usefulness of combinations of fungal biomarkers in pediatric cancer and HSCT.

KW - invasive fungal disease

KW - galactomannan

KW - ?-D-glucan

KW - polymerase chain reaction

KW - pediatric

KW - Invasive Fungal Infections/diagnosis

KW - Humans

KW - Child, Preschool

KW - Hematopoietic Stem Cell Transplantation

KW - Infant

KW - beta-Glucans/analysis

KW - Young Adult

KW - Neoplasms/therapy

KW - Polymerase Chain Reaction/methods

KW - Mannans/analysis

KW - Adolescent

KW - Adult

KW - Child

KW - Infant, Newborn

UR - http://www.scopus.com/inward/record.url?scp=84994414330&partnerID=8YFLogxK

U2 - 10.1093/cid/ciw592

DO - 10.1093/cid/ciw592

M3 - Review article

C2 - 27567122

VL - 63

SP - 1340

EP - 1348

JO - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

SN - 1058-4838

IS - 10

M1 - ciw592

ER -