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. 2020 Mar 13;6(1):36.
doi: 10.3390/jof6010036.

Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Jannik Stemler  1   2   3 , Caroline Bruns  1   2   3 , Sibylle C Mellinghoff  1   2   3 , Nael Alakel  4 , Hamdi Akan  5 , Michelle Ananda-Rajah  6 , Jutta Auberger  7 , Peter Bojko  8 , Pranatharthi H Chandrasekar  9 , Methee Chayakulkeeree  10 , José A Cozzi  11 , Elizabeth A de Kort  12 , Andreas H Groll  13 , Christopher H Heath  14   15   16 , Larissa Henze  17 , Marcos Hernandez Jimenez  18   19 , Souha S Kanj  20 , Nina Khanna  21 , Michael Koldehoff  22 , Dong-Gun Lee  23 , Alina Mager  24 , Francesco Marchesi  25 , Rodrigo Martino-Bufarull  26 , Marcio Nucci  27 , Jarmo Oksi  28 , Livio Pagano  29   30 , Bob Phillips  31   32 , Juergen Prattes  33 , Athina Pyrpasopoulou  34 , Werner Rabitsch  35 , Enrico Schalk  36 , Martin Schmidt-Hieber  37 , Neeraj Sidharthan  38 , Pere Soler-Palacín  39 , Anat Stern  40 , Barbora Weinbergerová  41 , Aline El Zakhem  42 , Oliver A Cornely  1   2   3   43 , Philipp Koehler  1   2
Affiliations

Baseline Chest Computed Tomography as Standard of Care in High-Risk Hematology Patients

Jannik Stemler et al. J Fungi (Basel). .

Abstract

Baseline chest computed tomography (BCT) in high-risk hematology patients allows for the early diagnosis of invasive pulmonary aspergillosis (IPA). The distribution of BCT implementation in hematology departments and impact on outcome is unknown. A web-based questionnaire was designed. International scientific bodies were invited. The estimated numbers of annually treated hematology patients, chest imaging timepoints and techniques, IPA rates, and follow-up imaging were assessed. In total, 142 physicians from 43 countries participated. The specialties included infectious diseases (n = 69; 49%), hematology (n = 68; 48%), and others (n = 41; 29%). BCT was performed in 57% (n = 54) of 92 hospitals. Upon the diagnosis of malignancy or admission, 48% and 24% performed BCT, respectively, and X-ray was performed in 48% and 69%, respectively. BCT was more often used in hematopoietic cell transplantation and in relapsed acute leukemia. European centers performed BCT in 59% and non-European centers in 53%. Median estimated IPA rate was 8% and did not differ between BCT (9%; IQR 5-15%) and non-BCT centers (7%; IQR 5-10%) (p = 0.69). Follow-up computed tomography (CT) for IPA was performed in 98% (n = 90) of centers. In high-risk hematology patients, baseline CT is becoming a standard-of-care. Chest X-ray, while inferior, is still widely used. Randomized, controlled trials are needed to investigate the impact of BCT on patient outcome.

Keywords: antifungal prophylaxis; infection in hematology; invasive aspergillosis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Geographic Distribution of Survey Participants.
Figure 2
Figure 2
Shows the different timepoints and techniques of chest imaging in high-risk hematology patients in detail; n = 95. CT = computed tomography.
Figure 3
Figure 3
Underlying condition and performance of X-ray or CT at diagnosis or at admission, respectively—defined as Baseline CT; n = 95. # Numbers are super-additive. CT = computed tomography; AML = acute myeloid leukemia; ALL = acute lymphoblastic leukemia; HCT = hematopoietic cell transplantation.
Figure 4
Figure 4
Timepoints and percentages of follow-up CT if IPA was diagnosed in a patient, n = 92 valid responses. CT = computed tomography; IPA = invasive pulmonary aspergillosis.
See this image and copyright information in PMC

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