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A risk prediction score for invasive mold disease in patients with hematological malignancies
Marta Stanzani1, Russell E Lewis, Mauro Fiacchini
1Institute of Hematology, Department of Hematology and Clinical Oncology, "Lorenzo e Ariosto Seràgnoli" S'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Background:
A risk score for invasive mold disease (IMD) in patients with hematological malignancies could facilitate patient screening and improve the targeted use of antifungal prophylaxis.
Methods:
We retrospectively analyzed 1,709 hospital admissions of 840 patients with hematological malignancies (2005-2008) to collect data on 17 epidemiological and treatment-related risk factors for IMD. Multivariate regression was used to develop a weighted risk score based on independent risk factors associated with proven or probable IMD, which was prospectively validated during 1,746 hospital admissions of 855 patients from 2009-2012.
Results:
Of the 17 candidate variables analyzed, 11 correlated with IMD by univariate analysis, but only 4 risk factors (neutropenia, lymphocytopenia or lymphocyte dysfunction in allogeneic hematopoietic stem cell transplant recipients, malignancy status, and prior IMD) were retained in the final multivariate model, resulting in a weighted risk score 0-13. A risk score of < 6 discriminated patients with low (< 1%) versus higher incidence rates (> 5%) of IMD, with a negative predictive value (NPV) of 0.99, (95% CI 0.98-0.99). During 2009-2012, patients with a calculated risk score at admission of < 6 had significantly lower 90-day incidence rates of IMD compared to patients with scores > 6 (0.9% vs. 10.6%, P <0.001).
Conclusion:
An objective, weighted risk score for IMD can accurately discriminate patients with hematological malignancies at low risk for developing mold disease, and could possibly facilitate "screening-out" of low risk patients less likely to benefit from intensive diagnostic monitoring or mold-directed antifungal prophylaxis.
Insights
A new risk score accurately identifies patients with hematological malignancies at low risk for invasive mold disease (IMD). This score can help target antifungal prophylaxis and reduce unnecessary monitoring for low-risk patients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Invasive mold disease (IMD) poses a significant risk to patients with hematological malignancies.
- Targeted antifungal prophylaxis and improved patient screening are crucial for managing IMD risk.
- Developing a reliable risk assessment tool is essential for optimizing patient care.
Purpose of the Study:
- To develop and validate a weighted risk score for predicting invasive mold disease (IMD) in patients with hematological malignancies.
- To identify independent risk factors associated with IMD in this patient population.
- To facilitate the screening of low-risk patients who may not require intensive monitoring or prophylaxis.
Main Methods:
- Retrospective analysis of 1,709 hospital admissions (2005-2008) in 840 patients with hematological malignancies.
- Identification of 17 epidemiological and treatment-related risk factors for IMD.
- Development of a weighted risk score using multivariate regression and prospective validation (1,746 admissions, 2009-2012).
Main Results:
- A weighted risk score (0-13) was developed based on four independent risk factors: neutropenia, lymphocytopenia/lymphocyte dysfunction (in HSCT recipients), malignancy status, and prior IMD.
- A risk score < 6 effectively discriminated low (<1%) from higher (>5%) IMD incidence rates, with a negative predictive value of 0.99.
- Prospective validation showed significantly lower 90-day IMD incidence in patients with scores < 6 (0.9%) versus > 6 (10.6%) (P <0.001).
Conclusions:
- An objective, weighted risk score accurately identifies patients with hematological malignancies at low risk for developing invasive mold disease.
- This risk score can aid in "screening-out" low-risk patients, potentially reducing the need for intensive diagnostic monitoring.
- The score supports a more targeted approach to antifungal prophylaxis, improving resource allocation and patient management.