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Liquid Biopsy for Invasive Mold Infections in Hematopoietic Cell Transplant Recipients With Pneumonia Through Next-Generation Sequencing of Microbial Cell-Free DNA in Plasma
Resource type
Journal Article
Authors/contributors
- Hill, Joshua A (Author)
- Dalai, Sudeb C (Author)
- Hong, David K (Author)
- Ahmed, Asim A (Author)
- Ho, Carine (Author)
- Hollemon, Desiree (Author)
- Blair, Lily (Author)
- Maalouf, Joyce (Author)
- Keane-Candib, Jacob (Author)
- Stevens-Ayers, Terry (Author)
- Boeckh, Michael (Author)
- Blauwkamp, Timothy A (Author)
- Fisher, Cynthia E (Author)
Title
Liquid Biopsy for Invasive Mold Infections in Hematopoietic Cell Transplant Recipients With Pneumonia Through Next-Generation Sequencing of Microbial Cell-Free DNA in Plasma
Abstract
Noninvasive diagnostic options are limited for invasive mold infections (IMIs). We evaluated the performance of a plasma microbial cell-free DNA sequencing (mcfDNA-Seq) test for diagnosing pulmonary IMI after hematopoietic cell transplant (HCT). We retrospectively assessed the diagnostic performance of plasma mcfDNA-Seq next-generation sequencing in 114 HCT recipients with pneumonia after HCT who had stored plasma obtained within 14 days of diagnosis of proven/probable Aspergillus IMI (n = 51), proven/probable non-Aspergillus IMI (n = 24), possible IMI (n = 20), and non-IMI controls (n = 19). Sequences were aligned to a database including >400 fungi. Organisms above a fixed significance threshold were reported. Among 75 patients with proven/probable pulmonary IMI, mcfDNA-Seq detected ≥1 pathogenic mold in 38 patients (sensitivity, 51% [95% confidence interval {CI}, 39%–62%]). When restricted to samples obtained within 3 days of diagnosis, sensitivity increased to 61%. McfDNA-Seq had higher sensitivity for proven/probable non-Aspergillus IMI (sensitivity, 79% [95% CI, 56%–93%]) compared with Aspergillus IMI (sensitivity, 31% [95% CI, 19%–46%]). McfDNA-Seq also identified non-Aspergillus molds in an additional 7 patients in the Aspergillus subgroup and Aspergillus in 1 patient with possible IMI. Among 19 non-IMI pneumonia controls, mcfDNA-Seq was negative in all samples, suggesting a high specificity (95% CI, 82%–100%) and up to 100% positive predictive value (PPV) with estimated negative predictive values (NPVs) of 81%–99%. The mcfDNA-Seq assay was complementary to serum galactomannan index testing; in combination, they were positive in 84% of individuals with proven/probable pulmonary IMI. Noninvasive mcfDNA-Seq had moderate sensitivity and high specificity, NPV, and PPV for pulmonary IMI after HCT, particularly for non-Aspergillus species.
Publication
Clinical Infectious Diseases
Date
2021-12-01
Volume
73
Issue
11
Pages
e3876-e3883
Journal Abbr
Clinical Infectious Diseases
Accessed
7/27/23, 8:46 AM
ISSN
1058-4838
Library Catalog
Silverchair
Citation
Hill, J. A., Dalai, S. C., Hong, D. K., Ahmed, A. A., Ho, C., Hollemon, D., Blair, L., Maalouf, J., Keane-Candib, J., Stevens-Ayers, T., Boeckh, M., Blauwkamp, T. A., & Fisher, C. E. (2021). Liquid Biopsy for Invasive Mold Infections in Hematopoietic Cell Transplant Recipients With Pneumonia Through Next-Generation Sequencing of Microbial Cell-Free DNA in Plasma. Clinical Infectious Diseases, 73(11), e3876–e3883. https://doi.org/10.1093/cid/ciaa1639
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