Prognostic Value of Serum and Bronchoalveolar Lavage Fluid Galactomannan Levels in Invasive Aspergillosis: An 8-Year Experience at a Tertiary Cancer Center

Background: Invasive aspergillosis (IA) is a life-threatening fungal infection that primarily affects immunocompromised individuals and has high morbidity and mortality rates, necessitating timely diagnosis and treatment. This study aimed to evaluate the prognostic utility of serum and bronchoalveolar lavage (BAL) fluid galactomannan levels, as well as galactomannan kinetics, in patients with IA. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with proven or probable IA from March 2016 to April 2024 at a tertiary cancer center. The collected data included patient characteristics, baseline and peak galactomannan levels from serum and BAL fluid, galactomannan trends, and clinical outcomes. Subgroup analyses were performed to assess the prognostic value of dual-source galactomannan positivity (positive serum and BAL galactomannan levels). Results: Elevated baseline serum galactomannan levels independently predicted treatment non-response (P = 0.039) and 12-week all-cause mortality (P < 0.001). Peak serum and BAL galactomannan levels were strongly associated with poor clinical outcomes (P < 0.01). Compared to single-source galactomannan positivity, dual-source galactomannan positivity was linked to reduced treatment response (22% vs. 42%, P = 0.009) and higher IA-attributable mortality (52% vs. 28%, P = 0.002). Patients with neutropenia had poorer outcomes compared to patients without neutropenia, but neutrophil recovery dramatically improved survival (25% vs. 69% mortality, P < 0.0001). Early galactomannan kinetics and malignancy type had limited prognostic value. Conclusion: Our findings highlight the potential role of galactomannan as a key biomarker for early prognostication for IA. The strong association between galactomannan levels and clinical outcomes suggests its utility in identifying high-risk patients who may benefit from more aggressive management. Further studies are needed to introduce a nuanced and context-specific use of galactomannan into clinical practice and assess its role as a prognostic biomarker.