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

  1. Lillian Sung10
  1. 1Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe University, Frankfurt, Germany
  2. 2Pediatric Oncology Group of Ontario, Toronto, Canada
  3. 3Division of Pediatric Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
  4. 4Infectious Diseases Unit, Istituto Giannina Gaslini, Genova, Italy
  5. 5Infectious Disease Research Program, Center for Bone Marrow Transplantation, Department of Pediatric Hematology/Oncology, University Children's Hospital Muenster, Albert Schweitzer Campus 1, Building A1, 48149 Muenster, Germany
  6. 6Division of Pediatric Infectious Diseases, Duke University Medical Center, Durham, NC 27710, USA
  7. 7Department of Mathematics & Statistics
  8. 8Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
  9. 9Leeds General Infirmary, Leeds Teaching Hospitals, NHS Trust, Leeds, United Kingdom and Centre for Reviews and Dissemination, University of York, York, UK
  10. 10Division of Haematology/Oncology, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
  1. Address for Correspondence: Thomas Lehrnbecher, MD Division of Pediatric Hematology and Oncology, Hospital for Children and Adolescents Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany; E-mail: Thomas.Lehrnbecher{at}


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.

  • Received May 27, 2016.
  • Accepted August 19, 2016.

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