Immunologic Markers for Treatment Monitoring in Invasive Aspergillosis – Results from a Multicenter ECMM Study

Invasive aspergillosis (IA) remains a major cause of morbidity and mortality in immunocompromised patients, with limited tools available for treatment monitoring and outcome prediction. As part of the ECMM working group on immunologic markers, a multicenter study evaluated the role of circulating inflammatory proteins for diagnosis and monitoring antifungal treatment response and predicting clinical outcomes in IA.

The results on the potential of immune markers for diagnosis of invasive aspergillosis in a matched cohort study has been published before:

Full article: https://pmc.ncbi.nlm.nih.gov/articles/PMC10896822/

For evaluation of treatment monitoring, thprospective multicenter ECMM study included patients with probable or proven IA and underlying hematological malignancies across several European centers. Serial serum samples collected over the first three weeks of antifungal therapy were analyzed using a high-throughput proteomic platform assessing inflammation-related biomarkers. Results were correlated with clinical response at day 7 and day 30, need for antifungal therapy escalation, and survival.

The study identified distinct temporal patterns of immune marker expression associated with treatment response. During early treatment, several inflammatory proteins were upregulated in patients showing clinical improvement, whereas specific markers such as Flt3L were associated with a lower likelihood of requiring switch to salvage antifungal therapy. In later stages, reduced levels of markers including MMP-10 and CXCL6 were associated with clinical improvement and higher survival probability.

Overall, the findings highlight the potential of host-derived immunologic biomarkers for dynamic treatment monitoring in invasive aspergillosis. These results support the concept that integrating immune markers with existing diagnostic tools may improve early identification of treatment failure and enable more personalized antifungal management strategies.

Full article: https://doi.org/10.1093/infdis/jiag140