Real-world application of the EORTC/MSGERC 2020 definitions in hematologic malignancy patients with suspected pulmonary fungal Infection: a single-center cohort study

Abstract

Purpose: Invasive fungal disease (IFD) remains a major cause of morbidity and mortality in patients with hematologic malignancies. The European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) definitions are widely used in research settings; however, their application in routine clinical practice is often constrained by limited availability of invasive diagnostic procedures and mycologic confirmation.
Materials and methods: This single-center retrospective cohort study included adult hematologic malignancy patients evaluated for suspected invasive pulmonary fungal infection at Pamukkale University Hospital (Jan 2024-Dec 2025). Patients were categorized per EORTC/MSGERC 2020 as Proven, Probable, Possible, or No IFD. Demographic, clinical, radiologic, and mycologic data including serum and bronchoalveolar lavage (BAL) galactomannan were collected. Analyses focused on EORTC/MSGERC diagnostic categories and real-world diagnostic testing patterns.
Results: A total of 91 patients were included (mean age 63.2±12.3 years; 50.5% male). According to EORTC/ MSGERC 2020 criteria, 22 patients (24.2%) were classified as Probable IFD, 52 (57.1%) as Possible IFD, and 17 (18.7%) as No IFD; no cases met the criteria for Proven IFD due to the absence of sterile-site mycologic or histopathologic confirmation. Radiologic findings compatible with IFD were present in 74 patients (81.3%). Serum galactomannan testing was available in 78 patients (85.7%), whereas BAL galactomannan testing was performed in only 18 patients (19.8%). Overall in-hospital mortality was 48.4%.
Conclusions: In this cohort, EORTC/MSGERC 2020 criteria application was hindered by difficulties in invasive sampling. The lack of Proven IFD and predominance of Possible IFD highlight gaps between research definitions and clinical practice, emphasizing the need for practical diagnostic strategies integrating clinical, radiologic, and non-invasive mycologic markers in high-risk hematology patients.

Keywords

• Invasive fungal disease
• fungal pneumonia
• hematologic malignancies
• bronchoalveolar lavage
• galactomannan

Şüpheli pulmoner fungal enfeksiyonu olan hematolojik malignite hastalarında EORTC/MSGERC 2020 tanımlarının gerçek dünya uygulaması: tek merkezli bir kohort çalışması

Abstract

Amaç: İnvaziv fungal hastalık (İFH), hematolojik malignitesi olan hastalarda önemli bir morbidite ve mortalite nedeni olmaya devam etmektedir. Avrupa Kanser Araştırma ve Tedavi Örgütü/Mikoz Çalışma Grubu Eğitim ve Araştırma Konsorsiyumu (EORTC/MSGERC) tanımları araştırma ortamlarında yaygın olarak kullanılmaktadır; ancak bunların rutin klinik uygulamadaki kullanımı, sıklıkla invaziv tanısal prosedürlerin ve mikolojik doğrulamanın sınırlı erişilebilirliği nedeniyle kısıtlanmaktadır.
Gereç ve yöntem: Bu tek merkezli retrospektif kohort çalışması, Pamukkale Üniversitesi Hastanesi'nde (Ocak 2024-Aralık 2025) invaziv pulmoner fungal enfeksiyon şüphesiyle değerlendirilen yetişkin hematolojik malignite hastalarını kapsamıştır. Hastalar, EORTC/MSGERC 2020 kriterlerine göre Kanıtlanmış, Olası, Şüpheli veya İFH Yok şeklinde sınıflandırılmıştır. Serum ve bronkoalveoler lavaj (BAL) galaktomannan değerleri dahil olmak üzere demografik, klinik, radyolojik ve mikolojik veriler toplanmıştır. Analizler, EORTC/MSGERC tanı kategorileri ve gerçek yaşam tanısal test modelleri üzerine odaklanmıştır.
Bulgular: Çalışmaya toplam 91 hasta dahil edilmiştir (ortalama yaş 63,2±12,3 yıl; %50,5'i erkek). EORTC/MSGERC 2020 kriterlerine göre; 22 hasta (%24,2) Olası İFH, 52 hasta (%57,1) Şüpheli İFH ve 17 hasta (%18,7) İFH Yok olarak sınıflandırılmış; steril bölgeden mikolojik veya histopatolojik doğrulama eksikliği nedeniyle hiçbir olgu Kanıtlanmış İFH kriterlerini karşılamamıştır. İFH uyumlu radyolojik bulgular 74 hastada (%81,3) mevcuttu. Serum galaktomannan testi 78 hastada (%85,7) yapılırken, BAL galaktomannan testi sadece 18 hastada (%19,8) gerçekleştirilmiştir. Genel hastane içi mortalite oranı %48,4 idi.
Sonuç: Bu kohortta, EORTC/MSGERC 2020 kriterlerinin uygulanması, invaziv örnekleme konusundaki zorluklar nedeniyle kısıtlanmıştır. Kanıtlanmış İFH vakalarının azlığı ve Olası İFH vakalarının baskınlığı, araştırma tanımları ile klinik uygulama arasındaki boşlukları gözler önüne sermekte; bu durum, yüksek riskli hematoloji hastalarında klinik, radyolojik ve invaziv olmayan mikolojik belirteçleri bir araya getiren pratik tanısal stratejilere duyulan ihtiyacı vurgulamaktadır.

Keywords

• İnvaziv fungal hastalık
• fungal pnömoniler
• hematolojik maligniteler
• bronkoalveolar lavaj
• galaktomannan

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