High-risk haematological malignancies included acute leukaemias, chronic myelocytic leukaemia with blastic transformation, myelodysplastic syndromes that required intensive chemotherapy and high-grade non-Hodgkin’s lymphomas. Patients who gave informed consent were included in the study starting from the day they were admitted to the wards and followed up until death, discharge or withdrawal of consent, whichever occurred earlier. Death or discharge within 10 days of hospitalisation, less than

10 days of neutropenia or major difficulty in obtaining blood samples were the exclusion criteria. Demographic characteristics, selleck underlying diseases and risk factors for invasive fungal infections (IFI), such as administration of chemotherapy, corticosteroids, antimicrobials, total parenteral nutrition within 30 days and stem-cell transplantation within 1 year, were noted. Patients were followed up by daily visits for vital signs, existing or newly developing signs and symptoms, clinical and laboratory findings. Colony stimulating factors, chemotherapeutic and antimicrobial agents administered were recorded during each visit. Culture growths and the results of the imaging studies were also noted. The HM781-36B study protocol required that blood be drawn twice a week during the follow-up of the patients,

however because of the problems in venous access and reluctance of the patients, regular sampling could not be performed all the time. Blood samples were then transported to the laboratory and preserved at −70 °C until all the specimens were analysed by the ELISA method at the end of the study period. All patients with haematological malignancies who developed fever were consulted with the infectious diseases team as a routine part of patient care at our centre. GM levels were tested subsequently; therefore the primary physician and the infectious Non-specific serine/threonine protein kinase diseases consultant were not aware of the results during patient care. No antifungal prophylaxis was used in this cohort of patients. Patients were treated with amphotericin B formulations

during inpatient periods and discharged on oral itraconazole when indicated for IA. Invasive fungal infections were defined according to the European Organization for Research and Treatment of Cancer – Mycoses Study Group (EORTC-MSG) consensus case definitions.27 As this study aimed to evaluate the accuracy of GM in diagnosis, GM positivity was not used as a microbiological criterion for classifying IA. Galactomannan levels were studied by sandwich ELISA commercial kit (Platelia®Aspergillus; Bio-Rad Laboratories) in accordance with the manufacturer’s instructions. Results are checked with positive and negative controls. The GM index was expressed as the ratio of the optical density of the sample relative to the optical density of the threshold control.