PONE-D-23-07952D-Index and invasive fungal infections (IFIs) in adult acute myeloid leukemia (AML) patients with the first episode of febrile neutropeniaPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Dr. Rattanathammethee et al. evaluated the relationship between area-based neutropenia index (D-index) and invasive fungal disease (IFD) in acute myeloid leukemia (AML) patients undergoing induction chemotherapy. Not only the D-index, but also the c-D-index in patients who developed IFD were significantly higher than the D-index in patients without IFD. The appropriate cut-off value of the c-D-index was set at 5625 with receiver-operating-curve (ROC) analysis, which was comparable to the previous study [Ref 8: J Clin Oncol 2009, 27: 3849-3854]. Using this cut-off value of the c-D-index and the prevalence of IFD to be 15.8%, the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the c-D-index for the diagnosis of IFD were 68.8%, 68.2%, 28.9%, and 92.1%, respectively. Superiority of the D-index for the prediction of the development of IFD to simple duration of neutropenia seems to be more clearly revealed in this study compared to the original D-index study [Ref 8: J Clin Oncol 2009, 27: 3849-3854]. This is well written manuscript, and the results are interesting and exciting in my mind. I have only a few minor comments regarding Table 1.

1) Table 1.　Please define the comorbidities in this study

2) Table 1.　AML and IFI should be also spelled out in the Table 1.

3) Table 1.　What does “WBC per week” mean ? In addition, Pease clarify its unit.

Reviewer #2: The study highlighted neutropenic burden measuring using the D-index in AML patients who experienced their first episode of febrile neutropenia performed well in terms of predicting IFIs. The D-index-guided technique minimized the usage of superfluous antifungal medications and may be utilized as a substitute decision-making tool prior to the commencement of empirical antifungal therapy for IFIs.

To Facilite the use of D-index and c-D-index please include the calculation spreadsheet in the supplementary material

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Reviewer #1: No

Reviewer #2: No

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D-Index and invasive fungal infections (IFIs) in adult acute myeloid leukemia (AML) patients with the first episode of febrile neutropenia

PONE-D-23-07952R1

Dear Dr. Rattanathammethee,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

Felix Bongomin, MB ChB, MSc, MMed, FECMM

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

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