Anidulafungin primary antifungal prophylaxis in 36 high-risk haematological patients undergoing haematopoietic stem cell transplantation
Background: Invasive fungal infections (IFIs) constitute a substantial source of morbidity and mortality among patients (pts) undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT). Anidulafungin (ANI) is an echinocandin that inhibits glucan sinthase, an important enzyme in the formation of fungal cell wall; it has a broad antifungal spectrum of action, low toxicity pro64257; le without relevant drug interactions. Aim: ANI safety and ef64257; cacy as antifungal prophylaxis agent was tested in pts with high risk hematological malignancies receiving alloHSCT from July 2009 to March 2011. Materials and Methods: In our institution, we analyzed 36 pts with high risk hematological malignancies (18 acute leukemia, 2 chronic myeloid leukemia, 2 non Hodgkin limphoma, 2 Hodgkin limphoma, 2 myelodysplastic syndrome, 2 myelo- 64257; brosis) undergoing allo-SCT: 19 Haploidentical SCT (Haplo), 9 Matched Related Donor (MRD), 7 Matched Unrelated Donor (MUD), 1 Cord Blood (CB). Disease status at SCT was intermediate/advanced in 21/36 pts; anti-thymocyte globulin was administered to 21/36 pts and 2/36 pts performed a previous allo-SCT. The median time from diagnosis to allo-SCT was 664 days (range: 51-4022). Antifungal prophylaxis with ANI was started 1 day before conditioning (200 mg die iv single dose, then 100 mg die iv) until [P486]S132 neutrophil engraftment (PMN >0.5 x 10e9/l for 3 consecutive days) and subsequently replaced with voriconazole. Prophylaxis was primary in 34/36 pts and secondary in 2/36 pts. Results: We observed in 1/36 pts an allergic grade II skin toxicity after the 64257; rst ANI administration that was immediately interrupted. Median duration of ANI therapy was 23 days (range: 1- 44). Median time to neutrophil engraftment was 20 days (range: 12- 52). 19/36 pts stopped ANI at neutrophil engraftment, without signs of IFIs. 16/36 pts stopped ANI for proven (3/19 pts) or probable IFIs (3/19 pts) (EORTC 2008 criteria) and we replaced it with Voriconazole. In the MRD setting, 7/9 pts stopped ANI for engraftment, 1 for allergic reaction and 1 for possible IFI. In the Haplo setting, 7/19 pts stopped ANI for engraftment and 5/19 for proven/probable IFIs. In the MUD setting, 5/7 pts stopped ANI for engraftment and 2/7 for possible IFI. Patient receiving CB stopped ANI for proven IFI. Overall fungi isolated in proven IFI were aspergillus. Conclusions: ANI is a well tolerated antifungal agent and a choice as primary prophylaxis in high risk pts receiving alloSCT.
Full conference title:
Annual Meeting of the EBMT, 38th