Antifungal prophylaxis with micafungin in recipients of allogeneic stem cell is effective: results from a single centre
Invasive fungal infections (IFI) constitute a major cause of mortality and morbidity among allogeneic hematopoietic stem cell transplant (ASCT) recipients. Because early diagnosis and treatment of IFI are the key factors for improving the prognosis, a prophylactic antifungal strategy has been recommended for high risk patients. Objectives: A retrospective study was conducted to evaluate the ef64257; cacy and safety of micafungin antifungal prophylaxis for IFI in pediatric and adult ASCT recipients during the neutropenic phase of high risk transplants (de64257; ned as myeloablative conditioning, mismatch transplants or umbilical cord blood transplant) and in patients with graft versus host disease (GvHD) to whom posaconazole could not be administered because of oral route unavailability or gastrointestinal dysfunction. The primary endpoint was treatment success, which was de64257; - ned as no change in antifungal therapy for any reason. The secondary endpoints were the incidence of proven, probable or possible IFI, safety, and overall survival 4 and 12 weeks postmicafungin initiation. Methods: The 64257; les of all the institutionâ€™s patients (pts) who received micafungin prophylaxis between October 2009 and December 2011 were retrospectively reviewed. The clinical signs, blood culture results, serum Aspergillus galactomannan antigen results, computed tomography scans, liver function test results and adverse events were recorded and analyzed. Results: Forty pts (29 adults and 11 children) received prophylactic micafungin at a dosage of 50 mg daily for adults and 1 mg/kg for children weighting <50 kg for a mean treatment duration of 21 days. Prophylaxis was given either during the neutropenic phase of ASCT (n=30) or to pts with GvHD (n=11). The overall success rate was 46% (45% for GvHD, 47% for neutropenic phase of ASCT). For 22 pts, antifungal prophylaxis was discontinued for the following reasons: persistant fever, which was treated empirically, in 13 pts (32%); possible or probable invasive aspergillosis in 5 pts (12%), invasive aspergillosis in 3 pts (7%) and candidemia in 1 patient (2%) (EORTC criteria). In the group of 30 pts treated during neutropenic phase, possible, probable or proved IFI were observed in only 3 pts. No toxicity or other serious adverse event resulted in treatment discontinuation. Conclusion: Micafungin may constitute a valuable prophylactic alternative in high-risk ASCT during neutropenic phase.
Full conference title:
Annual Meeting of the EBMT, 38th