Anidulafungin primary antifungal prophylaxis in 36 high-risk haematological patients undergoing haematopoietic stem cell transplantation

Ref ID: 18557


F. Matteazzi, G. Levati, A. Assanelli, S. Mastaglio, M. Carrabba,
E. Guggiari, R. Greco, A. Forcina, M. Tassara, M. Lupo-Stanghellini,
L. Vago, B. Gentner, C. Corti, F. Ciceri, J. Peccatori

Author address:

Scientifi c Institute H S Raffaele (Milan, IT)

Full conference title:

Annual Meeting of the EBMT, 38th


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 profi le without relevant drug
Aim: ANI safety and effi 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-
fi 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
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 fi 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.

Abstract Number: P488

Conference Year: 2012

Link to conference website: NULL

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