Antifungal prophylaxis with micafungin in recipients of allogeneic stem cell is effective: results from a single centre

Ref ID: 18559

Author:

A. Lamy, P. Ceballos, N. Fegueux, A. Sirvent

Author address:

University Hospital of Montpellier (Montpellier, FR)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

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
effi cacy and safety of micafungin antifungal prophylaxis for IFI
in pediatric and adult ASCT recipients during the neutropenic
phase of high risk transplants (defi 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 defi –
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 fi les of all the institution’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.

Abstract Number: P491

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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