Antigungal prophylaxis with micafungin in allogeneic stem cell transplantation, comparative results with intravenous itraconazole: a single-centre experience

Ref ID: 18558

Author:

D. Serrano, M. Kwon, J. Gayoso, F. Carretero, G. RodriguezMacias, M. Infante, L. Bento, I. Gonzalez, P. Balsalobre,
I. Buño, A. Perez, J. Anguita, J.L. Diez-Martin

Author address:

Hospital Gregorio Marañón (Madrid, ES)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Invasive fungal infections (IFIs) are an important cause of
morbidity and mortality in allogeneic hematopoietic stem cell
transplantation (HSCT). In patients with cancer a meta-analysis
showed that primary antifungal prophylaxis (PAP) with moldactive antifungals agents reduced the documented aspergillosis (Robenshtok JCO 2007).
Micafungin, an echinocandin with activity against Candida and
Aspergillus, has a good safety profi le, even in patients with
liver or kidney impairments, and it can be used at the same
time with the conditioning treatment (CT). Moreover it has no
signifi cant interactions with other drugs. In the last three years
(September-08/September-11) we have progressively changed
our PAP with intravenous itraconazole by micafungin during the
neutropenic period in HSCT. We used intravenous itraconazole
on the day +1 and micafungin at the beginning of CT. Both were
used until resolved mucositis and oral fungal prophylaxis with
posaconazole could be started. Moreover intravenous PAP
was changed by empirical antifungal treatment or pre-emptive /
targeted treatment when they were needed. We present the
characteristic and comparative results of the patients treated
with each of these drugs, Table 1, cohort 1(itraconazole 200
mg/day, load dose 400 mg one day) and cohort 2 (micafungin
50 mg/day)
Results: Both cohorts presented the same median age (43 vs.
42). In cohort 2 there were more patients diagnosed with AML/
MDS and HD and less with ALL and MM than in the cohort 1.
In the cohort 2 more haploidentical donors and less cord blood
cells as a source of progenitors cells were used. The number of match-related and unrelated donors was similar. There
were no differences in CT (MAC and RIC) and in neutrophils
engraftment in both cohorts (+16). Although empiric antifungal
treatment was used more frequently in cohort 1 this difference
was not statistically different. (50% cohort 1 vs. 33% cohort 2,
p:0.17).
In the neutropenic period our patients had a very low number
of IFIs (two possible in both cohorts and one probable in cohort
1). No toxicity due to micafungin was observed. In conclusion
during the neutropenic period in HSCT micafungin was well
tolerated with no associated toxicity or drug-drug interactions.
Patients receiving micafungin needed less empirical antifungal drugs compared to patients receiving itraconazole, and no
developed IFI. An analysis cost-effective is ongoing comparing
both drugs.

Abstract Number: P490

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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