Use of micafungin in haematopoietic stem cell transplantation: a single-centre experience

Ref ID: 18624

Author:

M. Cabrero, L. Vazquez, E. Perez-Lopez, J. Labrador, N. Puig,
M.T. Villaescusa, I. Cordoba, D. Caballero, J. San Miguel

Author address:

University Hospital (Salamanca, ES)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Invasive fungal infections remain one of the main causes of
mortality in hematopoietic stem cell transplant (HSCT). Among
these patients, micafungine has shown effi cacy as antifungal
prophylaxis and treatment. Micafungine is an echinocandin that
inhibits the b-1,3-glucano, and thus it is active against Candida
and Aspergillus. This antifungal spectrum with its safety profi le
makes it a good choice for hematological patients.
We assessed the effi cacy and safety of micafungine in 18
patients with a medium age of 37 years (1-65) undergoing allogeneic (17; donor: 7 related, 9 unrelated and 1 cord
blood) or autologous transplantation(1). Among the allogeneic
transplants, conditioning regimen was myeloablative(6) and
reduced intensity (11); all patients received graft versus host
disease(GVHD) prophylaxis and 76% of them developed acute
GVHD.
Fifteen patients received micafungine as antifungal prophylaxis.
Fifty percent of them received it as initial prophylaxis in transplant neutropenia and it was maintained from day +1 to discharge. The medium days of treatment was 38 (range, 8-62).
In 33%, posaconazole was switched to micafungine due to liver
toxicity and in 13% amphotericin B was switched to micafungine because of a high risk of aspergillosis and contraindication for using azoles due to treatment with rapamicine. Only
one of these 15 patients (receiving micafungine as antifungal
prophylaxis) developed a possible invasive fungal infection
(respiratory symptoms and suggestive images on CT scan) on
day +37. He was treated with amphotericin B without response
and passed away due to respiratory failure.
In 2 patients, micafungine was started as empirical treatment
in the event of neutropenic fever not responding to broad spectrum antibiotics. Both patients completely recovered. There
were no microbiological isolates.
In 1 patient, micafungine was used as targeted therapy after documenting the Candida in blood cultures. The clinical evolution of
the patient was favorable and blood cultures became negative. S229
We did not document any adverse effects potentially related
to micafungine. In patients with previous liver toxicity due to
posaconazole, an improvement in liver function tests was
observed.
In conclusion, from our centre experience, Micafungine is a safe
and effective antifungal prophylaxis in hematological patients,
and it can be an alternative for those with contraindications for
using azols or who have developed adverse effects with previous prophylaxis.

Abstract Number: P809

Conference Year: 2011

Link to conference website: NULL

New link: NULL


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