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.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)