Introduction: Fungal infections are associated with high morbidity and mortality in patients after hematopoietic stem-cell transplantation (HSCT). High risk of IFI after HSCT is a consequence of many factors. Among pathogens arises the proportion of Candida nonalbicans strains, invasive aspergillus, and rare fungi. The necessity for new antifungal prophylaxis emerges for paediatric HSCT patients.
Methods: Authors present experiences with micafungin prophylaxis in pediatric HSCT recipients at Bone Marrow Transplantation Unit in Bratislava, Slovakia. In a period of 44 months (January 2009 – August 2012) 56 patients, 38 boys and 18 girls, aged 3 months – 18 years, received HSCT for malignant and non-malignant diseases. 38/56 patients received graft from unrelated donor – 23 patients MUD 10/10, 10 patients MUD 9/10, 5 patients MUD 8/10. 18 patients underwent HSCT from family donor – 17 patients from MSD, 1 from HLA-identical mother. Micafungin was started at D -1; the weight adjusted standard dose was given once daily as a 1 hour infusion. Prophylaxis continued from day -1 to engraftment and restitution of oral intake. Median of engraftment was 19 days (11-34 days); duration of prophylaxis was 15-52 days. The tolerance and side effects were monitored by clinical examination, laboratory findings (whole blood count, biochemical analysis, microbial cultivations, and mycotic antigens evaluation), and other examinations based on a patient condition. The micafungin prophylaxis was satisfactory in 37/59 patients (66%). In 3/56 patients micafungin dose was adjusted from 1mg to 2 mg/kg/day due to prolonged febrile neutropenia without further need of antifungal drug change. In 8/56 patients micafungin was stopped – in 6/56 due to possible IFI, 1/56 for probable IFI, and in 1/56 patients for proven IFI – candidemia non albicans. In 7/56 micafungin administration was interrupted due to veno-occlusive disease of the liver (VOD), the multifactorial HSCT complication. With the exclusion of 7 VOD patients from analysis, micafungin was well tolerated in all 49/56 patients and antifungal prophylaxis was effective in 37/49 patients (75.5%). There were no deaths associated neither with VOD nor IFI in our cohort.
Conclusion: The increasing resistance and changes in spectrum of causative pathogens has to be taken into account while choosing treatment strategy. Echinocandine micafungin showed to be a suitable and efficient antifungal prophylaxis in HSCT children.
Full conference title:
- EBMT 39th (2013)