Background: Efficacy of antifungals given as monotherapy in IA in the BMT setting, carries a high failure rate and poor prognosis. Methods: We conducted a non-comparative study of MCF alone or in combination with OLAT in the treatment of IA. Patients (pts) had allogeneic (allo) or autologous (auto) BMT and IA (proven or probable); de novo, refractory (>3 days (d) or intolerant of OLAT. Responses were assessed by independent review panel. Results: 98 pts (88 allo, 10 auto) were treated with MCF alone (8 pts) or in combination with OLAT (90 pts). Of the 8 monotherapy pts, 4 were failing OLAT, 2 de novo and 2 intolerant to prior OLAT. Of the 90 combination pts, 7 had de novo IA and 83 were refractory. 83% had pulmonary IA, 43% had GVHD and 27% were neutropenic. Most pts with refractory IA received prior L-AMB (mean duration of 27Â±39d and mean dose 6.0Â±2.6mg/kg/d). Initial dose of MCF was 75 mg/d. 57 pts had MCF dose escalation; mean MCF was 105Â±60mg/d (max 291mg/d); mean duration 51Â±60d (max 425d). Response (complete+partial) was 25/98 (26%); additional 12 pts achieved stable disease. Responses seen in 2/9 (22%) de novo, 21/87 (24%) refractory and 2/2 toxicity failure pts; 22/90 (24%) in combination pts and 3/8 (38%) in pts treated with MCF alone. No differences in responses were seen according to type of BMT, site of IA, Aspergillus spp. No toxicity was seen. Conclusions: This is the largest experience of the use of an echinocandin, alone or in combination with OLAT, for the treatment of IA in BMT pts. In this high risk population, responses were similar to published limited experience with caspofungin.
Full conference title:
46th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 46th