Introduction: Fungal infections are known as a cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). Therefore effective antifungal prophylaxis is necessary. The echinocandine Micafungin is approved for the prophylaxis of candidiasis in HSCT recipients. Here we report our experience with Micafungin as antifungal prophylaxis in the setting of alloHSCT. Patients and Methods: We retrospectively analyzed fi ve male and two female patients (pts.) who underwent alloHSCT between december 2010 and may 2011 due to AML (n=4), MDS (n=1), ALL (n=1) and NHL (n=1), respectively. The pts. with a median age of 57 years (range 27 to 69 years) received 50 mg (n=6) or 100 mg (n=1) of Micafungin once daily as primary antifungal prophylaxis after alloHSCT. Median time of Micafunginadministration was 17 days (range 12 to 33 days), beginning between day -21 and day 0 prior to alloHSCT. In fi ve of seven patients Micafungin-prophylaxis was switched to other drugs (predominantly Posaconazole) as breakthrough-infections or major side-effects were observed. Results: The infusion of Micafungin was well tolerated. One patient developed an allergic drug rash and an elevation of liver enzymes, both resolving after discontinuitation of Micafungin. Three of seven pts. developed an oropharyngeal fungal colonisation caused by candida albicans occurring on day 8, 12 and 15 after beginning of antifungal prophylaxis. In addition we observed one severe breakthrough-infection with candida albicans recovered from the bloodstream on day 16 after beginning of Micafungin-prophylaxis. The pt. died from fulminant septicaemia with multi-organ failure on day +17 after alloHSCT. In the whole cohort there was no evidence of fungal-infections caused by aspergillus spp. Conclusion: Despite its known activity against candida spp., Micafungin administered at a dose of 50 mg daily showed no suffi cient antifungal activity, even against non-resistant candida-strains. Additionally, signifi cant side-effects were observed in our cohort of patients. Therefore, the role of Micafungin as antifungal prophylaxis after alloHSCT needs to be further evaluated.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)