Background: Invasive fungal infection (IFI) such as candidiasis and mold infections cause signifi cant morbidity and mortality in hematopoietic stem cell transplantation (HSCT). Although prophylactic antifungal therapy with fl uconazole has become the standard care for these patients, it has been associated with the emergence of fl uconazole-resistant Candida infections. Additionally, fl uconazole is not reliably effective against invasive aspergillosis. Methods: Between January 2010 and September 2011, We conducted a prospective study to evaluate the usefulness of the administration of micafungin (Mycamine® ), a class of echinocandin, as a prophylactic antifungal therapy for patients undergoing HSCT. Micafungin was started at a daily dose of 50 mg once a day intravenously over 1 hour from day 1 after HSCT. Therapy was continued until 3 days after hematological engraftment (defi ned as an absolute neutrophil count of over 500/uL after the nadir). Prophylactic success was defi ned as the absence of proven, probable, or suspected systemic fungal infection through the end of prophylaxis therapy and as the absence of a proven or probable systemic fungal infection through the end of the 4-week post treatment period. Results: A total of 35 patients who underwent HSCT were enrolled in the study. Underlying diseases included acute leukemia (n = 18), myelodysplastic syndrome (n = 5), aplastic anemia (n=4), non-Hodgkin’s lymphoma (n = 3), and others (n = 5). HSCT were HLA-matched sibling (n=11), matched unrelated (n=15), mismatched unrelated (n=2) or autologous (n=7). The median durations of administration of micafungin were 14 days (range 12-17 days). Prophylactic success was achieved in 34 (97.1%) of the 35 evaluated patients. No patients showed proven or probable IFI. Micafungin was well tolerated, and none of the patients required dose reduction due to adverse effects. Conclusions: Our results indicate the effectiveness and safety of micafungin a daily dose of 50 mg as an prophylactic antifungal therapy in patients undergoing HSCT.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)