Introduction: Echinocandins are highly effective antifungal agents against Candida and Aspergillus spp. Micafungin provides compared to other echinocandins better activity against some Candida spp. (specially C. glabrata) and also Aspergillus spp. All guidelines focused on antifungal prophylaxis recommend its use during neutropenic phase in hematopoietic stem cell transplant (HSCT) recipients. Moreover, its low profile of side effects and drug interactions makes micafungin a good alternative in those patients who need concomitant treatments, present hepatic insufficiency and also in those that do not tolerate oral drug administration. The aim of this study was to describe the experience with micafungin as primary prophylaxis during the neutropenic phase in patients undergoing allo-HSCT in a cohort of Transplant Spanish centres, and to evaluate it’s efficacy and tolerability in this population.
Materials (or patients) and methods: retrospective multicentre observational study including all consecutive adult patients admitted for allo-HSCT to haematological units belonging to participating centres of the Grupo Español de Trasplante Hematopoyético (GETH), from January 2010 to December 2013, which received micafungin as prophylactic treatment during the neutropenic phase. Patients that received less than 5 days of micafungin were excluded from the analysis. Failure of prophylaxis was considered in those patients who developed breakthrough invasive fungal infection (IFI) during prophylaxis with micafungin or early after.
Results: Data from 240 patients from 13 HSCT units belonging to the GETH group were collected. Eighty-one patients were excuded from the analysis for different reasons. Finally, 159 patients were included for the analysis. Ninety-four (59%) were men. Mean age was 48 (± 13) years. Underlying disease was leukaemia in 82 (51.6%) patients, lymphoma in 34 (21.4%), myelodysplastic syndromes in 26 (16.4%), multiple myeloma in 8 (5%) and other diseases in 9 (5.7%) patients. One hundred and fifty-one (94.9%) patients had been submitted to peripheral blood SCT, 6 (3.8%) to bone marrow SCT and 2 (1.3%) to umbilical cord SCT. Mean of says of prophylaxis with micafungin was 19 (± 9) days. Most patients (95.6%) received doses of 50mg per day, while the remaining ones received 100mg per day. During follow-up 7 (4.4%) patients developed breakthrough IFI, 1 proven IFI (Fusarium spp. in skin biopsy) and 6 probable IFI (positive galactomannan with suggestive radiological images), and one patient presented serious drug interactions that obliged micafungin cessation. The median of days of treatment with micafungin in these patients was 14 (10-25) days at a dose of 50mg per day. Four of these patients died: two with multiorganic failure, 1 patient because of venoocclusive disease and 1 because staphylococcal septic shock. Six other patients died because of different complications related to the underlying disease and it’s treatment. Finally, prophylaxis with micafungin was considered effective in 151 (94.9%) of the patients.
Conclusion: According to our experience, micafungin is an appropriate alternative for antifungal prophylaxis in patients undergoing an allo-HSCT, because it’s efficacy, it’s low profile of drug interaction and side-effects.
This study has been partially funded by Astellas.
Disclosure of Interest: C. López-Sánchez Funding from: Astellas, I. Ruiz-Camps Funding from: Astellas, V. Gómez Funding from: Astellas, J. López-Jiménez Funding from: Astellas, D. Serrano Funding from: Astellas, V. Rubio Funding from: Astellas, C. Solano Funding from: Astellas, D. Valcárcel Funding from: Astellas, L. Vázquez Funding from: Astellas
Full conference title:
- EBMT 41st (2015)