Invasive fungal infections remain one of the main causes of mortality in hematopoietic stem cell transplant (HSCT). Among these patients, micafungine has shown effi cacy as antifungal prophylaxis and treatment. Micafungine is an echinocandin that inhibits the b-1,3-glucano, and thus it is active against Candida and Aspergillus. This antifungal spectrum with its safety profi le makes it a good choice for hematological patients. We assessed the effi cacy and safety of micafungine in 18 patients with a medium age of 37 years (1-65) undergoing allogeneic (17; donor: 7 related, 9 unrelated and 1 cord blood) or autologous transplantation(1). Among the allogeneic transplants, conditioning regimen was myeloablative(6) and reduced intensity (11); all patients received graft versus host disease(GVHD) prophylaxis and 76% of them developed acute GVHD. Fifteen patients received micafungine as antifungal prophylaxis. Fifty percent of them received it as initial prophylaxis in transplant neutropenia and it was maintained from day +1 to discharge. The medium days of treatment was 38 (range, 8-62). In 33%, posaconazole was switched to micafungine due to liver toxicity and in 13% amphotericin B was switched to micafungine because of a high risk of aspergillosis and contraindication for using azoles due to treatment with rapamicine. Only one of these 15 patients (receiving micafungine as antifungal prophylaxis) developed a possible invasive fungal infection (respiratory symptoms and suggestive images on CT scan) on day +37. He was treated with amphotericin B without response and passed away due to respiratory failure. In 2 patients, micafungine was started as empirical treatment in the event of neutropenic fever not responding to broad spectrum antibiotics. Both patients completely recovered. There were no microbiological isolates. In 1 patient, micafungine was used as targeted therapy after documenting the Candida in blood cultures. The clinical evolution of the patient was favorable and blood cultures became negative. S229 We did not document any adverse effects potentially related to micafungine. In patients with previous liver toxicity due to posaconazole, an improvement in liver function tests was observed. In conclusion, from our centre experience, Micafungine is a safe and effective antifungal prophylaxis in hematological patients, and it can be an alternative for those with contraindications for using azols or who have developed adverse effects with previous prophylaxis.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)