Efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing haplo-identical hematopoietic SCT
| Autor: | Berger P, S. Furst, R. Bouabdallah, Diane Coso, A Granata, Duran S, Claire Oudin, Norbert Vey, Didier Blaise, G Venton, Christian Chabannon, E Fougereau, Roberto Crocchiolo, Jean El-Cheikh, C. Faucher |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male endocrine system medicine.medical_specialty Antifungal Agents Transplantation Conditioning MEDLINE Haplo identical Echinocandins Lipopeptides Young Adult hemic and lymphatic diseases Internal medicine medicine Humans In patient Young adult Intensive care medicine Transplantation business.industry Hematopoietic Stem Cell Transplantation Micafungin Hematology Middle Aged bacterial infections and mycoses Haematopoiesis surgical procedures operative Mycoses Female lipids (amino acids peptides and proteins) business medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 48:1472-1477 |
| ISSN: | 1476-5365 0268-3369 |
| Popis: | Invasive fungal infections (IFIs) such as candidiasis and mold infections have caused significant morbidity and mortality among immunocompromised patients in recent years. Micafungin, a new echinocandin, inhibits fungal cell wall β-glucan synthesis, with potent activity against most species of Candida and Aspergillus. The aim of this observational study was to investigate the efficacy and safety of micafungin in prophylaxis of IFIs in 26 high-risk adult patients with various hematological diseases receiving haplo-identical Allo-SCT. Only two patients had a history of possible aspergillosis before transplant treated by voriconazole. The patients received a median of four lines (2-7) of treatment before Allo-SCT. Thirteen patients (50%) received at least one prior Auto-SCT; and eight patients (31%) received a previous Allo-SCT. Patients received a median of 29 infusions (range, 15-85) of micafungin (50 mg/day i.v. as a 1-h infusion). The treatment was initiated at the beginning of the transplant conditioning regimen until the hospital discharge. None of our patients discontinued the treatment for drug-related adverse events. Micafungin was not associated with any hepatotoxicity. Only one patient (4%) discontinued the treatment because of early disease progression. In all patients no Candida and/or Aspergillus species was documented after 3 and 6 months from transplant. None of our patients presented a positive galactomannan antigenemia0.5. Nine patients (35%) presented a CMV reactivation. Four patients presented an acute GVHD grade II and two patients presented a chronic GVHD. The median follow-up was 11 months (3-23). At the last follow-up, there were 20 patients (77%) who were alive; four patients (12%) died because of disease progression and two patients because of graft failure. Micafungin has a good safety and tolerability profile, with an efficacy in preventing IFI in this high-risk population. Our data provide support for an efficacy study in a prophylaxis setting, but prospective and comparative clinical trials using micafungin are urgently needed to define the role of this drug in prophylaxis after haplo-identical Allo-SCT. |
| Databáze: | OpenAIRE |
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