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Micafungin as antifungal prophylaxis in recipients of allogeneic hematopoietic stem cell transplantation: results of different dosage levels in clinical practice
Author(s) -
Langebrake Claudia,
Rohde Holger,
Lellek Heinrich,
Wolschke Christine,
Kröger Nicolaus M.
Publication year - 2014
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12310
Subject(s) - micafungin , medicine , discontinuation , hematopoietic stem cell transplantation , transplantation , gastroenterology , toxicity , echinocandin , candida parapsilosis , itraconazole , fluconazole , surgery , antifungal , dermatology
Micafungin has been approved for the prophylaxis of Candida infections in patients undergoing allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ). Here, we report a single‐center experience of three different dose levels regarding efficacy, toxicity, and colonization with C andida ssp. in clinical practice. In total, 150 consecutive adult patients who underwent allo‐ HSCT received micafungin at a dosage of 50, 100, or 150 mg once daily for primary antifungal prophylaxis. Of those patients receiving more than six d of micafungin prophylaxis, 12/46 (26%), 6/44 (14%), and 9/46 (20%) were switched to empiric antifungal treatment. The frequency of invasive fungal infections ( IFI s) according to EORTC criteria did not differ significantly (7/46; 15% vs. 5/44; 11% vs. 5/46; 11%) across the different dosage groups. In the 50‐mg group, there was one case of candidemia with C. parapsilosis after 12 d of micafungin prophylaxis. In all three groups, micafungin prophylaxis was well tolerated without any case of toxicity‐related treatment discontinuation. Renal function was not significantly altered, while increase of bilirubin was mainly due to concomitant ATG application. The incidence of IFI s is similar irrespective of the micafungin dosage while there was a trend toward more frequent change to empiric antifungal treatment as well as oropharyngeal colonization with candida in the lowest dosage group.