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Caspofungin for primary antifungal prophylaxis after T‐cell–replete haploidentical stem cell transplantation with post‐transplant cyclophosphamide
Author(s) -
Mariotti Jacopo,
De Philippis Chiara,
Bramanti Stefania,
Sarina Barbara,
Tordato Federica,
Pocaterra Daria,
Casari Erminia,
CarloStella Carmelo,
Santoro Armando,
Castagna Luca
Publication year - 2019
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.13214
Subject(s) - caspofungin , medicine , transplantation , cyclophosphamide , hazard ratio , cumulative incidence , univariate analysis , hematopoietic stem cell transplantation , incidence (geometry) , context (archaeology) , immunology , chemotherapy , amphotericin b , multivariate analysis , biology , antifungal , confidence interval , paleontology , physics , dermatology , optics
Objectives T‐cell – replete haploidentical stem cell transplantation (Haplo‐SCT) with post‐transplant cyclophosphamide (PT‐Cy) is at high risk of invasive fungal infections (IFI), and anti‐mold–active drug is required for primary antifungal prophylaxis (PAP) according to international guidelines. No data are available on the efficacy of caspofungin as PAP in this setting. Methods Here, we report our retrospective experience with 103 consecutive patients treated with caspofungin as PAP after Haplo‐SCT. Caspofungin was administered only during the pre‐engraftment phase. Results Hundred‐day cumulative incidence of proven‐probable IFI (PP‐IFI) was 8.7% and median day of onset was 19 post‐SCT. No patient died of PP‐IFI, and overall survival (OS) and non‐relapse mortality (NRM) hazard ratio (HR) for patients experiencing IFI were 1.02 ( P = 0.9) and 0.7 ( P = 0.7), respectively. Three‐year overall survival (OS) and 1‐year non‐relapse mortality (NRM) were 55% and 19%, respectively. By univariate analysis, duration of neutropenic phase and partial remission pre‐transplant disease status were associated with increased incidence of IFI, but were not confirmed by multivariate analysis. Conclusion In summary, PAP with caspofungin is an effective strategy for preventing IFI in the context of Haplo‐SCT with PT‐Cy. Further efforts are required in order to identify more potent strategies able to avoid the occurrence of breakthrough infections.