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Sequential systematic anti‐mold prophylaxis with micafungin and voriconazole results in very low incidence of invasive mold infections in patients undergoing allogeneic hematopoietic stem cell transplantation
Author(s) -
Rosillo Claudia,
Avila Ana Maria,
Huang YaoTing,
Devlin Sean,
Cho Christina,
Montoro Juan,
Maloy Molly A.,
Papanicolaou Genovefa A.,
Barba Pere,
Perales MiguelAngel
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12897
Subject(s) - medicine , micafungin , voriconazole , cumulative incidence , hematopoietic stem cell transplantation , incidence (geometry) , transplantation , surgery , retrospective cohort study , aspergillosis , immunology , dermatology , antifungal , physics , optics
Abstract Recipients of allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ) are at high risk for invasive mold infections ( IMI ). The goal of the study is to describe the incidence and outcome of IMI in patients after allo‐ HSCT in a large cohort of patients receiving anti‐mold prophylaxis. We conducted a retrospective review of 988 consecutive adults who underwent allo‐ HSCT in our center from 2008 through 2014. Standard prophylaxis consisted of micafungin 150 mg IV daily from admission to day +7 ± 3 followed by voriconazole until day +75 to +100. Cases meeting criteria for proven or probable IMI according to EORTC ‐ MSG criteria were included. Median age at HSCT was 54 years. The most common diagnoses were acute myeloid leukemia (n = 351, 36%) and lymphoid malignancies (n = 248, 25%). Matched related or unrelated donors ( URD ) were used in 686 (69%) patients, mismatched URD in 142 (14%) and cord blood units in 154 (16%). Twenty‐one patients were diagnosed with IMI after allo‐ HSCT , 19 probable and 2 proven, and one patient was diagnosed postmortem. Microbiological diagnosis was established in 9 cases, 5 of them being Aspergillus . One‐year cumulative incidence ( CI ) of IMI was 1.6% (95% CI 0.9‐2.5) while 12‐week overall survival after IMI was 39% (95% CI 24‐65) Analyzed by disease, there was a trend for a higher 1‐year CI of IMI in patients with ALL (5% [95% CI 1.6‐11.4]) when compared with AML (1.4%), MDS (1.5%) and lymphoma (1.2%), P = .06. The 1‐year CI of IMI after transplantation is low in patients receiving anti‐mold prophylaxis with micafungin bridged to voriconazole, although these infections are associated with a higher risk of mortality.