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Abstract: PB1885

Type: Publication Only

Background
Micafungin is an echinocandin antifungal approved for prophylaxis in patients undergoing allogenic hematopoietic stem cell transplantation. It has a broad spectrum against yeasts and filamentous fungi.In our institution, we employ Posaconazole as antifungal primary prophilaxis for allogenic transplantation and Fluconazole for autologous procedures but there are different situations that require us to change the protocol such as tolerance or toxicity to azoles or interactions with other drugs such as rapamycin.

Aims
Analyze the efficacy and safety of  the use of Micafungin for antifungal prophylaxis in patients undergoing autologous and allogenic hematopoietic stem cell transplantation. 

Methods
Between January 2013 and December 2015, 77 patients have received Micafungin at doses 50 mg daily. 51 (66.2%)  of them were male. The mean age at transplantation was 43.7 years-old (20-61). Diagnoses were 23 acute leukemias (29.8%) twenty-two (28.5%) Non-Hodgkin Lymphoma, twelve (15.5%)  Hodgkin Disease, six (7.7%) myelodisplastic síndrome,  five (6.4%%) Multiple Myeloma, five (6.4%) philadelphia-negative chronic myeloproliferative neoplasms, three (3.8%) aplastic anemia  and one case of Chronic Myeloid Leukemia. Most of the stem cell transplantation were allogenic (85%). Only seven (8.8%) and five (6.5%) were autologous and haploidentical procedures respectively. Major of Conditioning regimen was myeloablative (71.3%), 17.5% undergoing reduced intensity conditioning regimen and only 11.3% no myeloblative regimen. 46.3% of the patients presented absolut neutrophils count  (ANC) less than 1000/mm³.The average duration of treatment with micafungin was 20.7 days (5-150) and the median duration was 14 days.The reason to start micafungin treatment was primary prophylaxis in ten cases (10%), bad gastrointestinal tolerance to azoles in fifty-four cases (70.1%), farmacological interactions with azoles in seven patients (9%) and toxicity to azoles in only five patients (6.4%). 

Results
Reason to finish prophilaxys with micafungin was the improve of the gastrointestinal syntoms and, consequently, the end of prophilaxys period in fifty-two cases (67.5%). Six patients (7.8%) presented breakthrough fungal infection. Other causes were positive antigen galactomannan (2 patient), persistent fever (5 patient), exitus not attributable to IFI (5 patient), toxicity to micafungin (2 patients) and unknown cause in four patients.Six patients (7.8%) presented breakthrough fungal infection (all probably invasive fungal infection according to the EORTC criteria). Isolated fungi were Geosmithia argillaceae, Aspergillus Fumigatus, Aspergillus Flavus and Aspergillus spp.  Mortality due to Fungal infection was 3.8 % (three patients).With regards to tolerance, there were no reports about any infusional reaction. Only 2 patient referred micafungin liver toxicity grade II without any problem when the micafungin was suspended.

Conclusion

1. Micafungin at doses of 50 mg/24 hours, is an effective and safe option for yeast prophylaxis in patients undergoing autologous and allogenic stem cell transplantation.
2. In our series, although they have identified six breakthrough infections (7.8%), it must be noted that these were patients with active refractory GVHD to several lines of immunosuppressive therapy, including, of course, high-dose steroids. Maybe, we have to use prophylaxis protocol based on liposomal anfotericin, with a better anti-mold spectrum, in this group of high risk patients.
3. The safety of the treatment was excellent, without tolerance problems. The kidney and liver function was not altered by treatment with micafungin.

Session topic: E-poster

Keyword(s): Fungal infection, Prophylaxis, Stem cell transplant