Contributions
Abstract: PB2067
Type: Publication Only
Background
Micafungin is a clinically important echinocandin antifungal drug, recently approved as prophylaxis treatment in patients undergoing allogeneic transplantation and in those undergoing prolonged neutropenia (> 10 days). The use and the role of micafungin however prophylaxis is still questionable in term of comparison with azole compounds and on the potential selective pressure of micafungin toward resistant fungi. Furthermore, the frequency of breakthrough invasive fungal diseases (IFI) during echinocandin therapy is unclear.
Aims
To evaluate the frequency of breakthrough IFI in a single center experience of hematological malignancies treated with primary antifungal prophylaxis by micafungin
Methods
To evaluate retrospectively the use of micafungin in 11 adult hematological patients treated at our institution and characterized by high and intermediate risk of infections for development of IFI according to the latest NCCN Guidelines (table 1).
Table 1. Patients characteristics
Median age, years (range) | 60 (33-74) |
Female: Male |
1:10 |
Patients at high risk for IFD n. (%)
|
6/11 (54.5%)
3/11 (27%)
1/11 (9%) 2/11 (18%) |
Patients at intermediate risk for IFD n. (%)
|
5/11 (45%)
|
History of previous infections
|
3/11 (27%) 2/3 (67%) 1/3 (33%) 0/3 |
CIRS SCORE
|
9/11 (82%) 2/11 (18%) |
Days of neutropenia at micafungin discontinuation,median (interquartile range) |
9 (6-13) |
Results
All patients received prophylactic micafungin at 50 mg/day during neutropenia until neutrophils recovery or breakthrough IFI. The median of the days of neutropenia at micafungin discontinuation was nine. Febrile neutropenic patients with suspected IFI underwent an infective work up including serum galactomannan and/or bronchoalveolar lavages (BAL), CT scan and multiple samplings of blood cultures. IFI occurred in three patients affected by high risk of IFI, with two proven IFI, Aspergillus and Mucor species, respectively (table 2). All patients had a grade IV neutropenia and the IFI occurred respectively after 30, 24 and 11 days of neutropenia from the first administration of micafungin. We observed two lung infections, with sepsis in a patient affected by severe aplastic anaemia and a CNS involvement in an AML patient, respectively. The third patients with AML secondary to myelodysplastic syndrome developed a probable liver fungal infection revealed by CT scan. All patients were treated empirically with liposomal amphotericin B followed by voriconazole: two died of IFI after 25 and 23 days, the third died because of refractory leukemia. No IFI were documented in the five patients at intermediate risk receiving micafungin prophylaxis, while the other three high-risk patients developed a fungal infection several months after micafungin discontinuation.
Conclusion
In our experience, micafungin was active as profilaxis treatment in intermediate risk patients. Whereas a feeble approach has been shown in patients with high risk of IFI. We suggest therefore evaluating in a larger series of patients this approach to clarify which patients may take advantage of micafungin prophylaxis
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Anti-fungal prophylaxis, Fungal infection, Risk factor
Abstract: PB2067
Type: Publication Only
Background
Micafungin is a clinically important echinocandin antifungal drug, recently approved as prophylaxis treatment in patients undergoing allogeneic transplantation and in those undergoing prolonged neutropenia (> 10 days). The use and the role of micafungin however prophylaxis is still questionable in term of comparison with azole compounds and on the potential selective pressure of micafungin toward resistant fungi. Furthermore, the frequency of breakthrough invasive fungal diseases (IFI) during echinocandin therapy is unclear.
Aims
To evaluate the frequency of breakthrough IFI in a single center experience of hematological malignancies treated with primary antifungal prophylaxis by micafungin
Methods
To evaluate retrospectively the use of micafungin in 11 adult hematological patients treated at our institution and characterized by high and intermediate risk of infections for development of IFI according to the latest NCCN Guidelines (table 1).
Table 1. Patients characteristics
Median age, years (range) | 60 (33-74) |
Female: Male |
1:10 |
Patients at high risk for IFD n. (%)
|
6/11 (54.5%)
3/11 (27%)
1/11 (9%) 2/11 (18%) |
Patients at intermediate risk for IFD n. (%)
|
5/11 (45%)
|
History of previous infections
|
3/11 (27%) 2/3 (67%) 1/3 (33%) 0/3 |
CIRS SCORE
|
9/11 (82%) 2/11 (18%) |
Days of neutropenia at micafungin discontinuation,median (interquartile range) |
9 (6-13) |
Results
All patients received prophylactic micafungin at 50 mg/day during neutropenia until neutrophils recovery or breakthrough IFI. The median of the days of neutropenia at micafungin discontinuation was nine. Febrile neutropenic patients with suspected IFI underwent an infective work up including serum galactomannan and/or bronchoalveolar lavages (BAL), CT scan and multiple samplings of blood cultures. IFI occurred in three patients affected by high risk of IFI, with two proven IFI, Aspergillus and Mucor species, respectively (table 2). All patients had a grade IV neutropenia and the IFI occurred respectively after 30, 24 and 11 days of neutropenia from the first administration of micafungin. We observed two lung infections, with sepsis in a patient affected by severe aplastic anaemia and a CNS involvement in an AML patient, respectively. The third patients with AML secondary to myelodysplastic syndrome developed a probable liver fungal infection revealed by CT scan. All patients were treated empirically with liposomal amphotericin B followed by voriconazole: two died of IFI after 25 and 23 days, the third died because of refractory leukemia. No IFI were documented in the five patients at intermediate risk receiving micafungin prophylaxis, while the other three high-risk patients developed a fungal infection several months after micafungin discontinuation.
Conclusion
In our experience, micafungin was active as profilaxis treatment in intermediate risk patients. Whereas a feeble approach has been shown in patients with high risk of IFI. We suggest therefore evaluating in a larger series of patients this approach to clarify which patients may take advantage of micafungin prophylaxis
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Anti-fungal prophylaxis, Fungal infection, Risk factor