Primary antifungal prophylaxis with micafungin in patients with haematological malignancies: real‐life data from a retrospective single‐centre observational study

Abstract

Mould-active antifungal prophylaxis is increasingly used in patients at risk for invasive fungal disease. Between June 2011 and June 2012, one hundred patients with various haematological malignancies at risk for invasive fungal disease received primary antifungal prophylaxis with intravenous micafungin at a daily dosage of 50 mg during neutropenia. The median number of days on micafungin prophylaxis was 14 (range, 6-48 d). The incidence of proven and probable breakthrough invasive fungal diseases (bIFDs) was 6% and 3%, respectively. There were two bloodstream infections caused by yeasts or yeast-like fungi (Candida krusei, Trichosporon asahii) in two patients during the neutropenic phase after allogeneic haematopoietic stem cell transplantation. Four proven bIFDs caused by non-Aspergillus moulds and three cases of probable pulmonary bIFDs were documented during the neutropenic phase after induction/consolidation chemotherapy for acute leukaemia. Colonisation with Candida spp. was documented in 51% of the patients with none of the isolates being in vitro micafungin resistant. Compared to a historical control, receiving primary prophylaxis with posaconazole micafungin is at least as effective in preventing IFD. In both cohorts, bIFDs were exclusively caused by emerging pathogens with a highly preserved in vitro sensitivity to amphotericin B.

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

“…The dose of micafungin was chosen based on initial studies suggesting the need for higher doses of anti-mold prophylaxis compared to the dose needed for Candida. 20,21 It is possible that a lower dose of micafungin could be equally effective based on recent data showing effective anti-mold prophylaxis with a daily dose of 50-100 mg. 22,23 Mortality after IMI was high in our patients, consistent with prior reports, 8,24 especially for those with Mucorales, reflecting the aggressiveness of these infections even in the prophylactic era and indicating the need for continuing improvement in this field despite the low prevalence of IMI.…”

“…The dose of micafungin was chosen based on initial studies suggesting the need for higher doses of anti‐mold prophylaxis compared to the dose needed for Candida . It is possible that a lower dose of micafungin could be equally effective based on recent data showing effective anti‐mold prophylaxis with a daily dose of 50‐100 mg …”

Esophageal Candidiasis as the Initial Manifestation of Acute Myeloid Leukemia

“…It should be noted that, at the present time, most patients with hematological malignancies or cancers undergoing chemotherapy take fluconazole for antifungal prophylaxis (9). In addition, an increasing number of clinical trials have reported to have optimized "prophylaxis" for invasive fungal infections (11). Thus, we demonstrated that afebrile Candida infection can be the sole initial manifestation of systemic disorders including hematological malignancies.…”

Primary antifungal prophylaxis: decrease of invasive fungal disease incidence and reduction of risk factors in haematological patients in a 5‐year retrospective study

“…The most popular PAP studies are about the choice of PAP drugs, including retrospective and prospective studies . Triazoles were the earliest and most widely used, accounting for more than 90% of PAP drugs .…”

“…The most popular PAP studies are about the choice of PAP drugs, including retrospective and prospective studies. [30][31][32][33][34][35][36] Triazoles were the earliest and most widely used, accounting for more than 90% of PAP drugs. 21 In this study, triazoles were also the most popular PAP drugs (n = 568, 75.8%), 2 followed by echinocandins (n = 98, 13.1%) and AmB (n = 83, 11.1%).…”