Micafungin, a novel antifungal agent, as empirical therapy in acute leukemia patients with febrile neutropenia.
OBJECTIVE
Invasive fungal infection is a major cause of morbidity and mortality in patients with febrile neutropenia unresponsive to antibacterial treatment. Empirical antifungal therapy with amphotericin B has been the standard of care for these patients; however, there remains a need for less toxic alternative drugs.


METHODS
We conducted a prospective study to evaluate the efficacy and safety of micafungin (MCFG), a novel antifungal agent of the echinocandin class, in an empirical therapy setting for patients with febrile neutropenia.


RESULTS
A total of 31 patients with acute leukemia who developed febrile neutropenia were enrolled in the study. Among them, 18 patients fulfilling the protocol-defined criteria, including 10 with persistent fever and 8 with recurrent fever, received MCFG empirically. Underlying diseases consisted of acute myeloid leukemia (n=15) and acute lymphoblastic leukemia (n=3). The median duration of neutropenia and drug administration was 22 and 9.5 days, respectively. Treatment success, defined as defervescence during the neutropenic period, absence of breakthrough fungal infections, and requiring no replacement of antifungal drugs, was achieved in 14 patients (78%). None of the patients required discontinuation or dose reduction due to adverse events except for one patient with severe hypokalemia.


CONCLUSIONS
Although the studied patients were limited in number, our results indicate that MCFG is an encouraging agent for empirical antifungal therapy in patients with febrile neutropenia, and deserves further investigation in large-scale studies.
Yanada
Masamitsu
M
Department of Hematology, Nagoya University Graduate School of Medicine.
Kiyoi
Hitoshi
H
Murata
Makoto
M
Suzuki
Momoko
M
Iwai
Masanori
M
Yokozawa
Toshiya
T
Baba
Hisashi
H
Emi
Nobuhiko
N
Naoe
Tomoki
T
D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D054714:Echinocandins; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007951:Leukemia, Myeloid / Q000150:complications; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications; D011446:Prospective Studies
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D000077551:Micafungin