Antifungal prophylaxis with micafungin in neutropenic patients with hematological malignancies.
The aim of the study was to assess the antifungal prophylactic efficacy, safety, and tolerability of micafungin, 150 mg daily, and to evaluate the usefulness of monitoring 1,3-beta-d-glucan (BG) in neutropenic patients undergoing chemotherapy for hematological malignancies. This investigation was a retrospective, non-randomized study. A group of patients who did not receive systemic antifungal prophylaxis was compared to another group of patients who received micafungin 150 mg daily. All patients admitted with hematological malignancy and undergoing chemotherapy or stem cell transplant were included. The plasma BG level was measured once weekly. The clinical endpoint was the diagnosis of invasive fungal infection (IFI). Antifungal prophylaxis led to a significant decrease in the occurrence of IFI (from 12.3% to 1.5%, p = 0.001). Few severe adverse effects clearly attributable to micafungin were seen. Sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of BG values >8.9 pg/mL for diagnosis of IFI were 0.90, 0.99, 0.82, 0.99, and 0.99, respectively. Micafungin, 150 mg daily, is an effective and safe drug for antifungal prophylaxis, and monitoring of BG antigenemia is a useful tool for diagnosis of IFI in neutropenic patients with hematological malignancies.
Hirata
Yuji
Y
Department of Internal Medicine (I), Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka 569-0801, Japan. in1274@poh.osaka-med.ac.jp
Yokote
Taiji
T
Kobayashi
Kichinosuke
K
Nakayama
Shoko
S
Oka
Satoko
S
Miyoshi
Takuji
T
Akioka
Toshikazu
T
Hiraoka
Nobuya
N
Iwaki
Kazuki
K
Takayama
Ayami
A
Nishimura
Yasuichiro
Y
Makino
Junko
J
Takubo
Takayuki
T
Tsuji
Motomu
M
Hanafusa
Toshiaki
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D006801:Humans; D055666:Lipopeptides / Q000627:therapeutic use*; D008297:Male; D020714:Maximum Tolerated Dose; D000077551:Micafungin; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control*; D009503:Neutropenia / Q000097:blood / Q000150:complications*; D011379:Prognosis; D011509:Proteoglycans; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate; D055815:Young Adult; D047071:beta-Glucans / Q000097:blood*
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011509:Proteoglycans; D047071:beta-Glucans; C010770:polysaccharide-K; D000077551:Micafungin