Successful allogeneic stem cell transplantation in two patients with acute myelogenous leukaemia and invasive aspergillosis by antifungal combination therapy.
Invasive aspergillosis (IA) is an important cause of infectious morbidity and mortality in patients who undergo haematopoietic stem cell transplantation (HSCT). History of IA before allogeneic HSCT is still challenging because of the high risk of recurrence after HSCT. Recent advances in early-stage diagnosis and new, more effective classes of antifungal agents have improved the management of IA in the HSCT recipients. We report two cases with acute myelogenous leukaemia after primary failure of induction chemotherapy with the patients developing pulmonary IA. They responded well to a combination of voriconazole (VCZ) and micafungin, resulting in a remarkable reduction of pulmonary IA lesions at short intervals. Thereafter, antifungal therapy was switched to liposomal amphotericin B (L-AmB), followed by conditioning regimen for allogeneic HSCT, because of the possibility of VCZ altering the metabolism of chemotherapeutic agents and calcineurin inhibitors. Successful engraftment was achieved without severe adverse side-effects or aggravation of IA after HSCT. Combining VCZ with micafungin followed by L-AmB throughout HSCT could be advantageous in stabilising IA in HSCT patients.
Aoki
Takatoshi
T
Miyamoto
Toshihiro
T
Mori
Yasuo
Y
Yoshimoto
Goichi
G
Yamauchi
Takuji
T
Kamezaki
Kenjiro
K
Takenaka
Katsuto
K
Iwasaki
Hiromi
H
Harada
Naoki
N
Nagafuji
Koji
K
Shimono
Nobuyuki
N
Teshima
Takanori
T
Akashi
Koichi
K
D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage*; D054714:Echinocandins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000628:therapy*; D055666:Lipopeptides / Q000008:administration & dosage; D000077551:Micafungin; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D065819:Voriconazole; D000077551:Micafungin