title: Experience with anidulafungin in patients with allogeneic hematopoietic stem cell transplantation and graft-versus-host disease.
abstract: BACKGROUND
  It is well known that both acute and chronic graft-versus-host disease (GVHD) are associated with invasive fungal disease (IFD). Because the galactomannan antigen diagnostic test has low specificity and sensitivity outside of the neutropenic period, many institutions use posaconazole or voriconazole for IFD prophylaxis during GVHD treatment. Moreover, several factors, mainly hepatic impairment, can limit the use of extended spectrum azoles, both in prophylaxis or treatment.
  
  
  METHODS
  We retrospectively analyzed 25 patients with allogeneic hematopoietic stem cell transplantation (HSCT) and GVHD - grade III-IV acute GHVD (n = 15), progressive chronic GVHD (n = 7), and "overlap" GVHD (n = 3) - who received intravenous anidulafungin (200 mg on day 1, followed by 100 mg once daily). If necessary, anidulafungin treatment was followed by oral administration of 200 mg voriconazole twice a day or 200 mg posaconazole 3 times daily until patients were considered not at risk for IFD.
  
  
  RESULTS
  Twenty-one patients (85%) received anidulafungin as prophylaxis and 5 patients (15%) received it as treatment. Median duration of intravenous anidulafungin administration was 8 days (range 6-17). Seven patients (28%) presented mild adverse effects, with no significant interactions with calcineurin inhibitors. Sequentially, 4 patients received voriconazole and 6 posaconazole. Two patients (8%) developed IFD after anidulafungin withdrawal: 1 with Candida albicans and the other with Mucor, 8 and 5 days after withdrawal, respectively.
  
  
  CONCLUSIONS
  Our results are of interest owing to the absence of data in the literature on anidulafungin use in HSCT patients with GVHD, and suggest that anidulafungin, because of its spectrum, pharmacological profile, low toxicity, and absence of interactions with immunosuppressants, could be a drug of choice in this setting.
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Yáñez
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Insunza
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ibarrondo
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: C
authors.initials: C
authors.lastname: de Miguel
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Bermúdez
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Colorado
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: M
authors.initials: M
authors.lastname: López-Duarte
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Richard
authors.affiliation: Hematology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Conde
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000077612:Anidulafungin; D000935:Antifungal Agents / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D000077612:Anidulafungin
keywords: anidulafungin; graft-versus-host disease; hematopoietic stem cell transplantation; invasive fungal disease; prophylaxis