Related Experiment Video
Updated: Apr 26, 2026
An Ex vivo Assay to Study Candida albicans Hyphal Morphogenesis in the Gastrointestinal Tract
Published on: July 1, 2020
Primary antifungal prophylaxis with micafungin in patients with haematological malignancies: real-life data from a
David Nachbaur1, Olga Angelova, Dorothea Orth-Höller
1Haematology & Oncology, University Hospital of Internal Medicine V, Innsbruck, Austria.
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.
Insights
Micafungin prophylaxis effectively prevents invasive fungal diseases in patients with hematological malignancies. This antifungal strategy shows comparable efficacy to posaconazole, with breakthrough infections caused by emerging pathogens sensitive to amphotericin B.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Invasive fungal diseases (IFDs) pose a significant risk to patients with hematological malignancies, particularly during neutropenia.
- Antifungal prophylaxis is crucial for managing this risk.
Purpose of the Study:
- To evaluate the efficacy and safety of intravenous micafungin as primary antifungal prophylaxis in patients with hematological malignancies.
- To compare micafungin's effectiveness against breakthrough invasive fungal diseases (bIFDs) with historical data.
Main Methods:
- A prospective study involving 100 patients with hematological malignancies receiving daily intravenous micafungin (50 mg) during neutropenia.
- Data collection included incidence of proven/probable bIFDs, causative pathogens, and Candida spp. colonization.
- Comparison with a historical cohort receiving posaconazole prophylaxis.
Main Results:
- The incidence of proven and probable bIFDs was 6% and 3%, respectively.
- Breakthrough infections included yeast (Candida krusei, Trichosporon asahii) and non-Aspergillus moulds.
- Candida spp. colonization occurred in 51% of patients, with no in vitro micafungin resistance.
- Micafungin demonstrated at least equivalent efficacy to posaconazole in preventing IFDs.
Conclusions:
- Intravenous micafungin is an effective primary prophylactic agent against IFDs in high-risk hematological malignancy patients.
- Emerging pathogens causing bIFDs showed preserved in vitro sensitivity to amphotericin B.
- Micafungin offers a viable alternative for antifungal prophylaxis in this patient population.
