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Twice-Weekly Micafungin as Antifungal Prophylaxis in Children Undergoing Hematopoietic Stem Cell Transplantation
Syaza Ab Rahman1, Xin Yee Chiew1, Vida Jawin2
1Bone Marrow Transplantation Unit, Department of Pediatrics, Universiti Malaya Medical Centre, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
Background:
Children undergoing hematopoietic stem cell transplantation are at increased risk of developing invasive fungal infection. Micafungin is an echinocandin with broad-spectrum antifungal properties. Recent trials have reported on the efficacy of intermittent daily dosing of micafungin for fungal prophylaxis in pediatric patients undergoing transplantation, with success rates of 76%-99%, success defined as absence of proven, probable, or possible invasive fungal infection. We implemented a twice-weekly micafungin regimen as antifungal prophylaxis in our unit.
Patients And Methods:
One hundred consecutive transplants performed between May 2018 and February 2024 were analyzed. Micafungin prophylaxis was dosed at 3-5 mg/kg daily given twice weekly from Day 0 till stable neutrophil engraftment, after which oral fluconazole was prescribed till Day +100. Fungal infection status was evaluated by radiological procedures and cultures from blood or sterile body sites as clinically indicated. The primary endpoint of the study was the evaluation of efficacy; secondary endpoints were safety and tolerability.
Results:
Ninety three patients who underwent 95 transplants fulfilled the inclusion criteria. Underlying diagnoses were: leukemia (47), inborn errors of immunity (11), other malignancies (11), hemoglobinopathy (8), and others (16). There were no proven or probable fungal infections. Seventeen patients (18%) required change from prophylaxis to empirical antifungal treatment for persistent fever (n = 5) and possible fungal infections, mainly oesophagitis (n = 8). All patients who failed micafungin prophylaxis received allogeneic transplants, and HLA-haploidentical was the majority (14/17). None of the patients had to discontinue micafungin due to safety or tolerability concerns.
Conclusions:
Twice-weekly IV micafungin is a safe and effective option as antifungal prophylaxis for children undergoing HSCT.
Insights
Twice-weekly micafungin prophylaxis effectively prevented invasive fungal infections in pediatric hematopoietic stem cell transplant patients. This safe regimen offers a viable option for antifungal protection during transplantation.
Area of Science:
- Pediatric Hematology-Oncology
- Infectious Diseases
- Pharmacology
Background:
- Children undergoing hematopoietic stem cell transplantation (HSCT) face a high risk of invasive fungal infections.
- Micafungin, an echinocandin, demonstrates broad-spectrum antifungal activity.
- Previous studies showed success with daily micafungin for prophylaxis in pediatric transplant patients.
Purpose of the Study:
- To evaluate the efficacy and safety of a twice-weekly micafungin regimen for antifungal prophylaxis in pediatric HSCT recipients.
- To assess the incidence of invasive fungal infections and treatment tolerability.
Main Methods:
- A retrospective analysis of 100 consecutive HSCT procedures between May 2018 and February 2024.
- Micafungin was administered at 3-5 mg/kg twice weekly from Day 0 until neutrophil engraftment, followed by fluconazole.
- Fungal infection status was monitored via imaging and cultures; efficacy, safety, and tolerability were assessed.
Main Results:
- No proven or probable fungal infections occurred in 93 eligible patients (95 transplants).
- Eighteen percent of patients required a switch to empirical antifungal treatment due to fever or possible fungal infections (e.g., esophagitis).
- No patients discontinued micafungin due to safety or tolerability issues.
Conclusions:
- A twice-weekly intravenous micafungin regimen is a safe and effective strategy for antifungal prophylaxis in pediatric HSCT.
- This dosing schedule provides a valuable alternative for preventing fungal infections in this vulnerable population.
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