Document Detail


Micafungin alone or in combination with other systemic antifungal therapies in hematopoietic stem cell transplant recipients with invasive aspergillosis.
MedLine Citation:
PMID:  18983417     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We describe herein 98 hematopoietic stem cell transplant (HSCT) recipients with invasive aspergillosis (IA) (refractory in 83) who received micafungin either alone (8 patients) or in combination with other licensed antifungal therapies (OLAT) (90 patients). Of the 8 monotherapy patients, 4 were failing OLAT, received de novo micafungin, or were intolerant to prior OLAT (2 patients each). Of the 90 patients treated with combination, 7 had de novo IA and 83 had refractory infection. Most patients (81) had pulmonary IA, 42 (43%) had graft-versus-host disease (GVHD), and 26 (27%) were neutropenic (absolute neutrophil count <500 cells/mm(3)) at onset of treatment. Successful response was seen in 25/98 (26%); an additional 12 patients achieved stable disease. Response was seen in 2/9 (22%) in de novo treatment, 21/87 (24%) in refractory patients, and 2/2 (100%) in toxicity failure patients. Additionally, response was seen in 22 of the 90 (24%) patients treated with combination therapy, and in 3 of 8 (38%) patients who were treated with micafungin alone. No significant differences in responses were found based on type of HSCT, GVHD status, site of IA, or Aspergillus species, and no significant toxicity was seen. Micafungin was well tolerated, even at high doses, and is a reasonable option for treatment of IA in this high-risk patient population.
Authors:
D P Kontoyiannis; V Ratanatharathorn; J-A Young; J Raymond; M Laverdière; D W Denning; T F Patterson; D Facklam; L Kovanda; L Arnold; W Lau; D Buell; K A Marr
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-08
Journal Detail:
Title:  Transplant infectious disease : an official journal of the Transplantation Society     Volume:  11     ISSN:  1399-3062     ISO Abbreviation:  Transpl Infect Dis     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-22     Completed Date:  2009-02-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883688     Medline TA:  Transpl Infect Dis     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  89-93     Citation Subset:  IM    
Affiliation:
Department of Infectious Diseases, Infection Control and Employee Health, Unit 402, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA. dkontoyi@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Antifungal Agents / administration & dosage,  therapeutic use*
Aspergillosis / drug therapy*,  microbiology
Aspergillus / drug effects
Child
Drug Therapy, Combination
Echinocandins / administration & dosage,  therapeutic use*
Hematopoietic Stem Cell Transplantation / adverse effects*
Humans
Invasive Pulmonary Aspergillosis / drug therapy*,  microbiology
Lipopeptides / administration & dosage,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Echinocandins; 0/Lipopeptides; 0/micafungin

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