Efficacy and Safety of Micafungin as Prophylaxis for Invasive Fungal Disease in Neutropenic Patients with Hematologic Malignancies

2014 ◽  
Vol 10 (4) ◽  
pp. 231-236 ◽  
Author(s):  
Liping Wan ◽  
Chun Wang ◽  
Lin Liu ◽  
Xiaoqiong Tang ◽  
Jinghua Wang ◽  
...  
Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4628-4628
Author(s):  
Li Gao ◽  
Ren Lin ◽  
Min Dai ◽  
Jing Sun ◽  
Zhiping Fan ◽  
...  

Abstract Objective To explore the efficacy and safety of micafungin as salvage treatment for invasive fungal disease(IFD) in patients with hematologic malignancies. Methods A retrospective, observational, sequential cohort study was performed between Feb 2012 and June 2015 at southern medical university nanfang Hospital. We selected a group of 51 patients who either refractory or intolerant to first-line antifungal therapies, received micafungin as salvage therapy. Of the 51 patients, IFD was proven in 5 and probable in 46 patients. The predominant cause for treatment switch to micafungin was refractory therapy in 33 patients, followed by intolerance in 15 patients or both in 3 patients. For their first-line antifungal therapies of IFD, 34 patients received voriconazole, 7 patients received itraconazole, 2 patients received amphotericin B,1 patients received caspofungin,1 patients received posaconazole and 6 patients received voriconazole combined amphotericin B. The median duration of antifungal treatment before salvage therapy was 26 days (range, 4 to 57 days). The successful resolution rates、the median time of micafungin treatment, the drug related adverse events and overall survival were assessed. Results All of the patients were treated with 150 mg/d micafungin. The median time of micafungin treatment was 23 days (range,12-72 days). The success rate was 64.7%, including 16 achieved complete response, 17 achieved partial response and 18 patients had no overall response (failure in 9 patients, 2 patient with stable disease and 7 patients died). Only one patient experienced an adverse event. No patient discontinued micafungin therapy due to an adverse event. Conclusions This study demonstrated that micafungin was efficacy and safety as salvage treatment IFD in patients with hematologic malignancies. Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S902-S902
Author(s):  
Tyler D Bold ◽  
Rahul S Vedula ◽  
Matthew P Cheng ◽  
Francisco M Marty ◽  
R Coleman Lindsley

Abstract Background Patients with hematologic malignancies (HM) are at risk of invasive fungal disease (IFD). Identification of those patients at the highest risk for IFD would help optimize prophylactic or preemptive treatment decisions in this population. We previously found that among patients with myeloid malignancies who develop invasive aspergillosis, 15% had a mutation in the gene GATA2. Here, we report the incidence of IFD in a cohort of patients with HM related to a pathogenic sequence variant of GATA2. Methods We identified 6343 patients cared for at Dana-Farber/Brigham and Women’s Cancer Center between January 2014 and August 2018 who underwent a next-generation sequencing assay of 95 genes recurrently mutated in hematologic malignancy. Those found to have a pathogenic GATA2 sequence variant were selected for retrospective chart review with respect to serious infectious complications including IFD. Results We identified 54 patients with a pathogenic GATA2 variant. 5 had a germline mutation related to familial GATA2 deficiency. The other 49 had a HM, mostly (41/49) acute myeloid leukemia or myelodysplastic syndrome. The frequency of the variant GATA2 allele in this group ranged from 2.5 to 92.0% of sequencing reads. 14 patients were excluded due to lack of sufficient follow-up, often related to treatment at another institution. Of the remaining 35 patients, 13 (37%) had proven/probable invasive fungal infection (IFI). Fourteen others had syndromes consistent with possible IFD. In total, 16 of these 35 patients (46%) received antifungal therapy for proven, probable or possible IFD. Four of the patients not treated with antifungals were diagnosed with a serious infection including 2 cases of Staphylococcus aureus bacteremia, and one case of disseminated Mycobacterium avium complex. Conclusion We identified a high incidence of IFD among patients with HM related to a pathogenic sequence variant of GATA2. The wide range of variant allele frequency observed raises the possibility that either inherited or acquired GATA2 dysfunction could incur predisposition to infection. These data suggest that personalized genetic diagnostics of patients with HM may be useful for assessment of infectious risk. Disclosures All authors: No reported disclosures.


2002 ◽  
Vol 36 (10) ◽  
pp. 1525-1531 ◽  
Author(s):  
Dawn I Warkentin ◽  
Joel B Epstein ◽  
Lara M Campbell ◽  
Judy G Yip ◽  
Victoria C Cox ◽  
...  

BACKGROUND: It is common practice to administer acyclovir as prophylaxis to patients with hematologic malignancies during neutropenia; however, effective therapy requires frequent dosing, which is difficult in this setting. Valacyclovir has greater oral bioavailability and requires less frequent dosing. OBJECTIVE: To evaluate the efficacy and safety of valacyclovir compared with acyclovir. METHODS: Patients who had been treated with chemotherapy or stem-cell transplantation were randomized to receive acyclovir 400 mg orally 3 × daily (n = 51), valacyclovir 500 mg orally twice daily (n = 48), or valacyclovir 250 mg orally twice daily (n = 52) during neutropenia. RESULTS: Clinical success, defined as the absence of an active herpes simplex virus (HSV) lesion or asymptomatic viral shedding, was similar between the 3 groups (acyclovir 96%, valacyclovir 500 mg 95%, valacyclovir 250 mg 100%). The overall rates of adverse events were similar in the 3 groups. CONCLUSIONS: Prophylactic treatment with valacyclovir is an effective and safe alternative to acyclovir for the prevention of HSV reactivation in patients with hematologic malignancies.


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