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  3. Sequential systematic anti-mold prophylaxis with micafungin and voriconazole results in very low incidence of invasive mold infections in patients undergoing allogeneic hematopoietic stem cell transplantation

Sequential systematic anti-mold prophylaxis with micafungin and voriconazole results in very low incidence of invasive mold infections in patients undergoing allogeneic hematopoietic stem cell transplantation

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Rosillo, C
  • Avila, AM
  • Huang, YT
  • Devlin, S
  • Cho, C
  • Maloy, MA
  • Papanicolaou, GA
  • Barba, P
  • Perales, MA

Grupos

Abstract

Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at high risk for invasive mold infections (IMI). The goal of the study is to describe the incidence and outcome of IMI in patients after allo-HSCT in a large cohort of patients receiving anti-mold prophylaxis. We conducted a retrospective review of 988 consecutive adults who underwent allo-HSCT in our center from 2008 through 2014. Standard prophylaxis consisted of micafungin 150mg IV daily from admission to day +7 +/- 3 followed by voriconazole until day +75 to +100. Cases meeting criteria for proven or probable IMI according to EORTC-MSG criteria were included. Median age at HSCT was 54years. The most common diagnoses were acute myeloid leukemia (n=351, 36%) and lymphoid malignancies (n=248, 25%). Matched related or unrelated donors (URD) were used in 686 (69%) patients, mismatched URD in 142 (14%) and cord blood units in 154 (16%). Twenty-one patients were diagnosed with IMI after allo-HSCT, 19 probable and 2 proven, and one patient was diagnosed postmortem. Microbiological diagnosis was established in 9 cases, 5 of them being Aspergillus. One-year cumulative incidence (CI) of IMI was 1.6% (95% CI 0.9-2.5) while 12-week overall survival after IMI was 39% (95% CI 24-65) Analyzed by disease, there was a trend for a higher 1-year CI of IMI in patients with ALL (5% [95% CI 1.6-11.4]) when compared with AML (1.4%), MDS (1.5%) and lymphoma (1.2%), P=.06. The 1-year CI of IMI after transplantation is low in patients receiving anti-mold prophylaxis with micafungin bridged to voriconazole, although these infections are associated with a higher risk of mortality.

Datos de la publicación

ISSN/ISSNe:
1398-2273, 1399-3062

TRANSPLANT INFECTIOUS DISEASE  WILEY

Tipo:
Article
Páginas:
-
PubMed:
29668073
Factor de Impacto:
0,785 SCImago ℠
Cuartil:
Q2 SCImago ℠

Citas Recibidas en Web of Science: 11

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Keywords

  • allogeneic hematopoietic stem cell transplantation; antifungal; invasive fungal infection; molds

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