Micafungin for Secondary Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients_West China Medical Journal

Authors：

HUANG Xiaobing , WANG Chunsen , ZHANG Jingling , WANG Xiaodong

Department of Hematology, Sichuan Academy of Medical Science & Sichuan Provincial People′s Hospital, Chengdu, Sichuan 610072, P. R. China;

Corresponding author：

Keywords：

R733.7; R730.5

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【摘要】　目的　探讨米卡芬净在有侵袭性真菌感染（invasive fungal infection，IFI）病史的患者行造血干细胞移植（haematopoietic stem cell transplantation，HSCT）时二级预防（secondary anti-fungal prophylaxis，SAP）的有效性和安全性。　方法　选择2009年1月-2011年1月行HSCT治疗血液病患者中有IFI史的18例患者，从预处理进行SAP，13例开始即使用米卡芬净钠，5例开始选用伏立康唑，后换为米卡芬净。预防至危险期结束（白细胞植活、无感染症状），18例患者随访时间62～220 d，中位随访时间为124 d。　结果　米卡芬净治疗有效17例，1例在预防期间+27 d出现真菌突破感染。预防过程中1例在输注的第2天出现躯干充血性皮疹伴瘙痒，经抗过敏治疗后逐渐好转。17例患者在米卡芬净使用过程中未观察严重不良反应发生，也未因此而调整环胞素A治疗浓度。　结论　米卡芬净作为HSCT中SAP的备选用药之一是安全、有效的。
【Abstract】　Objective　 To investigate the efficacy of micafungin on secondary anti-fungal prophylaxis (SAP) in hematopoietie stem cell transplantation (HSCT) recipients who had a history of antecedent invasive fungal infection (IFI) and to observe the safety of micafungin.　Methods　 The patients with hematological diseases，who underwent HSCT between January 2009 and January 2011, received our routine conditioning regimen. The patients, who had a history of antecedent IFI, were given by micafungin for SAP from the start of conditioning chemotherapy until the end of the risk period.　Results　 There were 18 patients had a history of antecedent IFI. The overall efficacy of micafungin was 17/18. One patients had IFI on the +27th day during SAP; one patient had body congestive rash accompanied with pruritus in the prevention period 2 days after treatment, who got better gradually after antianaphylaxis treatment. No patients had server adverse reaction and the concentration of cyclosporine A was not changed.　Conclusion　 Micafungin as one of drugs for SAP Is effective and safe for HSCT.

Citation： HUANG Xiaobing,WANG Chunsen,ZHANG Jingling,WANG Xiaodong. Micafungin for Secondary Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients. West China Medical Journal, 2011, 26(12): 1783-1786. doi: Copy

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10.	中华内科杂志编辑委员会. 血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)[J]. 中华内科杂志, 2007, 46(6): 607-611.
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12.	Madureira A, Bergemn A, Lacroix C, et al. Breakthrough invasive aspergiIlosis in allogeneic haematopoietic stem cell transplant recipients treated with easpofungin[J]. Int J Antimiemb Agents, 2007, 30(7): 551-554.
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14.	Fukuda T, Boecldl M,, Guthrie KA, et al. Invasive aspergillosis before allogeneic hematopoietie stem cell transplantation: 10-year experience at a single transphnt center[J]. Biol Blood Marrow Transplant, 2004, 10(13): 494-503.
15.	许兰平, 唐菲菲, 刘代红, 等. 造血干细胞移植中侵袭性真菌感染的二级预防[J]. 中华内科杂志 2009, 48(4): 853-856.

1. 　Gratwohl A, Brand R, Frassoni F, et al. Cause of death after allogeneic haematopoietic stem cell transp lantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious comp lications and changes over calendar time[J]. Bone Marrow Transplant, 2005, 36(11): 757-769.
2. 　Sipsas NV, Kontoyiannis DP. Clinical issues regarding relapsing asperlllosis and the efficacy of secondary antifungal prophylaxis in patients with hematological malignancies[J]. Clin Infect Dis, 2006, 42(9): 1584-1591.
3. 　Wingard M, Merz WG. Binaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutroponia treated prophylactically with fluconazole[J]. N Earl J Med, 1991, 325(17): 1274-1277.
4. 　Krtiger WH, Riissmann B, de Wit M, et al. Haemopoietie cell transplantation of patients witll a history of deep or invasive funsal infection during prophylaxis with lipesomal amphoteriein B[J]. Acts Haematol, 2005, 113(42): 104-108.
5. 　Petraitis V, Petraitiene R, Groll AH, et al. Comparative antifungal activities and plasma pharmacokinetics of micafungin (FK463) against disseminated candidiasis and invasive pulmonary aspergillosis in persistently neutropenic rabbits[J]. Antimicrob Agents Chemother, 2002, 46(26): 1857-1869.
6. 　David WD, Kieren AM, Wendi ML, et al. Micafungin (FK463), alone or in combination with other systemic antifungal agents, for the treatment of acute invasive aspergillosis[J]. J Infect, 2006, 53(12): 337-349.
7. 　Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis, 2009, 46(11): 327-360.
8. 　美国西雅图Fred Hutchinson癌症研究中心医学联合体. 造血干细胞移植标准实践手册[M]. 北京: 人民卫生出版社, 2007: 301.
9. 　van Burik JA, Ratanatharathorn V, Stepan DE. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation[J]. Clin Infect Dis, 2004, 39(10): 1407-1416.
10. 　中华内科杂志编辑委员会. 血液病/恶性肿瘤患者侵袭性真菌感染的诊断标准与治疗原则(修订版)[J]. 中华内科杂志, 2007, 46(6): 607-611.
11. 　Herbreeht R, Denning DW, Patterson V, et al. Voriconazole versus amphotericin B for primary thempy of invasive aspergillosis[J]. N Ensl J Med, 2002, 347(18): 408-415.
12. 　Madureira A, Bergemn A, Lacroix C, et al. Breakthrough invasive aspergiIlosis in allogeneic haematopoietic stem cell transplant recipients treated with easpofungin[J]. Int J Antimiemb Agents, 2007, 30(7): 551-554.
13. 　van Boxtel CJ, Santoso B, Edwards IR. 药物效益与风险[M]. 陈易新, 张素敏, 吴钟浩, 等译. 北京: 中国医药科技出版社, 2006: 274.
14. 　Fukuda T, Boecldl M,, Guthrie KA, et al. Invasive aspergillosis before allogeneic hematopoietie stem cell transplantation: 10-year experience at a single transphnt center[J]. Biol Blood Marrow Transplant, 2004, 10(13): 494-503.
15. 　许兰平, 唐菲菲, 刘代红, 等. 造血干细胞移植中侵袭性真菌感染的二级预防[J]. 中华内科杂志 2009, 48(4): 853-856.

West China Medical Journal

Micafungin for Secondary Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients

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