Paper: Tolerability of Daily Micafungin Antifungal Prophylaxis in High Risk Pediatric Patients Undergoing Hematopoietic Cell Transplantation for Non-Malignant Disorders

Contributed Abstracts

Hall 1 (Salt Palace Convention Center)

David Buchbinder, MD , Children's Hospital of Orange County, Orange, CA

Steven M Neudorf, MD , Children's Hospital of Orange County, Orange, CA

Felice Adler, MD , Infectious Disease, Children's Hospital of Orange County

Negar Ashouri, MD , Infectious Disease, Children's Hospital of Orange County

Carla Daum, RN, CPON , Children's Hospital of Orange County, Orange, CA

Loan Hsieh, MD , Children's Hospital of Orange County, Orange, CA

Van Huynh, MD , Children's Hospital of Orange County, Orange, CA

Ivan Kirov, MD , Children's Hospital of Orange County, Orange, CA

Edna Klinger, RN, BS , Children's Hospital of Orange County, Orange, CA

Nancy Kuntz, RN, PNP , Children's Hospital of Orange County, Orange, CA

Delma Nieves, MD , Infectious Disease, Children's Hospital of Orange County

Diane Jean Nugent, MD , Children's Hospital of Orange County, Orange, CA

Geetha Puthenveetil, MD , Children's Hospital of Orange County, Orange, CA

Elyssa Rubin, MD , Children's Hospital of Orange County, Orange, CA

Leonard Sender, MD , Oncology, UC Irvine Medical Center, Orange, CA

Jasjit Singh, MD , Infectious Disease, Children's Hospital of Orange County

Amit Soni, MD , Children's Hospital of Orange County, Orange, CA

Jill Stites, FNP , Children's Hospital of Orange County, Orange, CA

Lilibeth Torno, MD , Children's Hospital of Orange County, Orange, CA

Antonio Arrieta, MD , Infectious Disease, Children's Hospital of Orange County

Objective:

Invasive fungal infections are a cause of mortality in pediatric allogeneic hematopoietic cell transplantation (allo-HCT) recipients. Prophylaxis with triazoles present a challenge in patients with non-malignant disorders due to pre-HCT risk for organ dysfunction. Micafungin is an echinocandin with activity against Candida and Aspergillus species. Limited toxicity and drug interactions of micafungin make this an attractive option. Limited experience has been reported in pediatric HCT patients with non-malignant disorders. We report our experience with daily micafungin antifungal prophylaxis in pediatric allo-HCT patients with non-malignant disorders.

Methods:

A retrospective descriptive analysis of 28 pediatric patients with a variety of non-malignant disorders undergoing allo-HCT and prophylaxis with micafungin is provided. The median age at allo-HCT was 5 years (range, 0.4-11). No patient had a previous invasive fungal infections, hepatic, or renal dysfunction except for one patient with hepatic fibrosis. Cyclosporine was used for graft-versus-host disease prophylaxis.

Results:

Table 1 provides a summary of results associated with daily micafungin antifungal prophylaxis. Micafungin was discontinued in one patient due to liver function test abnormalities. A baseline elevation in AST, ALT, and bilirubin was documented in 25%, 39%, and 0% of patients; respectively. There was a two-fold increase in AST, ALT, and bilirubin in 60%, 67%, and 85% of patients during treatment; these decreased on therapy. A similar trend was noted in renal function. Cyclosporine levels did not fluctuate significantly during therapy.

Conclusion:

Daily micafungin prophylaxis is a well-tolerated method which may prevent fungal infections in pediatric allo-HCT patients with non-malignant disorders. Further study of micafungin prophylaxis to evaluate the efficacy of micafungin in the prevention of fungal infections in pediatric allo-HCT recipients with non-malignant disorders is needed.

Table 1: Daily Micafungin Antifungal Prophylaxis Results

Observations

Number (%) or Median (Range)

Total patients

28

Duration (days)

37 (3-94)

Average dose - start (mg/kg/day)

2.1 (0.8-4.3)

AST

                 Baseline elevation

7 (25)

                 End elevation

7 (25)

                 Increase ≥ 2x baseline

17 (61)

ALT

                 Baseline elevation

11 (39)

                 End elevation

10 (36)

                 Increase ≥ 2x baseline

19 (68)

Total Bilirubin

                 Baseline elevation

0

                 End elevation

4 (14)

                 Increase ≥ 2x baseline

24 (86)

Creatinine

                 Baseline elevation

1 (4)

                 End elevation

1 (4)

                 Increase ≥ 2x baseline

10 (36)

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Table 1: Daily Micafungin Antifungal Prophylaxis Results

Observations	Number (%) or Median (Range)
Total patients		28
Duration (days)		37 (3-94)
Average dose - start (mg/kg/day)		2.1 (0.8-4.3)
AST
Baseline elevation		7 (25)
End elevation		7 (25)
Increase ≥ 2x baseline		17 (61)
ALT
Baseline elevation		11 (39)
End elevation		10 (36)
Increase ≥ 2x baseline		19 (68)
Total Bilirubin
Baseline elevation		0
End elevation		4 (14)
Increase ≥ 2x baseline		24 (86)
Creatinine
Baseline elevation		1 (4)
End elevation		1 (4)
Increase ≥ 2x baseline		10 (36)

295 Tolerability of Daily Micafungin Antifungal Prophylaxis in High Risk Pediatric Patients Undergoing Hematopoietic Cell Transplantation for Non-Malignant Disorders