339 Micafungin Followed by Posaconazole Is Effective As Primary Antifungal Prophylaxis in First Three Months After Unrelated Donor Transplantation

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Naheed Alam, MBBS , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada
Coleman Rotstein, MD , Divison of Infectious Diseases, University of Toronto, Toronto, ON, Canada
Eshetu Atenafu , Department of Biostatistics, Princess Margaret Hospital
Vikas Gupta, MD, FRCP, FRCPath , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada
Dennis Kim , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada
Hans Messner, MD, PhD , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada
John Kuruvilla, MD , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada
Jeffrey H Lipton, MD, PhD , Allogeneic Blood and Marrow Transplant Program, Princess Margaret Hospital, University of Toronto, Canada

Introduction: Invasive fungal infections (IFI) contribute to morbidity and mortality of hematopoietic cell transplantation (HCT). We evaluated micafungin followed by posaconazole for primary IFI prophylaxis.

Methods: Consecutive patients who received unrelated HCT at PMH from July 2009 to Dec 2011 with antifungal prophylaxis of Micafungin (50 mg IV daily) during hospitalization followed by posaconazole (200 mg po tid) for three months were reviewed.

Results: 86 patients received HCT in above setting. Median age was 48.3(range 18.6-71.2) years. 71 were 10/10 matches (allele level) while 15 were 9/10 (allele or antigen mismatch) (table1).

72 (83.7%) developed acute GVHD (aGVHD). Median day of development of aGVHD was 28.5 (range 7-100) days. Overall 1 and 2 year survival were 81.2% and 64.1% respectively. Relapse rate was 11.63%.

Median day of start of posaconazole was 22.5 (range14-64) days. All patients tolerated posaconazole and micafungin well.

3(3.5%) of patients were diagnosed with IFI in first three months. Median day of diagnosis was 13(range11-81) days. Diagnosis was based on symptoms with abnormal imaging and BAL galactomannan positivity in one.  Two cases were treated for symptoms with imaging abnormalities (Table 2). All patients were switched to voriconazole and improved which makes it less likely that they were IFI.

2 (2%) patients developed other fungal related problems. One patient developed oral candidiasis treated with micafungin. One patient had splenic leisons (presumed fungal) treated with treatment dose posaconazole and improved.

None of these patients had aGVHD at time of IFI diagnosis. None of these patients died of fungal related causes. 4 out of 5 patients were alive at last follow up. One died of relapse.

Conclusion: Micafungin followed by posaconazole is effective as primary IFI prophylaxis in unrelated donor HCT.

Table1. Patient Characteristics

Characteristics

n (%)

Total patients

86(100)

Age, yrs

 

         Less than 50

48(56)

         More than 50

38(44)

Diagnosis

 

        AML

34(39)

        ALL

10(12)

        MDS

16(19)

        NHL/HD

8(9)

        Others

18(21)

Graft source

 

      Bone marrow

6(7)

      Peripheral blood stem cells

80(93)

Conditioning

 

        MA

55(64)

        RIC

31(36)

GVHD prophylaxis

 

        CSA/Campath

49(57)

        CSA/MMF

33(38)

        Others

4(5)

Table 2: IFI (EORTC/MSG Criteria)

UPN

Symptoms

Imaging

BAL

IFI

27

Yes

Ground glass opacity/consolidation

Galactomannan +ve

Probable

46

Yes

New focal opacity in previous consolidation

-ve

Possible

85

Yes

Small b/l pleural effusion with ground glass opacity and septal thickening

-ve

Possible

 

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