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KMID : 1144320100420030149
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감염과 화학요법
2010 Volume.42 No. 3 p.149 ~ p.155
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Efficacy and Safety of Micafungin for Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients
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Kim Si-Hyun
Lee Sung-Eun
Kim Hee-Je
Cho Byung-Sik
Kim Dong-Wook
Park Sun-Hee
Choi Su-Mi
Lee Dong-Gun
Choi Jung-Hyun
Yoo Jin-Hong
Min Woo-Sung
Park Chong-Won
Cho Seok-Goo
Lee Jong-Wook
Lee Seok
Min Chang- Ki
Kwon Jae-Cheol
Kim Yoo-Jin
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Abstract
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Background Micafungin, a potent inhibitor of 1,3-β-D-glucan synthase, is a novel antifungal agent of the echinocandin class. In vitro study showed that micafungin was effective against Aspergillus species as well as Candida species, but clinical data on the prophylactic efficacy against invasive fungal infections (IFIs) other than candidiasis are still lacking.
Materials and Methods We identified 60 consecutive adult hematopoietic stem cell transplantation (HSCT) recipients who received at least 3 doses of micafungin during neutropenic period. Micafungin was started as an alternative in patients who were intolerant or had adverse events (AEs) to primary prophylactic antifungal agents. We retrospectively reviewed the medical records and analyzed the efficacy and safety of micafungin for prophylaxis against IFIs.
Results The patients either had autologous (n=9) or allogeneic (n=51: 1 syngeneic, 24 sibling, 26 unrelated donor) HSCT. Itraconazole oral solution (n=58) was the most frequently used first line antifungal agent for prophylaxis and was administered for median 11 days. The most frequent cause of switch to micafungin was vomiting (n=42). The duration of neutropenia and micafungin administration was median 13 and 12 days, respectively. A successful outcome was achieved in 45 (75%) patients. Empirical antifungal therapy was initiated in 13 (22%) patients. There were 2 cases (3.3%) of breakthrough fungal infections which comprised a probable invasive pulmonary aspergillosis and a possible invasive fungal sinusitis. There was no case of invasive candidiasis. A total of 53 (88%) patients experienced at least one AE regardless of causality during micafungin administration. The most frequent AEs were hypokalemia, vomiting, diarrhea, and elevated serum aspartate aminotransferase or alanine aminotransferase. Among the aforementioned AEs, only 1 case of diarrhea could be classified as a probable relation with micafungin when causality was assessed. There was no AEs that caused discontinuation of micafungin.
Conclusions Micafungin seems to be a safe and effective agent for prophylaxis of IFIs including aspergillosis as well as candidiasis in HSCT recipients. However, further large, prospective, and randomized comparative studies are warranted for aspergillosis.
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KEYWORD
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Hematopoietic stem cell transplantation, Micafungin, Mycoses, Prophylaxis
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