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Efficacy and Safety Assessment of Antifungal Sequential Therapy from Micafungin to Liposomal Amphotericin B for Antibiotics-Refractory Febrile Neutropenia in Patients with Hematologic Malignancies

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Advances in Microbiology 2023年第6期13卷 315-322页

作者： Kazunori Nakase Koji Oka keiki kawakami Tetsuya Tsukada Shigehisa Tamaki Atsushi Fujieda Department of Personalized Cancer Immunotherapy Mie University Graduate School of Medicine Tsu Japan Department of Hematology and Oncology Mie University Hospital Tsu Japan Department of Internal Medicine Suzuka Kaisei Hospital Kameyama Japan Department of Internal Medicine Suzuka Chuo Hospital Suzuka Japan Department of Internal Medicine Takeuchi Hospital Tsu Japan Department of Internal Medicine Ise Red Cross Hospital Ise Japan

Invasive fungal infections are a major challenging problem in the management of febrile neutropenia (FN) in patients with hematologic malignancies. Liposomal amphotericin B (L-AmB) or micafungin (MCFG) has been widely used as a first-line empirical antifungal therapy for suspected fungal infection in such patients. However, there are several issues in patients receiving these agents: drug related toxicities for L-AmB and breakthrough fungal infections for MCFG. In order to make the best use of these 2 agents, we conducted a prospective study of sequential therapy from MCFG to L-AmB, and evaluated the efficacy and safety of this strategy in FN patients with hematologic malignancies. A total of 18 patients were enrolled, and 11 patients who fulfilled the protocol defined criteria were evaluated. Underlying diseases consisted of acute leukemia (n = 9), non-Hodgkin lymphoma (n = 1), and myelodysplastic syndrome (n = 1). Treatment success was achieved in 8 patients (72.7%). Drug-related adverse events occurred in 8 patients (72.7%). All of those adverse events except one case were below grade 2. Three patients required discontinuation of L-AmB. Although our empirical antifungal sequential therapy seems to be encouraging for antibiotics-refractory FN in patients with hematologic malignancies, further investigation in large-scale studies is warranted.

关键词： Empirical Antifungal Therapy Micafungin Liposomal Amphotericin B Febrile Neutropenia Hematologic Malignancy

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Advances in Microbiology 2023年第6期

作者： Kazunori Nakase Koji Oka keiki kawakami Tetsuya Tsukada Shigehisa Tamaki Atsushi Fujieda

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