Maximova Natalia, Schillani Giulia, Simeone Roberto, Maestro Alessandra, Zanon Davide
Bone Marrow Transplantation Unit, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
Department of Transfusion Medicine, Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy.
Adv Ther. 2017 May;34(5):1184-1199. doi: 10.1007/s12325-017-0534-7. Epub 2017 Apr 20.
The high morbidity and mortality associated with invasive fungal infections (IFIs) provide the rationale for antifungal prophylaxis in immuno-compromised pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Caspofungin and micafungin are antifungal agents of interest for prophylaxis of IFIs because of their potency against Candida and minimal toxicity or interactions with other drugs. Few studies have demonstrated the safety and efficacy of such echinocandins as prophylaxis for IFIs in patients undergoing HSCT.
This retrospective cohort study compared caspofungin and micafungin for prevention of IFIs in 93 pediatric patients undergoing HSCT for oncological or non-oncological disease. The observation began with the first dose of antifungal agent and ended 3 months after transplantation.
Patients in the micafungin group had a higher overall treatment success rate of 87.2 versus 84.8% in the caspofungin group, but the difference was not significant. There were no statistically significant differences in the incidence or type of proven/probable IFIs between the 2 groups. The low incidence of death did not differ statistically between the groups. Patients in the caspofungin group presented more frequently with fever, during and after neutropenia. In both groups, we observed an expected worsening of blood chemistry parameters. There were no adverse events definitely attributable to the two antifungal agents.
These results demonstrate good efficacy and tolerability for caspofungin and micafungin. However, better results with respect to the incidence and resolution of fever in the micafungin group may suggest its use in preference to that of caspofungin.
侵袭性真菌感染（IFI）相关的高发病率和死亡率为接受造血干细胞移植（HSCT）的免疫功能低下儿科患者进行抗真菌预防提供了依据。卡泊芬净和米卡芬净是预防IFI的抗真菌药物，因为它们对念珠菌有强效作用，且毒性极小或与其他药物相互作用少。很少有研究证明此类棘白菌素作为HSCT患者IFI预防药物的安全性和有效性。
这项回顾性队列研究比较了卡泊芬净和米卡芬净对93例因肿瘤或非肿瘤疾病接受HSCT的儿科患者预防IFI的效果。观察从第一剂抗真菌药物开始，至移植后3个月结束。
米卡芬净组患者的总体治疗成功率较高，为87.2%，而卡泊芬净组为84.8%，但差异不显著。两组之间确诊/可能的IFI的发生率或类型无统计学显著差异。两组的低死亡率在统计学上无差异。卡泊芬净组患者在中性粒细胞减少期间及之后发热更为频繁。在两组中，我们都观察到血液化学参数出现预期的恶化。没有明确归因于这两种抗真菌药物的不良事件。
这些结果表明卡泊芬净和米卡芬净具有良好的疗效和耐受性。然而，米卡芬净组在发热发生率和缓解方面的更好结果可能表明其比卡泊芬净更值得使用。
