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

作　　者：Kazunori Nakase Koji Oka Keiki Kawakami Tetsuya Tsukada Shigehisa Tamaki Atsushi Fujieda 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)

机构地区：[1]Department of Personalized Cancer Immunotherapy, Mie University Graduate School of Medicine, Tsu, Japan [2]Department of Hematology and Oncology, Mie University Hospital, Tsu, Japan [3]Department of Internal Medicine, Suzuka Kaisei Hospital, Kameyama, Japan [4]Department of Internal Medicine, Suzuka Chuo Hospital, Suzuka, Japan [5]Department of Internal Medicine, Takeuchi Hospital, Tsu, Japan [6]Department of Internal Medicine, Ise Red Cross Hospital, Ise, Japan

出　　处：《Advances in Microbiology》2023年第6期315-322,共8页微生物学（英文）

摘　　要：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.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 

分 类 号：R73[医药卫生—肿瘤]