scholarly journals 429: Voriconazole prophylaxis in patients at high risk for invasive fungal infections following allogeneic hematapoetic stem cell transplantion

2007 ◽  
Vol 13 (2) ◽  
pp. 153-154
Author(s):  
S. Trifilio ◽  
S. Singhal ◽  
S. Williams ◽  
J. Winter ◽  
M. Tallman ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Fungal Infections ◽  
Invasive Fungal Infections

scholarly journals Real-World Use of Isavuconazole as Primary Therapy for Invasive Fungal Infections in High-Risk Patients with Hematologic Malignancy or Stem Cell Transplant

2022 ◽  
Vol 8 (1) ◽  
pp. 74
Author(s):  
Hiba Dagher ◽  
Ray Hachem ◽  
Anne-Marie Chaftari ◽  
Ying Jiang ◽  
Shahnoor Ali ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Combination Therapy ◽  
Real World ◽  
Fungal Infections ◽  
Hematologic Malignancies ◽  
Invasive Fungal Infections ◽  
Cell Transplant ◽  
Primary Therapy ◽  
Significant Difference

(1) Introduction: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among immunocompromised patients with hematologic malignancies (HM) and stem cell transplants (SCT). Isavuconazole was approved by FDA as a primary therapy for Invasive Aspergillosis (IA) and Mucormycosis. The aim of this study is to look at the real-world use of Isavuconazole in patients with HM and evaluate their clinical outcomes and safety. (2) Methods: We conducted a retrospective study of HM patients at MD Anderson Cancer Center who had definite, probable or possible mold infections between 1 April 2016 and 31 January 2020 and were treated with Isavuconazole for a period of at least 7 days. Clinical and radiological findings were assessed at baseline and at 6 and 12 weeks of follow up. (3) Results: We included 200 HM patients with IFIs that were classified as definite (11), probable (63) and possible (126). Aspergillus spp was the most commonly isolated pathogen. The majority of patients (59%) received prophylaxis with anti-mold therapy and Isavuconazole was used as a primary therapy in 43% of patients, and as salvage therapy in 58%. The switch to Isavuconazole was driven by the failure of the primary therapy in 66% of the cases and by adverse effects in 29%. Isavuconazole was used as monotherapy in 30% of the cases and in combination in 70%. Adverse events possibly related to Isavuconazole were reported in eight patients (4%) leading to drug discontinuation. Moreover, a favorable response with Isavuconazole was observed in 40% at 6 weeks and in 60% at 12 weeks. There was no significant difference between isavuconazole monotherapy and combination therapy (p = 0.16 at 6 weeks and p = 0.06 at 12 weeks). Finally, there was no significant difference in outcome when Isavuconazole was used after failure of other anti-mold prophylaxis or treatment versus when used de novo as an anti-mold therapy (p = 0.68 at 6 weeks and p = 0.25 at 12 weeks). (4) Conclusions: Whether used as first-line therapy or after the failure of other azole and non-azole prophylaxis or therapies, isavuconazole seems to have a promising clinical response and a good safety profile as an antifungal therapy in high-risk cancer patients with hematologic malignancies. Moreover, combination therapy did not improve the outcome compared to Isavuconazole therapy.

Efficacy and Safety of Micafungin for Prophylaxis of Invasive Fungal Infections in Patients Undergoing Haplo-Identical Hematopoietic Stem Cell Transplant

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4505-4505
Author(s):  
Jean El-Cheikh ◽  
Geoffroy Venton ◽  
Roberto Crocchiolo ◽  
Sabine Furst ◽  
Catherine Faucher ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Ct Scan ◽  
Disease Progression ◽  
Fungal Infections ◽  
Conditioning Regimen ◽  
Median Number ◽  
Invasive Fungal Infections ◽  
Efficacy And Safety

Abstract Abstract 4505 Invasive fungal infections (IFI) such as candidiasis and mold infections cause significant morbidity and mortality among immunocompromised patients in recent years. Micafungin, a new echinocandin, inhibits fungal cell wall beta-glucan synthesis, with potent activity against most species of Candida and Aspergillus. The aim of this observational study was to investigate the efficacy and safety of Micafungin in prophylaxis of invasive fungal infections (IFI) in 20 high risk adult patients with various haematological diseases receiving haplo-identical allogeneic stem cell transplantation (Allo-SCT). Treatment success was defined as no proven, probable, or suspected IFI through therapy and the absence of proven or probable IFI through the end of 12 weeks after therapy. (EORTC criteria). These patients were monitored after Allo-SCT for galactomannan antigenemia at least once per week, and a computed tomography (CT) scan was performed in the case of persistent fever for at least 5 days after broad-spectrum empirical antibacterial therapy. Routine controls (e.g. detection of galactomannan antigenemia and CT scan) were performed systematically after 1 and 2 months and on day 100 after Allo-SCT. Only 2 patients had a history of possible aspergillosis before transplant treated by voriconazole. The patients received a median of 4 lines (2–7) of treatments before Allo-SCT. Ten patients (50%) received at least one auto-SCT; and 5 patients (25%) received a previous Allo-SCT. 18 patients (90%) received a reduced intensity conditioning regimen (RIC), with Fludarabine, Cyclophosphamide and Total body irradiation (TBI) 2 Gy based (75%), or Fludarabine, Busulfan, and Cyclophosphamide based (10%) or other (5%). while two patients (10%) received a myeloablative conditioning regimen with thiotepa. The patients and transplant details are shown in the table 1. Patients received a median of 26 infusions (range, 1–8) of Micafungin (50 mg/day i.v. as a 1h infusion). The treatment was initiated at the beginning of the transplant conditioning regimen until the hospital discharge. None of our patients discontinued the treatment for drug-related adverse events. Micafungin was not associated with any hepatotoxicity. Only one patient (5%) discontinued the treatment because an early disease progression. At last follow-up, there are 17 patients (85%) who are alive, with a median follow-up of 6 months (3–17). Three patients (15%) dead because disease progression. In all patients no candidas and/or Aspergillus species was documented after 3 and 6 months from transplant. None of our patients presented a positive galactomannan antigenemia >0.5. Seven patients (35%) presented a CMV reactivation. Only one patient presented an acute GvHD grade II. Micafungin has a good safety and tolerability profile, with an efficacy in preventing IFI in this high risk population. Our data provide support for an efficacy study in a prophylaxis setting, but prospective and comparative clinical trials using Micafungin are urgently needed to define the role of this drug in prophylaxis after haplo-identical Allo-SCT. Table 1. Patient and transplantation characteristics Patient and transplantation characteristics n = 20 (%) Patients Age (median) [range] 40 years (range, 20–60) Patients sex Male 12 (60) Female 8 (40) Disease type HL 6 (30) NHL 5 (25) AML 4 (20) MM 2 (10) MF 1 (5) MDS 1 (5) CLL 1 (5) Median number of prior chemotherapies before Allo-SCT [range] 4 (2–7) Median number of prior Auto-SCT [range] 1 (0–2) 1 8 (40) 2 2 (10) Status of disease at Allo-SCT >2 CR 11 (55) PR 6 (30) PD 3 (15) Median interval between auto and Allo-SCT months [range] Donor type Brother 8 (40) Mother 6 (30) Sister 3 (15) Son 2 (10) Father 1 (5) Donor/recipient sex mis match 9 (45) Conditioning regimen Flu 5+Cy 2+ TBI 15 (75) Flu 5 +Cy 2+ Bu 2 2 (10) Flu 3+TT 2+ Bu 3 2 (10) Flu 6+ Cy 1+ ATG 4 1 (5) GvHD prophylaxis CSA+MMF+Cy 20 (100) Stem cell source Peripheral Blood 11 (55) Bone Marrow 9 (45) Stem cell dose median [range] CD34+ × 106/kg 4,25 (0,8–10,8) CD3+ × 106/kg 140 (17–411) Days with ANC< 500 × 109/l 21 (14–49) Days with platelets<20 × 109/l 26 (14–140) Disclosures: No relevant conflicts of interest to declare.

scholarly journals 1182. The Real-World Use of Isavuconazole as Primary or salvage Therapy of Invasive Fungal infections in High-Risk Patients with Hematologic Malignancy or Stem Cell Transplant

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S616-S616
Author(s):  
Hiba dagher ◽  
Ray Y Hachem ◽  
Anne-Marie Chaftari ◽  
Ying Jiang ◽  
Shahnoor Ali ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Adverse Events ◽  
Real World ◽  
Salvage Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Primary Therapy ◽  
Material Support ◽  
Prolonged Qt

Abstract Background Invasive fungal infections (IFIs) are a major cause of morbidity and mortality among immunocompromised patients with hematologic malignancies (HM) and stem cell transplants (SCT). Isavuconazole was approved by FDA as a primary therapy for Invasive Aspergillosis (IA) and Mucormycosis. The aim of this study is to look at the real-world use of Isavuconazole in patients with HM and evaluate their clinical outcomes and safety. Methods We conducted a retrospective study of 200 HM patients at MD Anderson Cancer Center who had definite, probable or possible mold infections between April 2016 and January 2020 and were treated with Isavuconazole for a period of at least 7 days. Clinical and radiological findings were assessed at baseline and at 6 and 12 weeks of follow up. Results HM patients with IFIs were classified as definite (11), probable (66) and possible (123). IA was the most commonly isolated pathogen followed by mucor and candida. The majority of patients (65%) received prophylaxis with anti-mold therapy, 73% consisted of azoles and 22% of echinocandins. Isavuconazole was used as a primary therapy in 57.5% of patients, and as salvage therapy in 42.5%. The switch to Isavuconazole was driven by failure of the primary therapy in 50% of the cases and by adverse effects in 28%. These included elevated liver function tests (LFTs), subtherapeutic voriconazole levels and prolonged QT. Isavuconazole was used as monotherapy in 30% of the cases and combination in 70% mostly with a polyene (54%) and/or an echinocandin (27%). A favorable response with Isavuconazole was observed in 57% at 6 weeks of therapy. Adverse events possibly related to Isavuconazole were reported in 6 patients (3%) leading to drug discontinuation. These included 5 elevated transaminases and 1 nausea. All-cause mortality was reported in 46% of patients and IFI-attributable mortality in 25%. Conclusion Selecting Isavuconazole therapy was mainly driven by failure of other antifungal agents or adverse events to other antifungals such as increased LFTs, subtherapeutic voriconazole levels or prolonged QT. Isavuconazole seems to have a promising clinical response and a good safety profile as an antifungal therapy in high risk cancer patients with HM. Disclosures Issam I. Raad, MD, Citius (Other Financial or Material Support, Ownership interest)Cook Medical (Grant/Research Support)Inventive Protocol (Other Financial or Material Support, Ownership interest)Novel Anti-Infective Technologies (Shareholder, Other Financial or Material Support, Ownership interest)

scholarly journals Cost Analysis of the Use of Voriconazole, Posaconazole and Micafungin in the Primary Prophylaxis of Invasive Fungal Infections in Recipients of Allogeneic Hematopoietic Stem Cell Transplants

10.36469/9832 ◽  
2015 ◽  
Vol 3 (2) ◽  
pp. 153-161
Author(s):  
Santiago Grau ◽  
Carlos Solano ◽  
Carol García-Vidal ◽  
Isidro Jarque ◽  
Jon A. Barrueta ◽  
...  
Keyword(s):  
Stem Cell ◽  
Cost Analysis ◽  
Hematopoietic Stem Cell ◽  
Fungal Infections ◽  
Primary Prophylaxis ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Efficacy Rate ◽  
Hematopoietic Stem ◽  
The Cost

Objectives: Compare the cost of the primary prophylaxis of invasive fungal infections (IFI) with voriconazole, posaconazole, and micafungin in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in hospitals of the National Health System (NHS) in Spain. Methods: A cost analysis was made for 100 days and 180 days of prophylaxis and a decision tree model was developed. The efficacy rate of IFI prophylaxis and survival rate with liposomal amphotericin B treatment of prophylaxis failures were obtained from randomized trials and a meta-analysis of mixed treatment comparisons. The model simulation was interrupted with IFI treatment (prophylaxis failures). The costs of medication and its intravenous administration in the hospital (in the case of micafungin) were considered. Results: In the non-modeled analysis, the savings per patient of prophylaxis with voriconazole ranged from €1,709 to €9,655 compared with posaconazole oral solution, from €1,811 to €9,767 compared with posaconazole gastro-resistant tablets and from €3,376 to €7,713 compared with micafungin. In the modeled analysis, the mean cost per patient of the prophylaxis and treatment of IFIs was €6,987 to €7,619 with voriconazole, €7,749 with posaconazole, and €22,424 with micafungin. Therefore, the savings per patient of prophylaxis with voriconazole was €130 to €3,664 and €11,132 to €30,374 compared with posaconazole and micafungin, respectively. The result remained stable after modification of the number of days of antifungal prophylaxis and the cost of antifungal treatment of failures. Conclusion: Taking into account this model, antifungal prophylaxis with voriconazole in recipients of hematopoietic progenitor transplants, compared with posaconazole or micafungin, may represent savings for hospitals in Spain.

Retrospective study on the incidence and outcome of proven and probable invasive fungal infections in high-risk pediatric onco-hematological patients

2017 ◽  
Vol 99 (3) ◽  
pp. 240-248 ◽  
Author(s):  
Simone Cesaro ◽  
Gloria Tridello ◽  
Elio Castagnola ◽  
Elisabetta Calore ◽  
Francesca Carraro ◽  
...  
Keyword(s):  
Retrospective Study ◽  
High Risk ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Hematological Patients
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