Main Article Content

Jean Elcheikh


Micafungin, antifungal prophylaxis, haplo-identical haematopoietic stem cell transplantation.


Over the past decade, invasive fungal infections (IFI) have remained an important problem in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-HSCT). The optimal approach for prophylactic antifungal therapy has yet to be determined.

We conducted a retrospective, bi-institutional comparative clinical study, and compared the efficacy and safety of micafungin 50mg/day (iv) with those of fluconazole (400mg/day) or itraconazole 200mg/day (iv) as prophylaxis for adult patients with various haematological diseases receiving haplo-identical allogeneic stem cell transplantation (haplo).

Overall, 99 patients were identified; 30 patients received micafungin, and 69 patients received fluconazole or itraconazole. After a median follow-up of 13 months (range: 5-23), Proven or probable IFIs were reported in 3 patients (10%) in the micafungin group and 8 patients (12%) in the fluconazole or itraconazole group. Fewer patients in the micafungin group had invasive aspergillosis (1 [3%] vs. 5 [7%], P=0.6). A total of 4 (13%) patients in the micafungin group and 23 (33%) patients in the fluconazole or itraconazole group received empirical antifungal therapy (P = 0.14).

No serious adverse events related to treatment were reported by patients and there was no treatment discontinuation because of drug-related adverse events in both groups.

Despite the retrospective design of the study and limited sample, it contributes reassuring data to confirm results from randomised clinical trials, and to define a place for micafungin in prophylaxis after haplo.


Download data is not yet available.

Abstract 1438
PDF Downloads 692
HTML Downloads 1251



[1] Viscoli C, Girmenia C, Marinus A, Collette L, Martino P, Vandercam B, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis 1999;28:1071-9.
[2] Prentice HG, Kibbler CC, Prentice AG. Towards a targeted, risk-based, antifungal strategy in neutropenic patients. Br J Haematol 2000;110:273-84.
[3] Ascioglu S, Rex JH, de PB, Bennett JE, Bille J, Crokaert F, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002;34:7-14.
[4] Aversa F. Haploidentical haematopoietic stem cell transplantation for acute leukaemia in adults: experience in Europe and the United States. Bone Marrow Transplant 2008;41:473-81.
[5] Anaissie EJ. Diagnosis and therapy of fungal infection in patients with leukemia--new drugs and immunotherapy. Best Pract Res Clin Haematol 2008;21:683-90.
[6] Maertens J, Marchetti O, Herbrecht R, Cornely OA, Fluckiger U, Frere P, et al. European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3--2009 update. Bone Marrow Transplant 2011;46:709-18.
[7] Petraitis V, Petraitiene R, Groll AH, Roussillon K, Hemmings M, Lyman CA, et al. Comparative antifungal activities and plasma pharmacokinetics of micafungin (FK463) against disseminated candidiasis and invasive pulmonary aspergillosis in persistently neutropenic rabbits. Antimicrob Agents Chemother 2002;46:1857-69.
[8] Walsh TJ. Echinocandins--an advance in the primary treatment of invasive candidiasis. N Engl J Med 2002;347:2070-2.
[9] Denning DW, Marr KA, Lau WM, Facklam DP, Ratanatharathorn V, Becker C, et al. Micafungin (FK463), alone or in combination with other systemic antifungal agents, for the treatment of acute invasive aspergillosis. J Infect 2006;53:337-49.
[10] Hatano K, Morishita Y, Nakai T, Ikeda F. Antifungal mechanism of FK463 against Candida albicans and Aspergillus fumigatus. J Antibiot (Tokyo) 2002;55:219-22.
[11] Nakai T, Uno J, Otomo K, Ikeda F, Tawara S, Goto T, et al. In vitro activity of FK463, a novel lipopeptide antifungal agent, against a variety of clinically important molds. Chemotherapy 2002;48:78-81.
[12] Ikeda F, Tanaka S, Ohki H, Matsumoto S, Maki K, Katashima M, et al. Role of micafungin in the antifungal armamentarium. Curr Med Chem 2007;14:1263-75.
[13] Fukuoka N, Imataki O, Ohnishi H, Kitanaka A, Kubota Y, Ishida T, et al. Micafungin does not influence the concentration of tacrolimus in patients after allogeneic hematopoietic stem cell transplantation. Transplant Proc 2010;42:2725-30.
[14] Hashino S, Morita L, Takahata M, Onozawa M, Nakagawa M, Kawamura T, et al. Administration of micafungin as prophylactic antifungal therapy in patients undergoing allogeneic stem cell transplantation. Int J Hematol 2008;87:91-7.
[15] Hiramatsu Y, Maeda Y, Fujii N, Saito T, Nawa Y, Hara M, et al. Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation. Int J Hematol 2008;88:588-95.
[16] van Burik JA, Ratanatharathorn V, Stepan DE, Miller CB, Lipton JH, Vesole DH, et al. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis 2004;39:1407-16.
[17] Huang X, Chen H, Han M, Zou P, Wu D, Lai Y, et al. Multicenter, randomized, open-label study comparing the efficacy and safety of micafungin versus itraconazole for prophylaxis of invasive fungal infections in patients undergoing hematopoietic stem cell transplant. Biol Blood Marrow Transplant 2012;18:1509-16.
[18] El-Cheikh J, Venton G, Crocchiolo R, Furst S, Faucher C, Granata A, et al. Efficacy and safety of micafungin for prophylaxis of invasive fungal infections in patients undergoing haplo-identical hematopoietic SCT. Bone Marrow Transplant 2013;48:1472-7.
[19] Perfect JR. Management of invasive mycoses in hematology patients: current approaches. Oncology (Williston Park ) 2004;18:5-14.
[20] Aversa F. Full haplotype mismatched hematopoietic stem cell transplants. Haematologica 2002;87:9-12.
[21] Martelli MF, Aversa F, Bachar-Lustig E, Velardi A, Reich-Zelicher S, Tabilio A, et al. Transplants across human leukocyte antigen barriers. Semin Hematol 2002;39:48-56.
[22] Federmann B, Bornhauser M, Meisner C, Kordelas L, Beelen DW, Stuhler G, et al. Haploidentical allogeneic hematopoietic cell transplantation in adults using CD3/CD19 depletion and reduced intensity conditioning: a phase II study. Haematologica 2012;97:1523-31.
[23] Ciceri F, Bonini C, Stanghellini MT, Bondanza A, Traversari C, Salomoni M, et al. Infusion of suicide-gene-engineered donor lymphocytes after family haploidentical haemopoietic stem-cell transplantation for leukaemia (the TK007 trial): a non-randomised phase I-II study. Lancet Oncol 2009;10:489-500.
[24] Aversa F, Terenzi A, Tabilio A, Falzetti F, Carotti A, Ballanti S, et al. Full haplotype-mismatched hematopoietic stem-cell transplantation: a phase II study in patients with acute leukemia at high risk of relapse. J Clin Oncol 2005;23:3447-54.
[25] Luznik L, Fuchs EJ. High-dose, post-transplantation cyclophosphamide to promote graft-host tolerance after allogeneic hematopoietic stem cell transplantation. Immunol Res 2010;47:65-77.
[26] Luznik L, Jones RJ, Fuchs EJ. High-dose cyclophosphamide for graft-versus-host disease prevention. Curr Opin Hematol 2010;17:493-9.
[27] Luznik L, Bolanos-Meade J, Zahurak M, Chen AR, Smith BD, Brodsky R, et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood 2010;115:3224-30.
[28] Gangneux JP, El CJ, Caillot D, Yakoub-Agha I, Michallet M. [In Process Citation]. Med Mal Infect 2014;44:34.
[29] Marr KA, Crippa F, Leisenring W, Hoyle M, Boeckh M, Balajee SA, et al. Itraconazole versus fluconazole for prevention of fungal infections in patients receiving allogeneic stem cell transplants. Blood 2004;103:1527-33.
[30] Mattiuzzi GN, Alvarado G, Giles FJ, Ostrosky-Zeichner L, Cortes J, O'brien S, et al. Open-label, randomized comparison of itraconazole versus caspofungin for prophylaxis in patients with hematologic malignancies. Antimicrob Agents Chemother 2006;50:143-7.