Caspofungin for the Treatment of Candidemia in patients with Hematological Malignancies

Objective: To evaluate the efficacy of Caspofungin in patients with hematological malignancies (HM) and candidemia

Design: The study was prospectively conducted in 11 Hematology Divisions in a tertiary care or university hospital setting.; neutropenic hematological patients with clinical evidence of infection and a positive blood culture for Candida were enrolled.

Patients and results: Between January 2005 and November 2007, 38 episodes of candidemia among patients with HM were registered. Among these, 24 eligible neutropenic patients, collected in 8/11 participating centers, were evaluated. All these patients had received chemotherapy for their underlying hematological diseases: acute myeloid leukemia (AML) in 11 patients (46%); non Hodgkin’s lymphoma (NHL) in 6 patients (25%); acute lymphoblastic leukemia (ALL) in 4 patients (16%); multiple myeloma (MM) in 2 patients (8%); chronic lymphoblastic leukemia (CLL) in 1 patient. In 11 patients (46%) the infection onset after a HSCT procedure (7 allogeneic and 4 autologous). Before the infection onset, all patients were neutropenic (ANC<0.5×10⁹/l) for a median average of 12 days (range 2–41). Candidemia diagnosis was made after a median time of 3 days from the onset of fever. Candida isolated species were: C.albicans 46%, C. parapsilosis 17%, C. krusei 12.5%, C. tropicalis in 8%, C. lusitanae, C. guillermondii, C. dubliniensis, C. famata in 4% of patients each. Caspofungin at standard dosage was the first-line therapy in 17 pts (71%); in the other 7 pts, previous antifungal therapy (4 L-AmB, 1 itraconazole, 1 fluconazole, 1 voriconazole) was changed to Caspofungin at candidemia diagnosis after no more than 48 hours of treatment. The median duration of Caspofungin therapy was 12 days (range 3–26). No side effects were registered. A complete response to therapy of 58% was obtained. At 30 days following candidemia onset, 11 pts had died (41%), but the candidemia was responsible for the mortality in only 6 pts (overall attributable mortality 25%).

Conclusions: Our data confirm the efficacy of Caspofungin in the treatment of neutropenic pts with HM and concomitant candidemia as well as it was reported for non hematological subgroups. Caspofungin was well tolerated also in very compromised pts.