Micafungin As Antifungal Prophylaxis during Induction Phase of Chemotherapy in Pediatric Acute Lymphoblastic Leukemia

Background:

Invasive fungal infection (IFI) comprises a major cause of infection related morbidity and mortality in neutropenic patients receiving chemotherapy or hematopoietic stem cell transplantation (HSCT). Micafungin exhibits broad antifungal activity against both Aspergillus and Candida species.

Objective:

We performed a prospective study to determine the efficacy, safety, and tolerability of prophylactic micafungin against IFI in pediatric neutropenic patients during induction chemotherapy for acute lymphoblastic leukemia (ALL). Patients and methods:

The study included 70 patients randomized in to two groups: Intervention group: 35 patients were given micafungin daily at a dose of (1 mg/kg/day) with maximum of 50mg/day from day one to the end of induction with close follow up for toxicity, tolerability, and efficacy. In case of failure of prophylaxis (defined as development of proven, probable, or possible fungal infection according to revised definitions of EORTC/MSG consensus group), we shifted to either voriconazole or liposomal ampho-B. Control group: 35 patients were treated according to empirical antifungal approach. Follow up of patients by clinical examination, routine work up, serum galactomannan, blood cultures, and CT chest together with paranasal sinuses. Results:

Treatment success rate, defined as absence of proven, probable, or possible IFIs was 75%; in the control group 8/35 (22.8%) developed IFIs, while in the intervention group 2/35 (5.7%). No adverse events were observed that could be related to micafungin prophylaxis. Conclusions:

These results suggest that prophylactic micafungin is well tolerated and may prevent IFIs in pediatric patients with neutropenia receiving chemotherapy.

Keywords:Pediatric, ALL, induction chemotherapy, IFI, micafungin prophylaxis.