Twice-Weekly Micafungin as Antifungal Prophylaxis in Children Undergoing Hematopoietic Stem Cell Transplantation.

BACKGROUND

Children undergoing hematopoietic stem cell transplantation are at increased risk of developing invasive fungal infection. Micafungin is an echinocandin with broad-spectrum antifungal properties. Recent trials have reported on the efficacy of intermittent daily dosing of micafungin for fungal prophylaxis in pediatric patients undergoing transplantation, with success rates of 76%-99%, success defined as absence of proven, probable, or possible invasive fungal infection. We implemented a twice-weekly micafungin regimen as antifungal prophylaxis in our unit.

PATIENTS AND

METHODS

One hundred consecutive transplants performed between May 2018 and February 2024 were analyzed. Micafungin prophylaxis was dosed at 3-5 mg/kg daily given twice weekly from Day 0 till stable neutrophil engraftment, after which oral fluconazole was prescribed till Day +100. Fungal infection status was evaluated by radiological procedures and cultures from blood or sterile body sites as clinically indicated. The primary endpoint of the study was the evaluation of efficacy; secondary endpoints were safety and tolerability.

RESULTS

Ninety three patients who underwent 95 transplants fulfilled the inclusion criteria. Underlying diagnoses were: leukemia (47), inborn errors of immunity (11), other malignancies (11), hemoglobinopathy (8), and others (16). There were no proven or probable fungal infections. Seventeen patients (18%) required change from prophylaxis to empirical antifungal treatment for persistent fever (n = 5) and possible fungal infections, mainly oesophagitis (n = 8). All patients who failed micafungin prophylaxis received allogeneic transplants, and HLA-haploidentical was the majority (14/17). None of the patients had to discontinue micafungin due to safety or tolerability concerns.

CONCLUSIONS

Twice-weekly IV micafungin is a safe and effective option as antifungal prophylaxis for children undergoing HSCT.