Use of micafungin versus fluconazole for antifungal prophylaxis in neutropenic patients receiving hematopoietic stem cell transplantation

  • Yasushi Hiramatsu
  • Yoshinobu Maeda
  • Nobuharu Fujii
  • Takashi Saito
  • Yuichiro Nawa
  • Masamichi Hara
  • Tomofumi Yano
  • Shoji Asakura
  • Kazutaka Sunami
  • Takayuki Tabayashi
  • Akira Miyata
  • Ken-ichi Matsuoka
  • Katsuji Shinagawa
  • Kazuma Ikeda
  • Keitaro Matsuo
  • Mitsune Tanimoto
  • for the West-Japan Hematology and Oncology Group (West-JHOG)
Original Article

Abstract

A prospective randomized clinical trial assessed the efficacy and tolerance of micafungin compared with that of standard fluconazole treatment in patients undergoing hematopoietic stem cell transplantation (HSCT). Adult patients (n = 106) were randomly assigned to receive prophylaxis with either micafungin 150 mg (n = 52), or fluconazole 400 mg (n = 52). Success was defined as the absence of suspected, proven, or probable invasive fungal infection (IFI) through the end of therapy and the absence of proven or probable IFI through the end of the 4-week period following treatment. The overall efficacy of micafungin was comparable to that of fluconazole (94 vs. 88%; difference 6.0%; 95% confidence interval, −5.4 to +17.4%; P = 0.295). A total of 2 (4.0%) of 50 patients in the micafungin arm and 6 (12.0%) of 50 patients in the fluconazole arm received empirical antifungal therapy (P = 0.06). Micafungin treatment did not result in increasing adverse effects and had a safe profile as fluconazole in neutropenic patients. This randomized trial indicates that the efficacy and tolerance of micafungin 150 mg was comparable to that of fluconazole 400 mg, suggesting that micafungin at 150 mg daily represents a valuable new treatment option for antifungal prophylaxis in HSCT recipients.

Keywords

Micafungin Antifungal prophylaxis Hematopoietic stem cell transplantation 

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Copyright information

© The Japanese Society of Hematology 2008

Authors and Affiliations

  • Yasushi Hiramatsu
    • 1
  • Yoshinobu Maeda
    • 1
  • Nobuharu Fujii
    • 1
  • Takashi Saito
    • 2
  • Yuichiro Nawa
    • 3
  • Masamichi Hara
    • 3
  • Tomofumi Yano
    • 4
  • Shoji Asakura
    • 5
  • Kazutaka Sunami
    • 5
  • Takayuki Tabayashi
    • 6
  • Akira Miyata
    • 6
  • Ken-ichi Matsuoka
    • 1
  • Katsuji Shinagawa
    • 1
  • Kazuma Ikeda
    • 1
  • Keitaro Matsuo
    • 7
  • Mitsune Tanimoto
    • 1
    • 8
  • for the West-Japan Hematology and Oncology Group (West-JHOG)
  1. 1.Department of Hematology, Oncology, and Respiratory MedicineOkayama University Graduate School of MedicineOkayamaJapan
  2. 2.Department of Infection Control and PreventionKyoto University HospitalKyotoJapan
  3. 3.Division of HematologyEhime Prefectural Central HospitalMatsuyamaJapan
  4. 4.Department of HematologyOkayama Rousai HospitalOkayamaJapan
  5. 5.Department of HematologyNational Hospital Organization Okayama Medical CenterOkayamaJapan
  6. 6.Department of Internal MedicineChugoku Central HospitalHiroshimaJapan
  7. 7.Division of Epidemiology and PreventionAichi Cancer Center Research InstituteNagoyaJapan
  8. 8.Department of Internal MedicineOkayama UniversityOkayamaJapan

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