Abstract
Introduction
The high morbidity and mortality associated with invasive fungal infections (IFIs) provide the rationale for antifungal prophylaxis in immuno-compromised pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Caspofungin and micafungin are antifungal agents of interest for prophylaxis of IFIs because of their potency against Candida and minimal toxicity or interactions with other drugs. Few studies have demonstrated the safety and efficacy of such echinocandins as prophylaxis for IFIs in patients undergoing HSCT.
Methods
This retrospective cohort study compared caspofungin and micafungin for prevention of IFIs in 93 pediatric patients undergoing HSCT for oncological or non-oncological disease. The observation began with the first dose of antifungal agent and ended 3 months after transplantation.
Results
Patients in the micafungin group had a higher overall treatment success rate of 87.2 versus 84.8% in the caspofungin group, but the difference was not significant. There were no statistically significant differences in the incidence or type of proven/probable IFIs between the 2 groups. The low incidence of death did not differ statistically between the groups. Patients in the caspofungin group presented more frequently with fever, during and after neutropenia. In both groups, we observed an expected worsening of blood chemistry parameters. There were no adverse events definitely attributable to the two antifungal agents.
Conclusion
These results demonstrate good efficacy and tolerability for caspofungin and micafungin. However, better results with respect to the incidence and resolution of fever in the micafungin group may suggest its use in preference to that of caspofungin.
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Acknowledgements
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The journal’s article processing charges were funded by the authors. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.
Disclosures
Natalia Maximova, Giulia Schillani, Roberto Simeone, Alessandra Maestro, and Davide Zanon declare that they have no conflict of interest.
Compliance with Ethics Guidelines
This study was approved by the Ethical Committee of the Institute for Maternal and Child Health Burlo Garofolo, Trieste, Italy. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964, as revised in 2013.
Written informed consent for the use of any clinical data for research was obtained from the parents of all subjects at the time of admission to the Bone Marrow Transplant Unit.
Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on appropriate request.
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Maximova, N., Schillani, G., Simeone, R. et al. Comparison of Efficacy and Safety of Caspofungin Versus Micafungin in Pediatric Allogeneic Stem Cell Transplant Recipients: A Retrospective Analysis. Adv Ther 34, 1184–1199 (2017). https://doi.org/10.1007/s12325-017-0534-7
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DOI: https://doi.org/10.1007/s12325-017-0534-7