Safety, tolerability, and feasibility of antifungal prophylaxis with micafungin at 2 mg/kg daily in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation

Infection. 2014 Aug;42(4):639-47. doi: 10.1007/s15010-014-0601-9. Epub 2014 Feb 25.

Abstract

Introduction: Micafungin (MCFG) is used for the prophylaxis of invasive fungal disease (IFD) after allogeneic hematopoietic stem cell transplantation (HSCT). However, the safety, efficacy, or optimal dosage/blood levels as prophylaxis is uncertain in pediatric HSCT-patients.

Methods: We prophylactically administered MCFG at 2 mg/kg once daily to 38 children and adolescents undergoing allogeneic HSCT.

Results: During MCFG prophylaxis, infusion reactions or adverse events (grades 2-5) related to MCFG use were not found in all the patients. Thus, MCFG prophylaxis was not discontinued and other antifungal agents were not added except for 2 patients in whom probable or possible IFDs developed (completion rate, 94.7 %). To elucidate the influence of HSCT-related complications/drugs on blood concentration of MCFG, we determined the plasma trough and peak levels in 13 and 10 among 38 patients, respectively. The mean trough and peak levels were 3.04 ± 1.21 μg/mL (569 samples) and 9.63 ± 3.62 μg/mL (44 samples), respectively. The peak levels were moderately correlated to the trough levels (R (2) = 0.466). In a patient, the trough level of MCFG transiently increased up to 10.21 μg/mL during hepatic dysfunction due to acute graft-versus-host disease. The MCFG trough levels strongly correlated with T-Bil value (R (2) = 0.894). There was no relationship between the trough levels of MCFG and the circulating concentrations of tacrolimus (R (2) = 0.040). Additionally, MCFG levels were not influenced by treatment with cyclophosphamide or corticosteroids.

Conclusions: Prophylaxis with MCFG at 2 mg/kg once daily may be safe, tolerable, and feasible in pediatric HSCT-patients.

MeSH terms

  • Adolescent
  • Antifungal Agents / administration & dosage*
  • Antifungal Agents / adverse effects
  • Antifungal Agents / pharmacokinetics
  • Chemoprevention / adverse effects
  • Chemoprevention / methods*
  • Child
  • Child, Preschool
  • Drug-Related Side Effects and Adverse Reactions
  • Echinocandins / administration & dosage*
  • Echinocandins / adverse effects
  • Echinocandins / pharmacokinetics
  • Female
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Infant
  • Lipopeptides / administration & dosage*
  • Lipopeptides / adverse effects
  • Lipopeptides / pharmacokinetics
  • Male
  • Micafungin
  • Mycoses / prevention & control*
  • Plasma / chemistry

Substances

  • Antifungal Agents
  • Echinocandins
  • Lipopeptides
  • Micafungin