Clinical investigation of sequential therapy with micafungin and reduced-dose voriconazole in prevention of fungal in patients after allogeneic hematopoietic stem cell transplantation

Abstract

Objective To observe the clinical effect of sequential therapy with micafungin and reduced-dose voriconazole in prevention of invasive fungal infections in patients received allogeneic hematopoietic stem cell transplantion (Allo-HSCT). Methods 28 patients received the treatments for prevention of fungal infection with micafungin 50 mg per day from pretreatment to 30 days, then oral voriconazole at a dose of 100 mg two times per day until 90 days after Allo-HSCT.The occurrence of invasive fungal infection and the side effects of both medicine were observed during 180 days after Allo-HSCT. Results 8 patients(28.6%) developed above grade 2 acute graft verse host disease(GVHD), 2 patients developed grade 3 GVHD among the 8 patients.Two case with GVHD were cured by voriconazole with the therapeutic dose who occurred probably pulmonary invasive fungal infection at two months after Allo-HSCT.There were no other patients diagnosed fungal infection.No toxic efect were observed during the clinical observation during treatment with micafungin.5 patients appeared mild liver function abnormalities during treatment with voriconazole, and liver dysfunction were improved by symptomatic treatment.2 cases developed transient auditory hallucination and visual impairment induced by voriconazole. Conclusion Micafungin and reduced-dose voriconazole are effective and safe prophylaxis in prevention early invasive fungal infection after HSCT. Key words: Micafungin; Voriconazole; Hematopoietic stem cell transplantation; Fungal infection