Antifungal prophylaxis with micafungin in neutropenic patients with hematological malignancies

Abstract

The aim of the study was to assess the antifungal prophylactic efficacy, safety, and tolerability of micafungin, 150 mg daily, and to evaluate the usefulness of monitoring 1,3-beta-d-glucan (BG) in neutropenic patients undergoing chemotherapy for hematological malignancies. This investigation was a retrospective, non-randomized study. A group of patients who did not receive systemic antifungal prophylaxis was compared to another group of patients who received micafungin 150 mg daily. All patients admitted with hematological malignancy and undergoing chemotherapy or stem cell transplant were included. The plasma BG level was measured once weekly. The clinical endpoint was the diagnosis of invasive fungal infection (IFI). Antifungal prophylaxis led to a significant decrease in the occurrence of IFI (from 12.3% to 1.5%, p = 0.001). Few severe adverse effects clearly attributable to micafungin were seen. Sensitivity, specificity, positive predictive value, negative predictive value, and efficiency of BG values >8.9 pg/mL for diagnosis of IFI were 0.90, 0.99, 0.82, 0.99, and 0.99, respectively. Micafungin, 150 mg daily, is an effective and safe drug for antifungal prophylaxis, and monitoring of BG antigenemia is a useful tool for diagnosis of IFI in neutropenic patients with hematological malignancies.

Diagnostic Accuracy of Serum 1,3-β- d -Glucan for Pneumocystis jiroveci Pneumonia, Invasive Candidiasis, and Invasive Aspergillosis: Systematic Review and Meta-Analysis

“…In 17 cohort studies (1,2,4,16,19,20,24,29,30,34,45,47,50,51,54,61,62), the pooled sensitivity, specificity, DOR, and AUC-SROC were 72% (95% CI, 67% to 77%), 78% (95% CI, 76% to 80%), 12.3 (95% CI, 6.0 to 25.1), and 0.79 (95% CI, 0.73 to 0.85), respectively. In 14 case-control studies (3, 14, 26, 27, 33, 38, 40, 43-46, 48, 49, 60), the pooled sensitivity, specificity, DOR, and AUC-SROC for IFI were 83% (95% CI, 80% to 86%), 86% (95% CI, 84% to 88%), 68.3 (95% CI, 30.7 to 151.8), and 0.95 (95% CI, 0.92 to 0.98), respectively.…”

“…The 36 studies included six assays: 17 used Fungitell (1,3,4,12,16,17,27,29,34,(45)(46)(47)(48)(49)(50)(51), 9 used the Fungitec G test (2,20,26,33,43,44,57,59,60), 6 used the Wako ␤-glucan test (14,19,24,40,54,56), 3 used the GKT-25 M set (32,61,62), and 1 used the fungal index (38). All studies but one were based in 1 of 13 countries, with the majority of assays in Japan (n ϭ 13), as well as in the United States (n ϭ 7), China (n ϭ 4), Spain (n ϭ 2), Austria (n ϭ 1), Belgium (n ϭ 1), Czech Republic (n ϭ 1), France (n ϭ 1), Germany (n ϭ 1), Kuwait (n ϭ 1), The Netherlands (n ϭ 1), Sweden (n ϭ 1), and Switzerland (n ϭ 1); one study that performed assays in multiple countries (Spain, Argentina, and France) was also included.…”

Diagnosis of Invasive Fungal Disease Using Serum (1.RAR.3)-.BETA.-D-Glucan: A Bivariate Meta-Analysis

“…Of these publications, we eventually pooled 13 articles. The process of selection of flow diagram is not shown (Table 1) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Four articles had data from two and more definitions for a simultaneous BG-positive result (Table 2); therefore, there were 17 BG-related studies.…”

“…Twelve reports, including 15 studies, met the analysis method A (proven and probable IFD vs possible or no IFD) (20)(21)(22)(24)(25)(26)(27)(28)(29)(30)(31)(32) (Table 3 ) . When methods B, C and D were used to define true-positive cases and true-negative cases, 8 reports (20,21,24,26,(28)(29)(30)(31), 9 reports (20-22, 24-26, 30-32), and 6 reports (21,23,24,26,30,31) were included, respectively.…”

“…When methods B, C and D were used to define true-positive cases and true-negative cases, 8 reports (20,21,24,26,(28)(29)(30)(31), 9 reports (20-22, 24-26, 30-32), and 6 reports (21,23,24,26,30,31) were included, respectively. The test performances of BG assay were markedly higher in method B (proven IFD vs no IFD).…”