Efficacy of caspofungin as secondary prophylaxis in patients undergoing allogeneic stem cell transplantation with prior pulmonary and/or systemic fungal infection

Abstract

Transplanted patients with a history of invasive fungal infection (IFI) are at high risk of developing relapse and fatal complications. Eighteen patients affected by hematological malignancies and a previous IFI were submitted to allogeneic stem cell transplantation, using Caspofungin as a secondary prophylaxis. Patients had a probable or proven fungal infection and 16 had a pulmonary localization. No side effects were recorded during treatment with Caspofungin. Compared to pre-transplant evaluation, stability or improvement of the previous IFI was observed in 16 of the 18 patients at day 30, in 13 of the 15 evaluable patients at day 180 and in 11 of the 11 evaluable patients at day 360 post transplant. In particular, all the six patients with a proven fungal infection were alive, with a stable or improved IFI after 1 year from transplant. At a maximum follow-up of 31 months, eight patients died for disease progression or transplant-related complications, but only two had evidence of fungal progression. Secondary prophylaxis with Caspofungin may represent a suitable approach to limit IFI relapse or progression, allowing patients with hematological malignancies to adhere to the planned therapeutic program

The impact of prior invasive mold infections in leukemia patients who undergo allo-SCT in the era of triazole-based secondary prophylaxis

“…Most of the previous studies regarding secondary prophylaxis in patients with hematological malignancies are retrospective and include small heterogenous patients' populations, with various IMI classifications and different responses to antifungal treatment before HSCT. [2][3][4][5][6][7][8] Nonetheless, studies in which secondary prophylaxis was amphotericin B or first-generation triazoles reported commonly significant rates of relapsed IMIs (29-33%) and associated mortality rates (88%) in patients with hematological malignancies and histories of IMIs before allogeneic HSCT; 2-4 of note, liposomal amphotericin B was also shown to be associated with a high rate of kidney injury (36%). 4 In addition, other investigators described conflicting results about the efficacy of secondary prophylaxis with echinocandins with a wide range of IMI relapse (11-32%).…”

Hematopoietic SCT in patients with a history of invasive fungal infection

“…[7][8][9]11,12 Our experience in the treatment and prophylaxis of IFI confirmed the efficacy of the above agents. In January 2001, we introduced itraconazole and amphotericin B into the secondary prophylaxis of IFI during HSCT.…”

“…Our study showed a relatively low rate of IFI-related mortality in comparison with earlier studies. [4][5][6][7][8][9] This should be dedicated to the high active secondary prophylaxis, for most of our patients (95.9%, 47/49) received broad-spectrum antifungal agents. [7][8][9] The low proportion (10.2%, 5/49) of proven cases of historical IFI may explain the difference between our results and the literature, which reflects the higher severity of infection in Days after transplantation Figure 1 Cumulative incidence of failure of prophylaxis in patients with versus without residual diseases before transplantation.…”

“…2 The delayed immune reconstitution after Allo-HSCT put patients at a risk of reactivation of preceding IFI. 4,6,7,16 Therefore, we analyzed the outcome of IFI in the 29 patients receiving Allo-HSCT. In comparison with Auto-HSCT, there was no significant difference in the incidence of the failure of prophylaxis (24.1 versus 10% at 2 years, P ¼ 0.17), IFI-related mortality rate (6.9 versus 5% at 2 years, P ¼ 0.71) and OS rate (54.6 versus 73.6% at 2 years, P ¼ 0.18).…”

“…In recent years, several studies have evaluated the efficacy of secondary prophylaxis in HSCT and showed remarkable results. 4,[7][8][9][10] On account of the relatively small scale of cases, further studies are needed to evaluate the feasibility of HSCT in such patients.…”