David J Epstein1, Susan K Seo2, Yao-Ting Huang1, Jay H Park3, Virginia M Klimek3, Ellin Berman3, Martin S Tallman3, Mark G Frattini3, Genovefa A Papanicolaou4. 1. Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 2. Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA. 3. Department of Medicine, Weill Cornell Medical College, New York, NY, USA; Leukemia Service, Division of Hematologic Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 4. Infectious Disease Service, Division of Subspecialty Medicine, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA. Electronic address: papanicg@mskcc.org.
Abstract
OBJECTIVES: To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). METHODS:Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis. RESULTS: From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized tomicafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. CONCLUSIONS: Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.
RCT Entities:
OBJECTIVES: To compare the effectiveness and tolerability of micafungin versus posaconazole during chemotherapy-induced neutropenia in acute leukemia (AL) and myelodysplastic syndrome (MDS). METHODS:Patients with AL or MDS undergoing chemotherapy were randomized to open-label micafungin 100 mg intravenously daily or posaconazole suspension 400 mg orally twice daily until neutrophil recovery, up to 28 days. Patients were followed for 12 weeks. The primary endpoint was prophylaxis failure (premature discontinuation due to infection, intolerance, adverse event, or death). Time to failure and survival were calculated by Kaplan-Meier analysis. RESULTS: From March 2011 to May 2016, 113 patients who received at least 2 doses of prophylaxis were analyzed (58 patients randomized to micafungin and 55 to posaconazole). Prophylaxis failure occurred in 34.5% and 52.7% of patients on micafungin and posaconazole, respectively (P = 0.0118). The median number of days on prophylaxis was 16 [interquartile range (IQR) 12-20] for micafungin and 13 [IQR 6-16] for posaconazole (P = 0.01). Micafungin failures were largely due to antifungal treatment; posaconazole failures were mostly due to gastrointestinal intolerance or adverse effects. IFI incidence and survival were similar between study arms. CONCLUSIONS: Our data support micafungin as alternative antifungal prophylaxis in patients with AL and MDS.
Authors: Brad Moriyama; Stacey A Henning; Janice Leung; Oluwaseun Falade-Nwulia; Paul Jarosinski; Scott R Penzak; Thomas J Walsh Journal: Mycoses Date: 2011-11-29 Impact factor: 4.377
Authors: Oliver A Cornely; Johan Maertens; Drew J Winston; John Perfect; Andrew J Ullmann; Thomas J Walsh; David Helfgott; Jerzy Holowiecki; Dick Stockelberg; Yeow-Tee Goh; Mario Petrini; Cathy Hardalo; Ramachandran Suresh; David Angulo-Gonzalez Journal: N Engl J Med Date: 2007-01-25 Impact factor: 91.245
Authors: Alison G Freifeld; Eric J Bow; Kent A Sepkowitz; Michael J Boeckh; James I Ito; Craig A Mullen; Issam I Raad; Kenneth V Rolston; Jo-Anne H Young; John R Wingard Journal: Clin Infect Dis Date: 2011-01-04 Impact factor: 9.079
Authors: J El-Cheikh; G Venton; R Crocchiolo; S Fürst; C Faucher; A Granata; C Oudin; D Coso; R Bouabdallah; N Vey; S Duran; E Fougereau; P Berger; C Chabannon; D Blaise Journal: Bone Marrow Transplant Date: 2013-06-10 Impact factor: 5.483
Authors: Thomas F Patterson; George R Thompson; David W Denning; Jay A Fishman; Susan Hadley; Raoul Herbrecht; Dimitrios P Kontoyiannis; Kieren A Marr; Vicki A Morrison; M Hong Nguyen; Brahm H Segal; William J Steinbach; David A Stevens; Thomas J Walsh; John R Wingard; Jo-Anne H Young; John E Bennett Journal: Clin Infect Dis Date: 2016-06-29 Impact factor: 9.079
Authors: Jo-Anne H van Burik; Voravit Ratanatharathorn; Daniel E Stepan; Carole B Miller; Jeffrey H Lipton; David H Vesole; Nancy Bunin; Donna A Wall; John W Hiemenz; Yoichi Satoi; Jeanette M Lee; Thomas J Walsh Journal: Clin Infect Dis Date: 2004-10-27 Impact factor: 9.079
Authors: Ibrahim Aldoss; Sanjeet Dadwal; Jianying Zhang; Bernard Tegtmeier; Matthew Mei; Shukaib Arslan; Monzr M Al Malki; Amandeep Salhotra; Haris Ali; Ahmed Aribi; Karamjeet Sandhu; Samer Khaled; David Snyder; Ryotaro Nakamura; Anthony S Stein; Stephen J Forman; Guido Marcucci; Vinod Pullarkat Journal: Blood Adv Date: 2019-12-10
Authors: Heena P Patel; Anthony J Perissinotti; Twisha S Patel; Dale L Bixby; Vincent D Marshall; Bernard L Marini Journal: Open Forum Infect Dis Date: 2019-04-12 Impact factor: 3.835
Authors: Lynn Miesel; Melanie T Cushion; Alan Ashbaugh; Santiago R Lopez; Voon Ong Journal: Antimicrob Agents Chemother Date: 2021-02-17 Impact factor: 5.191
Authors: Jannik Stemler; Philipp Koehler; Christian Maurer; Carsten Müller; Oliver A Cornely Journal: Ann Hematol Date: 2020-06-08 Impact factor: 3.673
Authors: T Villaescusa; L Vázquez; J M Bergua; J García; A Romero; M T Olave; D García Belmonte; M P Queipo de Llano Journal: Rev Esp Quimioter Date: 2019-12-23 Impact factor: 1.553