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Antifungal prophylaxis with micafungin three times a week in children after allogeneic bone marrow transplantation

BACKGROUND The use of azoles for antifungal prophylaxis after familial
allogeneic stem cell transplantation in children (SCT) is hindered by
adverse events and drug interactions especially in children affected by
sickle cell disease. Intermittent, higher dose of micafungin could be an
alternative. METHODS A prospective, observational, longitudinal,
single-center study was conducted between May 2015 and June 2018. The
study included 30 patients between 2 and 18 years old who underwent
allogeneic SCT and received prophylaxis with micafungin on alternating
days after the bone marrow engraftment phase. FINDINGS Fifty transplants
performed, 30 included prophylaxis against IFIs, with micafungin in an
alternating pattern according to the previously described protocol. The
indication for HSCT was hemoglobinopathies in 76.7%, acute leukemia in
20.0% and Fanconi anemia in 3.3%. The prophylaxis duration was 2.33
months (1.53 to 3.98). In our study, 40.0% (12/30) of the patients had
acute GVHD, and 6.7% (2/30) had chronic GVHD, which prolonged the
duration of alternating prophylaxis. No serious adverse effects of the
use of micafungin were observed in any of the patients. There was also
no breakthrough Invasive fungal infection (IFI) during alternating
prophylaxis. CONCLUSION: In selected patients, micafungin was well
tolerated without breakthrough IFI in our study.