Caspofungin for primary antifungal prophylaxis after T-cell-replete haploidentical stem cell transplantation with post-transplant cyclophosphamide

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Abstract

OBJECTIVES: T-cell-replete haploidentical stem cell transplantation (Haplo-SCT) with post-transplant cyclophosphamide (PT-Cy) is at high risk of invasive fungal infections (IFI), and anti-mold-active drug is required for primary antifungal prophylaxis (PAP) according to international guidelines. No data are available on the efficacy of caspofungin as PAP in this setting.

METHODS: Here, we report our retrospective experience with 103 consecutive patients treated with caspofungin as PAP after Haplo-SCT. Caspofungin was administered only during the pre-engraftment phase.

RESULTS: Hundred-day cumulative incidence of proven-probable IFI (PP-IFI) was 8.7% and median day of onset was 19 post-SCT. No patient died of PP-IFI, and overall survival (OS) and non-relapse mortality (NRM) hazard ratio (HR) for patients experiencing IFI were 1.02 (P = 0.9) and 0.7 (P = 0.7), respectively. Three-year overall survival (OS) and 1-year non-relapse mortality (NRM) were 55% and 19%, respectively. By univariate analysis, duration of neutropenic phase and partial remission pre-transplant disease status were associated with increased incidence of IFI, but were not confirmed by multivariate analysis.

CONCLUSION: In summary, PAP with caspofungin is an effective strategy for preventing IFI in the context of Haplo-SCT with PT-Cy. Further efforts are required in order to identify more potent strategies able to avoid the occurrence of breakthrough infections.

Original languageEnglish
Pages (from-to)357-367
Number of pages11
JournalEuropean Journal of Haematology
Volume102
Issue number4
DOIs
Publication statusPublished - Apr 2019

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Keywords

  • Antibiotic Prophylaxis
  • Antifungal Agents/pharmacology
  • Case-Control Studies
  • Caspofungin/pharmacology
  • Cyclophosphamide/adverse effects
  • Female
  • Hematopoietic Stem Cell Transplantation/adverse effects
  • Humans
  • Male
  • Mycoses/etiology
  • Proportional Hazards Models

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