Micafungin versus posaconazole prophylaxis in acute leukemia or myelodysplastic syndrome: A randomized study Journal Article


Authors: Epstein, D. J.; Seo, S. K.; Huang, Y. T.; Park, J. H.; Klimek, V. M.; Berman, E.; Tallman, M. S.; Frattini, M. G.; Papanicolaou, G. A.
Article Title: Micafungin versus posaconazole prophylaxis in acute leukemia or myelodysplastic syndrome: A randomized study
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 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. © 2018 The British Infection Association
Keywords: leukemia; neutropenia; myelodysplastic syndrome; prophylaxis; posaconazole; micafungin; immunocompromised hosts; invasive fungal infections
Journal Title: Journal of Infection
Volume: 77
Issue: 3
ISSN: 0163-4453
Publisher: W.B. Saunders Co.  
Date Published: 2018-09-01
Start Page: 227
End Page: 234
Language: English
DOI: 10.1016/j.jinf.2018.03.015
PROVIDER: scopus
PUBMED: 29746955
DOI/URL:
Notes: Article -- Export Date: 4 September 2018 -- Source: Scopus
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MSK Authors
  1. Virginia Klimek
    107 Klimek
  2. Susan Seo
    59 Seo
  3. Martin Stuart Tallman
    408 Tallman
  4. Jae Hong Park
    132 Park
  5. Ellin Berman
    89 Berman
  6. Yao-Ting Huang
    26 Huang