Vehreschild, M.J., von Bergwelt-Baildon, M., Tran, L., Shimabukuro-Vornhagen, A., Wisplinghoff, H., Bangard, C., . . . Vehreschild, J.J. (2014). Feasibility and effectiveness of posaconazole prophylaxis in combination with micafungin bridging for patients undergoing allogeneic stem cell transplantation: A 6-yr analysis from the Cologne cohort for neutropenic patients. European Journal of Haematology, 93, 400–406. 

To compare the effectiveness of two antifungal prophylaxis regimens in the setting of hematopoietic cell transplantation (HCT)

The study compared patient outcomes between patients undergoing HCT who received only 200 mg posaconazolel three times daily for 100 days to those who also received intermittent IV micafungin at 50–100 mg. Micafungin was provided for patients who were unable to take the oral medication for any reason. The decision to switch to micafungin was at the physician’s discretion.

• N = 212
• MEAN AGE = 46.7 years
• MALES: 58%, FEMALES: 42%
• KEY DISEASE CHARACTERISTICS: Most patients undergoing HCT had acute leukemia or lymphoma.

• SITE: Multi-site  
• SETTING TYPE: Multiple settings    
• LOCATION: Germany

PHASE OF CARE: Active antitumor treatment

• Retrospective

• Incidence of proven or probable invasive fungal infection (IFI) defined according to European Organization for Research and Treatment of Cancer and the Mycoses Study Group (EORTC/MSG)
• Febrile neutropenia defined as incidence of fever not responsive to antibiotics for at least 72 hours.
• Pneumonia—fever with positive diagnostic imaging

Mean number of febrile days was 5.9 in the posaconzole group and 4.3 in the group also receiving micafungin (p = 0.051). The number of possible IFI in the group receiving micafungin bridging was significantly lower (16% versus 3.8%, p = 0.005). Those receiving micafungin bridging had higher fungal-free survival at 100 days post-HCT (p = 0.009). There was no difference in overall survival between groups.

Use of IV micafungin in patients unable to take oral posaconazole was effective in reducing fungal infections.

• Risk of bias (no random assignment)

This study shows that intermittent use of IV micafungin was effective for patients unable to take oral posaconazole for antifungal prophylaxis following HCT. Both of these regimens were shown to be feasible and effective. Further research in this area is warranted to determine most effective drug combinations and timing to prevent breakthrough IFI.