Experience with anidulafungin in patients with allogeneic hematopoietic stem cell transplantation and graft‐versus‐host disease. Issue 5 (26th September 2015)

• Record Type: Journal Article
• Authors: Yáñez, L.; Insunza, A.; Ibarrondo, P.; de Miguel, C.; Bermúdez, A.; Colorado, M.; López‐Duarte, M.; Richard, C.; Conde, E.
• Is Part Of: Transplant infectious disease. Volume 17:Issue 5(2016)
• Page Start: 761
• Page End: 767
• Publication Date: 2015-09-26
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12429
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12429-abs-0001"> <title>Abstract</title> <sec id="tid12429-sec-0001" sec-type="section"> <title>Background</title> <p>It is well known that both acute and chronic graft‐versus‐host disease (GVHD) are associated with invasive fungal disease (IFD). Because the galactomannan antigen diagnostic test has low specificity and sensitivity outside of the neutropenic period, many institutions use posaconazole or voriconazole for IFD prophylaxis during GVHD treatment. Moreover, several factors, mainly hepatic impairment, can limit the use of extended spectrum azoles, both in prophylaxis or treatment.</p> </sec> <sec id="tid12429-sec-0002" sec-type="section"> <title>Methods</title> <p>We retrospectively analyzed 25 patients with allogeneic hematopoietic stem cell transplantation (HSCT) and GVHD – grade III–IV acute GHVD (<italic>n</italic> = 15), progressive chronic GVHD (<italic>n</italic> = 7), and "overlap" GVHD (<italic>n</italic> = 3) – who received intravenous anidulafungin (200 mg on day 1, followed by 100 mg once daily). If necessary, anidulafungin treatment was followed by oral administration of 200 mg voriconazole twice a day or 200 mg posaconazole 3 times daily until patients were considered not at risk for IFD.</p> </sec> <sec id="tid12429-sec-0003" sec-type="section"> <title>Results</title> <p>Twenty‐one patients (85%) received anidulafungin as prophylaxis and 5 patients (15%) received it as treatment. Median duration of intravenous anidulafungin administration was 8 days (range 6–17). Seven patients (28%) presented mild adverse effects, with no significant interactions with calcineurin inhibitors. Sequentially, 4 patients received voriconazole and 6 posaconazole. Two patients (8%) developed IFD after anidulafungin withdrawal: 1 with <italic>Candida albicans</italic> and the other with <italic>Mucor</italic>, 8 and 5 days after withdrawal, respectively.</p> </sec> <sec id="tid12429-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Our results are of interest owing to the absence of data in the literature on anidulafungin use in HSCT patients with GVHD, and suggest that anidulafungin, because of its spectrum, pharmacological profile, low toxicity, and absence of interactions with immunosuppressants, could be a drug of choice in this setting.</p> </sec> </abstract>