Author(s)

Kazunori Nakase^1,2*, Koji Oka³, Keiki Kawakami⁴, Tetsuya Tsukada⁵, Shigehisa Tamaki⁶, Atsushi Fujieda²

¹Department of Personalized Cancer Immunotherapy, Mie University Graduate School of Medicine, Tsu, Japan.
²Department of Hematology and Oncology, Mie University Hospital, Tsu, Japan.
³Department of Internal Medicine, Suzuka Kaisei Hospital, Kameyama, Japan.
⁴Department of Internal Medicine, Suzuka Chuo Hospital, Suzuka, Japan.
⁵Department of Internal Medicine, Takeuchi Hospital, Tsu, Japan.
⁶Department of Internal Medicine, Ise Red Cross Hospital, Ise, Japan.

Invasive fungal infections are a major challenging problem in the management of febrile neutropenia (FN) in patients with hematologic malignancies. Liposomal amphotericin B (L-AmB) or micafungin (MCFG) has been widely used as a first-line empirical antifungal therapy for suspected fungal infection in such patients. However, there are several issues in patients receiving these agents: drug related toxicities for L-AmB and breakthrough fungal infections for MCFG. In order to make the best use of these 2 agents, we conducted a prospective study of sequential therapy from MCFG to L-AmB, and evaluated the efficacy and safety of this strategy in FN patients with hematologic malignancies. A total of 18 patients were enrolled, and 11 patients who fulfilled the protocol defined criteria were evaluated. Underlying diseases consisted of acute leukemia (n = 9), non-Hodgkin lymphoma (n = 1), and myelodysplastic syndrome (n = 1). Treatment success was achieved in 8 patients (72.7%). Drug-related adverse events occurred in 8 patients (72.7%). All of those adverse events except one case were below grade 2. Three patients required discontinuation of L-AmB. Although our empirical antifungal sequential therapy seems to be encouraging for antibiotics-refractory FN in patients with hematologic malignancies, further investigation in large-scale studies is warranted.

Empirical Antifungal Therapy, Micafungin, Liposomal Amphotericin B, Febrile Neutropenia, Hematologic Malignancy

Nakase, K. , Oka, K. , Kawakami, K. , Tsukada, T. , Tamaki, S. and Fujieda, A. (2023) Efficacy and Safety Assessment of Antifungal Sequential Therapy from Micafungin to Liposomal Amphotericin B for Antibiotics-Refractory Febrile Neutropenia in Patients with Hematologic Malignancies. Advances in Microbiology, 13, 315-322. doi: 10.4236/aim.2023.136020.