米卡芬净在造血干细胞移植二级预防中的临床应用分析

Micafungin for Secondary Prophylaxis of Invasive Fungal Infection in Hematopoietic Stem Cell Transplantation Recipients

目的探讨米卡芬净在有侵袭性真菌感染(invasive fungal infection,IFI)病史的患者行造血干细胞移植(haematopoietic stem cell transplantation,HSCT)时二级预防(secondary anti-fungal prophylaxis,SAP)的有效性和安全性。方法选择2009年1月2011年1月行HSCT治疗血液病患者中有IFI史的18例患者,从预处理进行SAP,13例开始即使用米卡芬净钠,5例开始选用伏立康唑,后换为米卡芬净。预防至危险期结束(白细胞植活、无感染症状),18例患者随访时间62～220d,中位随访时间为124d。结果米卡芬净治疗有效17例,1例在预防期间+27d出现真菌突破感染。预防过程中1例在输注的第2天出现躯干充血性皮疹伴瘙痒,经抗过敏治疗后逐渐好转。17例患者在米卡芬净使用过程中未观察严重不良反应发生,也未因此而调整环胞素A治疗浓度。结论米卡芬净作为HSCT中SAP的备选用药之一是安全、有效的。

Objective To investigate the efficacy of micafungin on secondary anti-fungal prophylaxis（SAP） in hematopoietie stem cell transplantation（HSCT） recipients who had a history of antecedent invasive fungal infection（IFI） and to observe the safety of micafungin.Methods The patients with hematological diseases,who underwent HSCT between January 2009 and January 2011,received our routine conditioning regimen.The patients,who had a history of antecedent IFI,were given by micafungin for SAP from the start of conditioning chemotherapy until the end of the risk period.Results There were 18 patients had a history of antecedent IFI.The overall efficacy of micafungin was 17/18.One patients had IFI on the ＋27th day during SAP;one patient had body congestive rash accompanied with pruritus in the prevention period 2 days after treatment,who got better gradually after antianaphylaxis treatment.No patients had server adverse reaction and the concentration of cyclosporine A was not changed.Conclusion Micafungin as one of drugs for SAP Is effective and safe for HSCT.