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Post-Transplant Events

High-dose caspofungin combination antifungal therapy in patients with hematologic malignancies and hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 39, pages 157–164 (2007)Cite this article

Abstract

Pneumocandins have concentration-dependent antifungal activity and higher dose of caspofungin (HD-CAP) in combination with other licensed antifungal therapy (OLAT) may improve response. Thirty-four patients who received HD-CAP were compared with 63 patients who received standard dose (SD)-CAP. There were no differences between the groups in either patient or disease characteristics. Significantly more patients in the HD-CAP arm had extrapulmonary infections (29 vs 8% in SD group; P=0.0053), and non-Aspergillus species infection (21 vs 6%; P=0.05) and had received prior antifungal therapy (71 vs 33%; P=0.0004). No serious adverse reactions were noted in patients receiving HD- or SD-CAP therapy. Twelve weeks after treatment commenced 44% had a complete or partial response compared with 29% in SD-CAP group (P=0.1). Logistic regression analysis showed a significant probability of a favorable outcome at 12 weeks in patients who received HD-CAP (OR 3.066, 95% CI, 1.092–8.61; P=0.033). This may in part reflect higher number of patients in HD group had received granulocyte–macrophage colony-stimulating factor (41 vs 14% in SD group; P=0.04) and/or interferon γ (26 vs 5% in SD group; P=0.003) immune enhancement. Further studies are needed to evaluate efficacy of HD-CAP in severely immunosuppressed cancer patients with invasive fungal infections.

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Acknowledgements

Portions of this study were presented at the 15th European Congress of Clinical Microbiology and Infectious Diseases, April 2–5, 2005, Copenhagen, Denmark (Abstract # O343) and the 45th Interscience Conference on Antimicrobial Agents and Chemotherapy, (Abstract # M-955), December 16–19, 2005, Washington, DC, USA. We thank Carla Warneke of the Department of Biostatistics and Applied Mathematics for her assistance in the data analysis.

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Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control, and Employee Health, MD Anderson Cancer Center, Houston, TX, USA

    A Safdar, G Rodriguez, K V I Rolston, I I Raad & D P Kontoyiannis

  2. Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA

    S O'Brien, M J Keating & H M Kantarjian

  3. Department of Blood and Marrow Transplantation, MD Anderson Cancer Center, Houston, TX, USA

    I F Khouri, E J Shpall & R E Champlin

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  1. A Safdar
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Correspondence to A Safdar.

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Safdar, A., Rodriguez, G., Rolston, K. et al. High-dose caspofungin combination antifungal therapy in patients with hematologic malignancies and hematopoietic stem cell transplantation. Bone Marrow Transplant 39, 157–164 (2007). https://doi.org/10.1038/sj.bmt.1705559

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