Use of Micafungin for the Management of a Cluster of Invasive Aspergillosis in Children with Cancer

Abstract

Background: Progressive increase of the capacity to cure children with cancer makes their rescue from life-threatening infectious complications, such as invasive fungal infections, a compelling challenge. Local outbreak among patients at risk may occur, and the optimal strategy for their management, including prophylactic regimens, is not defined. Purpose: We describe our experience in the use of micafungin to break a cluster of invasive aspergillosis in children and adolescent with cancer. Methods: Since study start, all in-patients who had severe neutropenia (<500/mm3) received prophylaxis with micafungin (1 mg/kg; ≤50 mg) daily i.v. until discharge. Serial testing of galactomannan was used as screening test for invasive aspergillosis; lung computed tomography was performed in patients who tested positive at repeated assay. Results: Among 27 patients enrolled, one was excluded due to breakthrough invasive aspergillosis diagnosed on day 2. The remaining 26 patients were observed for a minimum of 90 days. Four patients had one positive galactomannan test; this was confirmed at second (but not at third) serial assay in a single patient. None of the patients developed invasive aspergillosis. The drug was very well tolerated, with no side effects related to micafungin administration. The total cost of the drug used for this “prophylaxis” in the study patients was €30.451, with a mean cost per patient of €1.133. Conclusions: “Prophylactic” use of micafungin was safe, feasible and turned out to be associated with breaking the cluster of invasive aspergillosis in neutropenic patients exposed to an environmental risk. The pharmaco-economic evaluation also turned to be highly favorable.