%0 Journal Article
%T Efficacy and Safety Assessment of Antifungal Sequential Therapy from Micafungin to Liposomal Amphotericin B for Antibiotics-Refractory Febrile Neutropenia in Patients with Hematologic Malignancies
%A Kazunori Nakase
%A Koji Oka
%A Keiki Kawakami
%A Tetsuya Tsukada
%A Shigehisa Tamaki
%A Atsushi Fujieda
%J Advances in Microbiology
%P 315-322
%@ 2165-3410
%D 2023
%I Scientific Research Publishing
%R 10.4236/aim.2023.136020
%X 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.
%K Empirical Antifungal Therapy
%K Micafungin
%K Liposomal Amphotericin B
%K Febrile Neutropenia
%K Hematologic Malignancy
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=125715