Caspofungin as secondary prophylaxis or therapy in patients undergoing allogeneic stem cell transplantation with a prior or ongoing history of systemic or invasive fungal infections

Background: Patients with a history of or ongoing invasive fungal infection (IFI) who undergo allogeneic stem cell transplantation (SCT) have a high risk of reactivation or progression.In a prospective study we evaluated the efficacy and safety of caspofungin as secondary prophylaxis or as therapy for persistent disease.Methods: Twenty-eight adult patients were included in this study, all of whom had acute leukemia. At the time of SCT 16 patients had no signs of infection, while in 12 cases radiographic signs (CT scan) of florid fungal infections were noted. Caspofungin 50 mg intravenously was given daily from start of conditioning until stable engraftment.Results: No patient experienced side effects leading to the discontinuation of caspofungin. In 14 out of 16 patients (88 %) without active signs of infection at start of transplantation, no fungal disease was observed after prophylaxis with caspofungin. In 10 out of 12 cases (83 %) with radiographic signs of florid fungal infection pre-transplantation, complete (n=4) or partial (n=6) responses after caspofungin treatment were achieved.Conclusions: The use of caspofungin is safe and effective in high-risk patients with a history of IFI when undergoing allogeneic SCT.