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Antifungal prophylaxis with micafungin three times a week in children after allogeneic bone marrow transplantation
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  • Carmen Garrido-Colino,
  • Ana Haro-Díaz,
  • Eduardo Bardón-Cancho,
  • Marisa Navarro-Gómez,
  • Cristina Beléndez,
  • Jorge Huerta-Aragonés,
  • Marina García-Morin,
  • Cecilia Fernández-Llamazares,
  • Almudena Burillo,
  • Elena Cela
Carmen Garrido-Colino
Hospital General Universitario Gregorio Marañón
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Ana Haro-Díaz
Hospital Universitario de Torrejón
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Eduardo Bardón-Cancho
Hospital General Universitario Gregorio Marañón
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Marisa Navarro-Gómez
Hospital General Universitario Gregorio Marañón
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Cristina Beléndez
Hospital General Universitario Gregorio Marañón
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Jorge Huerta-Aragonés
Hospital General Universitario Gregorio Marañón
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Marina García-Morin
Hospital General Universitario Gregorio Marañón
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Cecilia Fernández-Llamazares
Hospital General Universitario Gregorio Marañón
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Almudena Burillo
Hospital General Universitario Gregorio Marañón
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Elena Cela
Hospital General Universitario Gregorio Marañón
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Abstract

BACKGROUND The use of azoles for antifungal prophylaxis after familial allogeneic stem cell transplantation in children (SCT) is hindered by adverse events and drug interactions especially in children affected by sickle cell disease. Intermittent, higher dose of micafungin could be an alternative. METHODS A prospective, observational, longitudinal, single-center study was conducted between May 2015 and June 2018. The study included 30 patients between 2 and 18 years old who underwent allogeneic SCT and received prophylaxis with micafungin on alternating days after the bone marrow engraftment phase. FINDINGS Fifty transplants performed, 30 included prophylaxis against IFIs, with micafungin in an alternating pattern according to the previously described protocol. The indication for HSCT was hemoglobinopathies in 76.7%, acute leukemia in 20.0% and Fanconi anemia in 3.3%. The prophylaxis duration was 2.33 months (1.53 to 3.98). In our study, 40.0% (12/30) of the patients had acute GVHD, and 6.7% (2/30) had chronic GVHD, which prolonged the duration of alternating prophylaxis. No serious adverse effects of the use of micafungin were observed in any of the patients. There was also no breakthrough Invasive fungal infection (IFI) during alternating prophylaxis. CONCLUSION: In selected patients, micafungin was well tolerated without breakthrough IFI in our study.