米卡芬凈在造血干細胞移植二級預防中的臨床應用分析_《華西醫學》

作者：

黃曉兵 , 王春森 , 張晉林 , 王曉冬

四川省醫學科學院·四川省人民醫院血液科（成都，610072）;

關鍵詞：

R733.7 R730.5

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【摘要】　目的　探討米卡芬凈在有侵襲性真菌感染（invasive fungal infection，IFI）病史的患者行造血干細胞移植（haematopoietic stem cell transplantation，HSCT）時二級預防（secondary anti-fungal prophylaxis，SAP）的有效性和安全性。　方法　選擇2009年1月-2011年1月行HSCT治療血液病患者中有IFI史的18例患者，從預處理進行SAP，13例開始即使用米卡芬凈鈉，5例開始選用伏立康唑，后換為米卡芬凈。預防至危險期結束（白細胞植活、無感染癥狀），18例患者隨訪時間62～220 d，中位隨訪時間為124 d。　結果　米卡芬凈治療有效17例，1例在預防期間+27 d出現真菌突破感染。預防過程中1例在輸注的第2天出現軀干充血性皮疹伴瘙癢，經抗過敏治療后逐漸好轉。17例患者在米卡芬凈使用過程中未觀察嚴重不良反應發生，也未因此而調整環胞素A治療濃度。　結論　米卡芬凈作為HSCT中SAP的備選用藥之一是安全、有效的。
【Abstract】　Objective　 To investigate the efficacy of micafungin on secondary anti-fungal prophylaxis (SAP) in hematopoietie stem cell transplantation (HSCT) recipients who had a history of antecedent invasive fungal infection (IFI) and to observe the safety of micafungin.　Methods　 The patients with hematological diseases，who underwent HSCT between January 2009 and January 2011, received our routine conditioning regimen. The patients, who had a history of antecedent IFI, were given by micafungin for SAP from the start of conditioning chemotherapy until the end of the risk period.　Results　 There were 18 patients had a history of antecedent IFI. The overall efficacy of micafungin was 17/18. One patients had IFI on the +27th day during SAP; one patient had body congestive rash accompanied with pruritus in the prevention period 2 days after treatment, who got better gradually after antianaphylaxis treatment. No patients had server adverse reaction and the concentration of cyclosporine A was not changed.　Conclusion　 Micafungin as one of drugs for SAP Is effective and safe for HSCT.

引用本文： 黃曉兵,王春森,張晉林,王曉冬. 米卡芬凈在造血干細胞移植二級預防中的臨床應用分析. 華西醫學, 2011, 26(12): 1783-1786. doi: 復制

1.	Gratwohl A, Brand R, Frassoni F, et al. Cause of death after allogeneic haematopoietic stem cell transp lantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious comp lications and changes over calendar time[J]. Bone Marrow Transplant, 2005, 36(11): 757-769.
2.	Sipsas NV, Kontoyiannis DP. Clinical issues regarding relapsing asperlllosis and the efficacy of secondary antifungal prophylaxis in patients with hematological malignancies[J]. Clin Infect Dis, 2006, 42(9): 1584-1591.
3.	Wingard M, Merz WG. Binaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutroponia treated prophylactically with fluconazole[J]. N Earl J Med, 1991, 325(17): 1274-1277.
4.	Krtiger WH, Riissmann B, de Wit M, et al. Haemopoietie cell transplantation of patients witll a history of deep or invasive funsal infection during prophylaxis with lipesomal amphoteriein B[J]. Acts Haematol, 2005, 113(42): 104-108.
5.	Petraitis V, Petraitiene R, Groll AH, et al. Comparative antifungal activities and plasma pharmacokinetics of micafungin (FK463) against disseminated candidiasis and invasive pulmonary aspergillosis in persistently neutropenic rabbits[J]. Antimicrob Agents Chemother, 2002, 46(26): 1857-1869.
6.	David WD, Kieren AM, Wendi ML, et al. Micafungin (FK463), alone or in combination with other systemic antifungal agents, for the treatment of acute invasive aspergillosis[J]. J Infect, 2006, 53(12): 337-349.
7.	Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis, 2009, 46(11): 327-360.
8.	美國西雅圖Fred Hutchinson癌癥研究中心醫學聯合體. 造血干細胞移植標準實踐手冊[M]. 北京: 人民衛生出版社, 2007: 301.
9.	van Burik JA, Ratanatharathorn V, Stepan DE. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation[J]. Clin Infect Dis, 2004, 39(10): 1407-1416.
10.	中華內科雜志編輯委員會. 血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(修訂版)[J]. 中華內科雜志, 2007, 46(6): 607-611.
11.	Herbreeht R, Denning DW, Patterson V, et al. Voriconazole versus amphotericin B for primary thempy of invasive aspergillosis[J]. N Ensl J Med, 2002, 347(18): 408-415.
12.	Madureira A, Bergemn A, Lacroix C, et al. Breakthrough invasive aspergiIlosis in allogeneic haematopoietic stem cell transplant recipients treated with easpofungin[J]. Int J Antimiemb Agents, 2007, 30(7): 551-554.
13.	van Boxtel CJ, Santoso B, Edwards IR. 藥物效益與風險[M]. 陳易新, 張素敏, 吳鐘浩, 等譯. 北京: 中國醫藥科技出版社, 2006: 274.
14.	Fukuda T, Boecldl M,, Guthrie KA, et al. Invasive aspergillosis before allogeneic hematopoietie stem cell transplantation: 10-year experience at a single transphnt center[J]. Biol Blood Marrow Transplant, 2004, 10(13): 494-503.
15.	許蘭平, 唐菲菲, 劉代紅, 等. 造血干細胞移植中侵襲性真菌感染的二級預防[J]. 中華內科雜志 2009, 48(4): 853-856.

1. 　Gratwohl A, Brand R, Frassoni F, et al. Cause of death after allogeneic haematopoietic stem cell transp lantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious comp lications and changes over calendar time[J]. Bone Marrow Transplant, 2005, 36(11): 757-769.
2. 　Sipsas NV, Kontoyiannis DP. Clinical issues regarding relapsing asperlllosis and the efficacy of secondary antifungal prophylaxis in patients with hematological malignancies[J]. Clin Infect Dis, 2006, 42(9): 1584-1591.
3. 　Wingard M, Merz WG. Binaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutroponia treated prophylactically with fluconazole[J]. N Earl J Med, 1991, 325(17): 1274-1277.
4. 　Krtiger WH, Riissmann B, de Wit M, et al. Haemopoietie cell transplantation of patients witll a history of deep or invasive funsal infection during prophylaxis with lipesomal amphoteriein B[J]. Acts Haematol, 2005, 113(42): 104-108.
5. 　Petraitis V, Petraitiene R, Groll AH, et al. Comparative antifungal activities and plasma pharmacokinetics of micafungin (FK463) against disseminated candidiasis and invasive pulmonary aspergillosis in persistently neutropenic rabbits[J]. Antimicrob Agents Chemother, 2002, 46(26): 1857-1869.
6. 　David WD, Kieren AM, Wendi ML, et al. Micafungin (FK463), alone or in combination with other systemic antifungal agents, for the treatment of acute invasive aspergillosis[J]. J Infect, 2006, 53(12): 337-349.
7. 　Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America[J]. Clin Infect Dis, 2009, 46(11): 327-360.
8. 　美國西雅圖Fred Hutchinson癌癥研究中心醫學聯合體. 造血干細胞移植標準實踐手冊[M]. 北京: 人民衛生出版社, 2007: 301.
9. 　van Burik JA, Ratanatharathorn V, Stepan DE. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation[J]. Clin Infect Dis, 2004, 39(10): 1407-1416.
10. 　中華內科雜志編輯委員會. 血液病/惡性腫瘤患者侵襲性真菌感染的診斷標準與治療原則(修訂版)[J]. 中華內科雜志, 2007, 46(6): 607-611.
11. 　Herbreeht R, Denning DW, Patterson V, et al. Voriconazole versus amphotericin B for primary thempy of invasive aspergillosis[J]. N Ensl J Med, 2002, 347(18): 408-415.
12. 　Madureira A, Bergemn A, Lacroix C, et al. Breakthrough invasive aspergiIlosis in allogeneic haematopoietic stem cell transplant recipients treated with easpofungin[J]. Int J Antimiemb Agents, 2007, 30(7): 551-554.
13. 　van Boxtel CJ, Santoso B, Edwards IR. 藥物效益與風險[M]. 陳易新, 張素敏, 吳鐘浩, 等譯. 北京: 中國醫藥科技出版社, 2006: 274.
14. 　Fukuda T, Boecldl M,, Guthrie KA, et al. Invasive aspergillosis before allogeneic hematopoietie stem cell transplantation: 10-year experience at a single transphnt center[J]. Biol Blood Marrow Transplant, 2004, 10(13): 494-503.
15. 　許蘭平, 唐菲菲, 劉代紅, 等. 造血干細胞移植中侵襲性真菌感染的二級預防[J]. 中華內科雜志 2009, 48(4): 853-856.

《華西醫學》

米卡芬凈在造血干細胞移植二級預防中的臨床應用分析

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《華西醫學》

米卡芬凈在造血干細胞移植二級預防中的臨床應用分析

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