Akut Lenfoblastik Lösemili Hastalarda Mikafungin Profilaksisi

Öz

Amaç: Hematolojik maligniteli hastaların tedavisindeki gelişmelere rağmen invaziv fungal infeksiyon (İFİ), bu hastalıkların seyri sırasında önemli bir morbidite ve mortalite nedeni olmaya devam etmektedir. Antilösemik tedavinin başarısı ve komplikasyon gelişme riskini azaltabilmesi nedeniyle antifungal profilaksi önem arz etmektedir.

Yöntem: Bu retrospektif çalışmada profilaktik bir antifungal olarak mikafunginin akut lenfoblastik lösemi (ALL) hastalarındaki etkinliği ve güvenilirliliği değerlendirilmiştir. Çalışmaya erişkin yaş grubundaki ALL tanısı ile indüksiyon, reindüksiyon veya kurtarma tedavisi alan ve tedavi sırasında mikafungin ile antifungal profilaksi uygulanan 36 hasta ve bu hastaların almış oldukları toplam 113 kemoterapi kürü dahil edilmiştir. Hastaların tamamına indüksiyon, reindüksiyon ve konsolidasyon tedavileri sırasında mikafungin 50 mg/gün intravenöz profilaksisi verilmiştir. Çalışmanın sonlanım noktası olarak ise; tedavinin tamamlanması, profilaksi altında ampirik, preemptif veya hedefe yönelik antifungal değişikliği ve herhangi bir nedenle ölüm kabul edilmiştir.

Bulgular: Çalışmamızın sonuçları incelendiğinde ALL hastalarında İFİ varlığı ile sağ kalım arasındaki kuvvetli ilişki ilk başta dikkati çekmektedir. Bununla birlikte; yan etki veya ilaç etkileşimi nedeniyle tedaviyi kesme gerekliliğinin olmaması, düşük preemptif antifungal ihtiyacı, ALL hastalarında mikafungin profilaksisinin etkinliğini göstermiştir.

Sonuç: Etkin ve güvenilir bir antifungal profilaksi stratejisi bu grup hastalar için hayati önem taşımaktadır, hayat kurtarıcı olabilmektedir.

Anahtar Kelimeler

• Lösemi
• İnvazif fungal enfeksiyon
• Mortalite

Micafungin Prophylaxis in Patients with Acute Lymphoblastic Leukemia

Öz

Aim: Despite advances in the treatment of patients with hematological malignancies, invasive fungal infection (IFI) remains an important cause of morbidity and mortality during the course of these diseases. Antifungal prophylaxis is important because of the success of antileukemic treatment and reducing the risk of complications.

Methods: This retrospective study evaluated the efficacy and safety of micafungin as a prophylactic antifungal in patients with acute lymphoblastic leukemia (ALL). A total of 113 chemotherapy courses were included in the study, which included 36 patients with the diagnosis of ALL in the adult age group who received induction, reinduction or salvage therapy, and received antifungal prophylaxis with micafungin during the treatment. Micafungin 50 mg/day intravenous prophylaxis was given to all patients during induction, induction and consolidation treatments. The endpoint of the study was accepted as; treatment completion, empirical, preemptive or targeted antifungal change under prophylaxis, and death from any cause.

Results: When the results of our study are examined, the strong relationship between the presence of IFI and survival in ALL patients is remarkable at first. On the other hand; the absence of the need to discontinue treatment due to side effects or drug interactions, and the low need for preemptive antifungals have demonstrated the efficacy of micafungin prophylaxis in ALL patients.

Conclusion: An effective and reliable antifungal prophylaxis strategy is vital for this group of patients and can be life-saving.

Anahtar Kelimeler

• Leukemia
• Mortality
• Invasive fungal infection

Kaynakça

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