665. Safety of High-Dose (100 mg) Caspofungin (HD-CSP) Therapy in 91 Cancer and Stem Cell Transplant (SCT) Patients with Invasive Fungal Disease (IFD)
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Pneumocandins exert concentration-dependent antifungal effect. We sought to assess safety of HD-CSP in 91 oncology patients.

Methods: Retrospective evaluation of patients receiving HD-CSP during 2002-2005 was followed for >5 years after the end of HD-CSP therapy. All values are shown as mean ± SD or median (range). Laboratory values are given as mg/dl. Response included complete and/or partial clinical/radiographic response.

Results: Forty-five of 60 leukemia patients had acute disease. Eighty percent of 45 SCT recipients received allogeneic grafts; 8 of 21 patients with GvHD had acute disease. APACHE score was 14 (2-29); 26 patients received ≥600 mg equivalent of prednisone. Please refer to IFD table. Lungs were frequently involved (n=73), sinuses in 7 patients and 6 had disseminated infection. HD-CSP doses were 18.5 ± 21.5; 8 patients received ≥ 40 doses and 161 doses were given in a single patient. Total bilirubin (tb) was 0.5 (0.2-3.9) at the start and 0.7 (0.2-7.1) at the end of HD-CSP therapy; similarly, alanine aminotransferase (ALT) was 27 (9-135) and 29 (12-723), respectively. Eleven patients had tb levels > 1.3 mg/dl prior to HD-CSP and in 18% tb normalized during therapy; in 3 of 6 patients with worsening tb during HD-CSP therapy voriconazole was continued. Tb increased from normal baseline in 8 patients during HD-CSP and in half of these patients voriconazole was also continued. There were no abnormalities in serum creatinine, electrolytes and minerals following HD-CSP therapy. Clinical response was seen in 40 patients (44%); 20 (22%) deaths were associated with progressive fungal infection. Most common cause of death was progression of cancer (n=54; 59%) followed by bacterial sepsis (n=15; 16%); non-infectious pulmonary complications including diffuse alveolar hemorrhage (n=12; 13%) and severe GvHD (n=8; 9%).

Conclusion: Prolonged HD-CSP treatment was well-tolerated in these severely immunosuppressed cancer and SCT patients with IFD.  

 

 

Possible fungal infection

Probable fungal infection

Proven fungal infection

Number

54

9

28

Aspergillus species

6

5

15

Zygomycetes species

0

0

5

other/unknown

53

0

7

Use of steroids

13

3

10

High dose caspofungin plus voriconazole or posaconazole

23

2

5

High dose caspofungin plus polyene

15

2

12


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Fadi Al Akhrass, MD , University of Texas, Houston, TX
Gilhen Rodriguez, MD , Pediatrics, University of Texas Health Science Center at Houston, Houston, TX
Jorge Zuniga, MD , University of Texas, Houston, TX
Anupam Pande, MD , Michael E. DeBakey VA Medical Center, Houston, TX
Amar Safdar, MD , The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

F. Al Akhrass, None

G. Rodriguez, None

J. Zuniga, None

A. Pande, None

A. Safdar, Yes
Merck: Speaker's Bureau,

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