High-dose caspofungin as a component of combination antifungal therapy in 91 patients with neoplastic diseases and hematopoietic stem cell transplantation: A critical review of short-term and long-term adverse events

Amar Safdar, Gilhen Rodriguez, Jorge Zuniga, Fadi Al Akhrass, Anupam Pande

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

The antifungal activity of echinocandins is concentration dependent. Previously, we demonstrated that high-dose caspofungin (HD-CSP; 100 mg daily) was well tolerated in 34 immunosuppressed patients with cancer and may have favorably influenced outcomes. We retrospectively assessed all 91 patients in whom HD-CSP was given for the treatment of invasive fungal disease (IFD). The median number of doses was 18.5 ± 21.5, and in 8 (9%) patients more than 40 doses were given. Most (62%) of the patients had leukemia. A total of 45 (49%) patients had undergone stem cell transplantation; 80% received allogeneic grafts and 47% had graft-versus-host disease. High-dose corticosteroids were given during antifungal therapy in 26 (29%) patients. In all, 8 (9%) patients had new elevation in serum bilirubin during HD-CSP therapy; normalization occurred after voriconazole and HD-CSP were discontinued in 4 patients each. No other short-term or delayed adverse events were observed. In all, 40 (44%) patients died of IFD. High-dose corticosteroids during HD-CSP (odds ratio [OR] 8, 95% confidence interval [CI] 2.1-30.4; P <.002) and starting HD-CSP in the critical care unit (OR 67.5, 95% CI 5.25-868.9; P <.001) were associated with death from fungal disease. Prolonged HD-CSP therapy was well tolerated. Drug-induced hyperbilirubinemia may pose a potential limitation for continued HD-CSP use in highly susceptible patients with hematologic neoplasms and stem cell transplantation.

Original languageEnglish
Pages (from-to)175-182
Number of pages8
JournalJournal of Pharmacy Practice
Volume28
Issue number2
DOIs
StatePublished - Apr 15 2015
Externally publishedYes

Keywords

  • corticosteroids
  • critical care unit
  • fungemia
  • high-dose caspofungin
  • immune suppression
  • invasive candidiasis
  • invasive fungal disease
  • leukemia
  • pulmonary aspergillosis
  • stem cell transplantation

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