bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.18821/0234-5730-2017-62-4-188-196bloodjour-670Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESПрименение микафунгина – препарата из класса эхинокандинов у больных опухолями системы кровиThe use of micafungin in patients with hematological malignancieshttps://orcid.org/0000-0002-6195-4508ОхматВ. А.OkhmatV. A.

Охмат Владимир Александрович, кандидат мед. наук, научный сотрудник лаборатории клинической бактериологии, микологии и антибиотической терапии

ResearcherID: M-7089-2014

125167, г. Москва

Okhmat Vladimir A., MD, PhD, researcher of the Laboratory of clinical bacteriology, mycology and antibiotic therapy

Moscow, 125167

okhmatvladimir@mail.ruhttps://orcid.org/0000-0001-5973-5763КлясоваГ. А.KlyasovaG. A.

ResearcherID: M-6329-2014

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0001-6177-3566ПаровичниковаЕ. Н.ParovichnikovaE. N.

ResearcherID: N-4840-2016

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0002-9808-8519ДвирныкВ. Н.DvirnikV. N.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0001-6201-6276КузьминаЛ. А.KuzminaL. A.

ResearcherID: E-4195-2015

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0002-6778-997XКравченкоС. К.KravchenkoS. K.

125167, г. Москва

Moscow, 125167

https://orcid.org/0000-0001-8188-5557СавченкоВ. Г.SavchenkoV. G.

125167, г. Москва

Moscow, 125167

ФГБУ «Национальный медицинский исследовательский центр гематологии» Минздрава РоссииРоссияNational Medical Research Center for HematologyRussian Federation201717102025624188196Copyright © Охмат В.А., Клясова Г.А., Паровичникова Е.Н., Двирнык В.Н., Кузьмина Л.А., Кравченко С.К., Савченко В.Г., 20252025Охмат В.А., Клясова Г.А., Паровичникова Е.Н., Двирнык В.Н., Кузьмина Л.А., Кравченко С.К., Савченко В.Г.Okhmat V.A., Klyasova G.A., Parovichnikova E.N., Dvirnik V.N., Kuzmina L.A., Kravchenko S.K., Savchenko V.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/670

Цель исследования – изучить показания к назначению и эффективность микафунгина, а также частоту нежелательных явлений со стороны показателей функции печени (трансаминаз, общего билирубина, щелочной фосфатазы) при применении у больных с опухолями системы крови.

Материал и методы

Материал и методы. Исследование проводилось в 2014–2017 гг. Микафунгин использовали в дозе 100 мг внутривенно 1 раз в сутки.

Результаты

Результаты. Первичную профилактику микафунгином назначали 16 (46%) из 35 больных, при этом все из них были реципиентами аллогенных стволовых гемопоэтических клеток (СГК), острую или хроническую реакцию «трансплантат против хозяина» (РТПХ) имели 81% больных – они получали преднизолон в суточной дозе ≥ 1 мг/кг. Медиана длительности профилактики составила 27 (4–105) дней, у 14 (88%) больных от 7 дней и более, у 2 (12%) – менее 7 дней. У реципиентов СГК, получавших микафунгин  от 7 дней и более, инвазивный аспергиллез легких («вероятный») развился у 1 (7%) из 14 больных. Лечение микафунгином назначали 19 (54%) из 35 больных с медианой продолжительности 13 (3–32) дней.  Показания для лечения включали кандидемию (n = 7), гепатолиенальный кандидоз (n = 4), эмпирический (n = 6) и превентивный (n = 2) подходы. Летальные исходы были у 2 из 7 больных с кандидемией, в остальных случаях лечение микафунгином было эффективным. У 21 (60%) из 35 больных перед назначением микафунгина наблюдалось превышение референсных значений одного и более показателей функции печени. За период применения микафунгина медианы параметров функции печени снижались у больных, имевших повышение этих показателей до назначения микафунгина, и сохранялись без  изменений у больных с исходными нормальными значениями.

Заключение

Заключение. Подтверждена эффективность микафунгина в профилактике инвазивных микозов у реципиентов СГК с острой и хронической РТПХ и в лечении доказанного и предполагаемого инвазивного микоза. Доказана безопасность применения микафунгина у больных с опухолями системы крови.

The aim of this study was to evaluate indications, efficacy and rate of hepatic dysfunction in patients with hematological malignancies treated with micafungin.

Material and Methods

Material and Methods. Micafungin was administered in dose of 100 mg intravenously once daily.

Results

Results. Primary prophylaxis with micafungin was performed in 16 (46%) of 35 patients, all of them were recipients of allogeneic hematopoietic stem cells (allo-HSC), 81% – had graft-versus-host disease (GVHD) and  received prednisolone in dose of ≥ 1 mg/kg daily. Median duration of prophylaxis was of 27 (4–105) days, in 14 (88%) patients – 7 days and more, in 2 (12%) – less than 7 days. Invasive aspergillosis (“probable”) occurred in 1 (7%) of 14 allo-HSCT recipients under micafungin treatment for ≥ 7 days. Micafungin treatment was initiated in 19 (54%) of 35 patients with median duration of 13 (3–32) days. Indications for micafungin treatment were candidemia (n = 7), hepatosplenic candidiasis (n = 4), empirical therapy (n = 6) and preemptive therapy. Fatal outcome was in 2 of 7 patients with candidemia, other patients had favorable outcome. Prior to the beginning of the treatment with micafungin 21 (60%) of 35 patients had elevation in one or more liver function tests.  During micafungin treatment liver function parameters decreased in patients with initially elevated levels of these parameters and remained in reference ranges in patients with previously normal values.

Conclusion

Conclusion. The study demonstrated the efficacy of micafungin both for prophylaxis of invasive  mycoses in allo-HSCT recipients with GVHD and the treatment of proven and suspected invasive candidiasis.  We confirmed the safety of the micafungin use in patients with hematological malignancies.

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The authors declare that there are no conflicts of interest present.