Micafungin is a novel echinocandin antifungal agent,with a special michanism of action and broad spectrum fungicida activity against both Candida spp.and Aspergillus spp.It has been shown to be safe and effective for the treatment of invasive fungal infections(IFIs)in some clinical setting or trials.In recent years,it is playing an increasingly important role in the field of antifungal.Therefore,we analyzed and reviewed the antifungal efficacy,pharmacoeconomics,application in the special populations and drug interactions of micafungin based on the pharmacology & pharmacodynamics of micafungin and cited several correlated clinical trial in this article.

Autologous stem cell transplantation(ASCT) significantly increased the complete response rate(CR) and long-term survival in the patients younger than 65 years with multiple myeloma(MM). ASCT in the early stage of disease is currently considered the standard therapy in younger patients with newly diagnosed MM. High-dose melphalan with 200 mg/m2 is still considered the best conditioning. Double autotransplant is recommended for the patients without having VGPR after the first ASCT. Novel pretransplant induction regimens and conditioning with novel drugs such as bortezomib could improve the effect of ASCT. The best curative approach in multiple myeloma is allogeneic transplantation (allo-HSCT) with much higher CR. The long-term survival of patients receiving conventional/myeloablative conditioning (MAC) allo-HSCT is not better than that of the ASCT because of higher transplant-related mortility (TRM). Allo-HSCT with MAC has almost universally been replaced by the dose-reduced intensity conditioning allogeneic transplantation (Allo-RIC),which has lower TRM. More patients and long-term follow-up are needed to test the efficacy of single ASCT followed by Allo-RIC in patients with multiple myeloma.

Objective To retrospectively analyse the impact of imatinib mesylate(Gleevec)on HSCT outcome in patients with Ph(+)leukemias.Methods From June 2001 to June 2005,31 CML-BC/AP patients and 8 refractory Ph(+)ALL patients were treated with imatinib mesylate to induce remission,followed by allogeneic transplantation,and we evaluated its influence on engraftment,graft versus host disease(GVHD),overall survival(OS),disease free survival(DFS),relapse rate(RR)and transplant-related mortality(TRM).Results Eighteen of 39 patients achieved complete hematologic remission(CHR),9 patients bone marrow remission(BMR)and 4 patients partial response(PR),the overall response rate being 70.96%.After HSCT,all patients achieved complete allogeneic engraftment with a median of 14 and 13.5 days for neutrophil and platelet recovery,respectively.The cumulative incidence rates of Ⅱ~Ⅳ? and Ⅲ~Ⅳ? aGVHD were 61.53% and 15.38%.The probability of OS and DFS was(73.51?9.61)% and(61.28?12.37)%,when HSCT was performed in CR,compared with(36.36?14.50)% and(31.25?13.98)% in NR.The 3-year cumulative relapse rate(RR)was 20.41% vs 75.00%.Four cases died of transplant-related complications.Conclusion Pre-transplant imatinib mesylate seems effective and safe for refractory Ph(+)leukemias;it allows transplantation to be in a more favorable status,and leads to better outcome.

Objective To explore the role of inositol requiring enzyme 1 α (IRE1α) mediated endoplasmic reticulum stress associated apoptotic molecules in hippocampal neuronal injury in rats with status epilepsy following lithium-pilocarpine.Methods All 96 Wistar rats were randomly divided into control group and status epilepsy (SE) group.The SE group was further divided into 5 subgroups (3,6,12,24,48 h) according to different time points.pmmunofluorescence was used to observe the expressions of endoplasmic reticulum stress (ERS) markers glucose-regulating protein 78 kd (GRP78) and phosphoIRE1α (active form of endoplasmic reticulum resident protein IRE1α) at the CA3 area of rats in each group.Then,the expressions of IRElα mediated downstream apoptotie markers phospho-c-JunN-terminalkinase (JNK) and caspase12 were detected.Finally,TUNEL assay was used to observe neuronal apoptosis of hippocampal CA3 area at different time points after SE in rats.Results Immunofluorescence showed that GRP78 and phospho-IRE1α positive neurons were significantly increased in the SE subgroups compared with control group (6.90％ ± 0.96％,4.60％ ± 1.12％,respectively) and 12 h subgroup reached the peak (GRP78:87.45％ ±3.63％,F =356.82,P ＜0.05; phospho-IRE1α:86.90％ ±3.82％,F =300.80,P ＜ 0.05).Immunohistochemistry and Western blot demonstrated that the levels of phospho-JNK and caspase12 in the SE subgroups were significantly higher than that in the control group which reached the peak at 12 h after SE.The changes were in accord with phospho-IRE1α.Simultaneously,hippocampal neuronal apoptosis was detected in each SE subgroup and was most severe at 12 h after SE,which showed similar changes to the expressions of phospho-IRE1α,phospho-JNK and caspase12.Conclusions ERS was induced in rats following SE evidenced by increasing the expression of GRP78.IRE1α may promote hippocampal neuron apoptosis in rats following SE through activating JNK and caspase12.

Objective To investigate the efficacy of chimeric anti-CD2 monoclonal antibody (basiliximab) on acute graft-versus-host disease (GVHD) in patients following aliogeneic hematopoietic stem cell transplantation. Methods Thirty-six patients who were suffered from acute GVHD from March 2005 to July 2007 were studied. All of them were treated with steroid first and got no response, then began basiliximab therapy. Results Thirty of 36 patients showed response to basiliximab therapy including 25 complete responses and 5 partial responses. The efficacy was associated with the degree of GVHD and the source of donor. Conclusion Patients suffered from steroid-resistant acute GVHD can be successfully treated with basiliximab.

Objective To study the outcome of HLA-identical hematopoietic stem cell transplantation ( HSCT) for severe aplastic anemia (SAA). Methods Twenty patients diagnosed with SAA received allogeneic HSCT from HLA-identical donors ( 17 from siblings and 3 from unrelated donors) between January 2000 and November 2008. Conditioning regimen consisted of cyclophosphamide ( Cy) and anti-thymocyte immunoglobulin (ATG). The patients were administrated with G-CSF-primed bone marrow (G-BM) and mobilized peripheral blood (G-PB) as grafts from the sibling donors or only G-PB from the unrelated donors. Results The median infused number of mononuclear cells and CD_(34)~+ cells were 7. 89 (4-14.21) × 10~8/kg and 2.60 (0.81-4.45) × 10~6/kg. All the patients got engraftment with 100% donor chimerism. The median time of neutrophil and platelet engraftment were 14 ( 11-20) d and 12 (8-108 )d respectively. The cumulative incidence rate of acute GVHD at 100 d was 16% (grade I : 3 cases,grade II :3 cases). Chronic GVHD occurred in 7 of the 19 evaluable cases (4 limited, 3 extensive). Till February 28, 2009, with a median follow-up of 18 months, 17 patients were alive and the overall survival rate was 82. 5%. Conclusion The study confirms that using G-PB with or without G-BM as graft after Cy + ATG conditioning results in excellent outcome of HLA-identical HSCT in patients with SAA.

Objective To investigate the development of Staphylococcal scalded skin syndrome (SSSS) in patients with hematologic malignancy. Methods The clinical data of 4 cases of SSSS admitted from November 2006 to June 2008 were analyzed, and the related literatures were reviewed. Results Four patients developed SSSS all under severe immunosuppression. Two of them were in neutropenia, and the others had been intensively treated for severe graft versus host disease. They presented high fever and erythema, followed by the formation of flaccid bullae and exfoliation. Three patients recovered successfully with the treatment of vancomycin and intravenous administration of immunoglobulin. Withdraw of mmunosuppressive agents in patients following hematopoietie stem cell transplantation was helpful. Conclusions SSSS should be considered when high fever and erythema suddenly occur in patients with hematologic malignancy.

Objective To investigate the efficacy and safety of secondary anti-fungal prophylaxis (SAP) in haematopoietic stem cell recipients who had a history of antecedent invasive fungal infection(IFI). Methods The patients with hematological diseases,who were scheduled to undergo haernatopoietic stem cell transplantation (HSCT) in our unit from April 2005 to July 2008, received our routine conditioning regimen. Patients,who had a history of antecedent IFI,were given SAP from the start of conditioning chemotherapy until the end of the at-risk period. We chose the effective antifungal drug that was used for antecedent IFI as the secondary prophylaxis drug. Results There were 26 patients at entry. Six patients had probably adverse events (AEs) related to the secondary prophylaxis drug during the prophylactic process and the secondary prophylaxis terminated in two patients because of AEs. The remaining patients received SAP for a medium of 75 days (range 10-212 days). Relapsing IFI occurred in four patients during SAP and in one after SAP. The rate of reLapsing IFI was 19. 2% (5/26). The median time of re]apsing IFI was day 42(range,1-146). The mortality rate among relapsed patients was 60. 0% (3/5). No risk factors that might be associated with IFI was identified by logistic regression model. Conclusion Prior IFI is not an absolute contraindication for HSCT. Secondary antifungal prophylaxis can reduce the risk of recurrent infection in patients with prior IFI, but its schedule and time of therapy need further study.

theengraftment of neutrophil and platelet after HLA-matched sibling allogeneic blood and marrow transplantation.Duration from diagnosis to trarmplantation was another factor influencing engraftment of platelet.