Pancreatic toxicity after liposomal amphotericin B.
Though liposomal amphotericin B has been available in Germany since 1992, efficacy and safety of this formulation of amphotericin B are still not well-documented in children. As far as gastrointestinal side-effects are concerned, an elevated alkaline phosphatase and elevated transaminases have been reported. In our department, liposomal amphotericin B had been used since 1994 to treat patients with proven or suspected fungal infections in a daily dose of 1-3 mg kg-1. Additionally, patients with high-dose chemotherapy and autologous stem cell support received liposomal amphotericin B prophylactically in a dose of 1 mg kg(-1) three times per week. We performed a retrospective analysis of all 31 patients who had received liposomal amphotericin B by 1999. In five patients, an isolated transient elevation of the serum lipase level during, or shortly after, the therapy with liposomal amphotericin B was detected. Three of these patients showed clinical signs of pancreatitis, with one patient displaying slightly elevated transaminases. So far, elevated levels of serum lipase have not been described as a possible side-effect of a liposomal amphotericin B therapy. The pathogenesis of this elevation is unclear. As possible reasons, an enzyme induction due to fat overload or a toxic damage of the pancreatic tissue by the liposomes or amphotericin B itself are discussed.
Stuecklin-Utsch
A
A
Department of Pediatric Haematology-Oncology, University of Bonn, Germany. fleischh@mailer.meb.uni-bonn.de
Hasan
C
C
Bode
U
U
Fleischhack
G
G
D000293:Adolescent; D000666:Amphotericin B / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood; D008081:Liposomes; D008297:Male; D009181:Mycoses / Q000188:drug therapy* / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications; D009503:Neutropenia / Q000150:complications; D010195:Pancreatitis / Q000139:chemically induced*; D020799:Pancrelipase / Q000378:metabolism; D012189:Retrospective Studies
D008081:Liposomes; D020799:Pancrelipase; D000666:Amphotericin B; D008049:Lipase