Efficacy and toxicity of intermediate-dose amphotericin B lipid complex as a primary or salvage treatment of fungal infections in patients with hematological malignancies.
We treated 74 adults with a hematological malignancy and documented or suspected invasive fungal infection (IFI) with amphotericin B lipid complex (ABLC) at 3 mg/kg/day. Forty-five patients (61%) received upfront therapy and 29 patients (39%) received salvage therapy for their IFI. Forty-eight of 71 evaluable patients responded [complete responses in 40 (56%) and partial responses in 8 (11%)] and 15 (21%) died as a consequence of the IFI. Response rates in invasive aspergillosis were 33 out of 49 (67%) for probable/definite cases and 6 out of 11 (55%) for invasive candidiasis. In 40 patients with neutropenia-associated IFI, rapid neutropenic recovery ( < 10 days from study entry) was essential for response to therapy (90% vs. 32%, P < 0.01). Treatment was well tolerated, with 15% infusions followed by infusion-related adverse events, nephrotoxicity in 7% of patients and 11% of withdrawals due to toxicity. These data suggest that intermediate-doses of ABLC may be of similar efficacy than higher doses with less toxicity, making it a cost-effective alternative worthy of study in future trials.
Martino
Rodrigo
R
Divisions of Clinical Haematology, Hospital de la Sant Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain. rmartino@hsp.santpau.es
Cortés
Montserrat
M
Subirá
Maricel
M
Parody
Rocio
R
Moreno
Estela
E
Sierra
Jorge
J
D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage* / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D008055:Lipids / Q000008:administration & dosage / Q000737:chemistry; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy*; D016879:Salvage Therapy
D000935:Antifungal Agents; D008055:Lipids; D000666:Amphotericin B