Assessment of nephrotoxicity of high-cumulative dose of liposomal amphotericin B in a pediatric patient who underwent allogeneic bone marrow transplantation.
We describe a 9-yr-old boy who received the highest cumulative dose so far reported of liposomal amphotericin B. The patient underwent an allogeneic bone marrow transplantation (BMT) for adrenoleucodystrophy, after a conditioning regimen with busulfan, thiothepa and cyclophosphamide. Rabbit antithymoglobulin, cyclosporin and prednisone were used as prophylaxis against graft vs. host disease (GVHD). Post-transplant Epstein-Bar-virus-related lymphoma was diagnosed on day +68 and was treated with donor-derived lymphocytes. The patient developed a severe form of GVHD, and a progressive worsening of his neurological status because of progression of his underlying disease. Death from septic shock occurred 23 months after BMT. During prolonged hospitalization, 19,750 mg of liposomal amphotericin B, about 1000 mg/kg, were given for prophylactic or empirical therapeutic purposes without significant nephrotoxicity. This case suggests that liposomal amphotericin B is safe and well-tolerated even if is administered for long periods and a cumulative dose fivefold greater than the nephrotoxic threshold of amphotericin B deoxycholate is achieved.
Cesaro
Simone
S
Department of Pediatrics, Clinic of Pediatric Hematology Oncology, University of Padova, Padova, Italy. simone.cesaro@unipd.it
Zignol
Matteo
M
Burlina
Alberto B
AB
Tridello
Gloria
G
Visintin
Gianluca
G
Messina
Chiara
C
D000326:Adrenoleukodystrophy / Q000601:surgery; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D016026:Bone Marrow Transplantation / Q000276:immunology; D002177:Candidiasis / Q000517:prevention & control; D002648:Child; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D020031:Epstein-Barr Virus Infections; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007668:Kidney / Q000187:drug effects; D007674:Kidney Diseases / Q000139:chemically induced*; D008081:Liposomes; D008223:Lymphoma / Q000628:therapy / Q000821:virology; D008297:Male; D011552:Pseudomonas Infections / Q000517:prevention & control; D012772:Shock, Septic / Q000382:microbiology; D013602:T-Lymphocytes, Cytotoxic; D019172:Transplantation Conditioning
D000935:Antifungal Agents; D008081:Liposomes; C068538:liposomal amphotericin B; D000666:Amphotericin B; D003404:Creatinine