title: Once-weekly liposomal amphotericin B for prophylaxis of invasive fungal infection after graft-versus-host disease in allogeneic hematopoietic stem cell transplantation: a comparative retrospective single-center study.
abstract: OBJECTIVE
  The liposomal formulation of amphotericin B (LAmB) has been shown to cause few and mild infusion-related reactions, while achieving high plasma and tissue concentrations compared with conventional amphotericin B. We investigated the efficacy and safety of high-dose LAmB (7.5 mg/kg once weekly) prophylaxis of fungal infections in allogeneic stem-cell transplanted (allo-SCT) patients with graft-versus-host disease (GvHD).
  
  
  METHODS
  Retrospective, comparative, single-center.
  
  
  METHODS
  Forty-two patients receiving high-dose prednisone for GvHD after allo-SCT had LAmB prophylaxis; 83 patients in the control group received other antifungal prophylaxis.
  
  
  RESULTS
  In the LAmB prophylaxis group, the median duration of treatment was 7 weeks. The cumulative incidence of invasive fungal infection was 8% at 1 year after transplantation, 8% at 2 years and 16% at 3 years in the LAmB group vs. 36% at 1 year, 44% at 2 years and 49% at 3 years in the other prophylaxis group (P=.008). Fungal infection-related mortality after transplantation was observed in none of the patients in the LAmB prophylaxis group vs. 12 patients (14%) at 1 year, 14 patients (17%) at 2 years and 16 patients (19%) at 3 years in the control group (P=.005). The tolerance of the treatment was good with only 5 patients (12%) having a reversible nephrotoxicity leading to temporary treatment discontinuation.
  
  
  CONCLUSIONS
  High-dose LAmB prophylaxis seems effective and well tolerated in this short series of allo-SCT patients with GvHD. Prospective clinical studies are required to confirm these results.
authors.affiliation: Institut Paoli Calmettes, Marseille, France. elcheikhj@marseille.fnclcc.fr
authors.forename: Jean
authors.initials: J
authors.lastname: El Cheikh
authors.forename: Luca
authors.initials: L
authors.lastname: Castagna
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.forename: Benjamin
authors.initials: B
authors.lastname: Esterni
authors.forename: Catherine
authors.initials: C
authors.lastname: Faucher
authors.forename: Sabine
authors.initials: S
authors.lastname: Furst
authors.forename: Segolene
authors.initials: S
authors.lastname: Duran
authors.forename: Pierre
authors.initials: P
authors.lastname: Berger
authors.forename: Stephane
authors.initials: S
authors.lastname: Ranque
authors.forename: Mohamad
authors.initials: M
authors.lastname: Mohty
authors.forename: Didier
authors.initials: D
authors.lastname: Blaise
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D011239:Prednisolone