title: Retrospective Analysis on the Use of Amphotericin B Lipid Complex in Neutropenic Cancer Patients with Suspected Fungal Infections in Lebanon, a Single Center Experience and Review of International Guidelines.
abstract: BACKGROUND
  Immunocompromised patients carry a high risk for invasive fungal disease (IFD), which is associated with high mortality.
  
  
  METHODS
  This is a retrospective chart review of a 4-year experience of amphotericin B lipid complex (ABLC) utilization for the management of suspected IFD at the Hematology/Oncology and Bone Marrow Transplantation unit at Makassed General Hospital, Beirut, Lebanon between January 2011 and December 2014. We focused on treatment strategy, response rate, and adverse drug events associated with ABLC therapy. We also reviewed ABLC indications in international guidelines beyond its Food and Drug Administration approval.
  
  
  RESULTS
  A total of 89 patients received ABLC therapy for suspected fungal infection. Forty-eight percent were treated for a possible fungal infection, 19% for a problable fungal infection, 12% based on hospital guidelines, and 20% based on treating physician's recommendations. The overall response rate was 71%. Nephrotoxicity occurred in 24% of patients and serum creatinine improved in 10% of these patients. Moderate hypokalemia was observed in 61% of the patients and severe hypokalemia in 10% but was corrected in both cases. Hepatotoxicity was observed in 12% of the patients throughout ABLC therapy. Infusion-related reactions were observed in 36% of the patients. There was a decrease in the incidence of these reactions upon using combination of premedication drugs.
  
  
  CONCLUSIONS
  In this study, ABLC proved to be an effective and safe option in the management of suspected IFD in immunocompromised patients failing previous therapies.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Ain WaZein Hospital, Shouf, Lebanon; Infection Control Program, Ain WaZein Hospital, Shouf, Lebanon; Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon; Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon.
authors.forename: Rima
authors.initials: R
authors.lastname: Moghnieh
authors.affiliation: Department of Internal Medicine, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Nabila
authors.initials: N
authors.lastname: El-Rajab
authors.affiliation: Pharmacy Department, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Dania Issam
authors.initials: DI
authors.lastname: Abdallah
authors.affiliation: Department of Internal Medicine, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Ismail
authors.initials: I
authors.lastname: Fawaz
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Anas
authors.initials: A
authors.lastname: Mugharbil
authors.affiliation: Department of Laboratory Medicine, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Tamima
authors.initials: T
authors.lastname: Jisr
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, Makassed General Hospital , Beirut , Lebanon.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Ibrahim
keywords: amphotericin B lipid complex; guidelines; hematopoietic stem cell transplantation; infusion-related reactions; invasive fungal disease; nephrotoxicity