Efficacy and safety of amphotericin B Lipid Complex (ABLC) in adult oncohematological patients after failure of antifungal prophylaxis

Ref ID: 19440

Author:

L. Drgona,1 E. Bojtarova,2 B. Ziakova,2 L. Demitrovicova,3
E. Mikuskova,3 I. Oravkinova4 and A. Vranovsky3

Author address:

1National Cancer Institute and Comenius University, Bratislava,
Slovak Republic; 2University Hospital, Bratislava, Slovak Republic;
3National Cancer Institute, Bratislava, Slovak Republic and
4Children’s University Hospital, Kosice, Slovak Republi

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Objective To assess clinical response and safety of amphotericin B
lipid complex (ABLC) administration in patients with hematologic
malignancy and/or hematopoietic stem cell transplantation, with
invasive fungal infections despite primary antifungal prophylaxis.
Methods Observational, mulicentric, non-interventional study from
3 centers in Slovakia during the years 2010-2012. Patients with
breakthrough IFD while on antifungal prophylaxis who were treated
with ABLC were enrolled. EORTC/MSG criteria 2008 were used for
classification of IFD. Data regarding risk factors, prophylaxis,
response to ABLC, toxicity and survival at the end of the study and
at day + 30 after the last dose of ABLC was collected and analyzed.
Results 47 adult patients (26 males) with hematological malig-
nancy, with average age 47 years, mainly with AML (60%) and ALL
(17%) were enrolled. 5 patients underwent allogeneic HSCT. 36
patients were neutropenic for average 18 days (2-52 days). Prophy-
lactic posaconazole was administred in 25, fluconazole in 13, voriko-
nazole in 8 patients and micafungin in 1 patient. Average duration
of prophylaxis was 23 days (3-120 days). Proven/probable IFD was
documented in 26 patients, possible IFD in 21 cases. The most com-
mon IFD reported was invasive aspergillosis (42 cases/89%). ABLC
was administred in standard dose (3.0-5.2 mg/kg), in 42 patients as
monotherapy, with average duration of 13 days (4-30 days). Com-
plete and partial response (CR+PR) rate at the end of ABLC therapy was 57% (14% + 43%). Survival at this time point was 85%. Sur-
vival at day 30 after the stop of ABLC therapy was 74%, majority of
patients continued with other antifungal treatment (follow-on ther-
apy or secondary prophylaxis in 80%). 14 patients (30%) developed
toxicity (9 cases of nephrotoxicity). Average serum creatinine value
was 71 and 97 (lmol/L) at the start and at the end of ABLC admin-
istration, respectively.
Conclusion Due to our observation, ABLC is reasonable choice for
treatment of breakthrough IFD in high-risk hematological patients
when azole prophylaxis failed. Clinical response and toxicity of ABLC
were acceptable but follow-on antifungal therapy or secondary pro-
phylaxis after polyene discontinuation is usually needed to maintain
the response.
This study was supported by Cephalon/Teva.

Abstract Number: p381

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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