Reducing Invasive Aspergillosis (IA) with Inhaled Liposomal Amphotericin-B(L-AmB) an Observation of 193 Consecutive AML/MDS Patients

Ref ID: 18664

Author:

B. Rijnders, MD, PhD – MD, F. Broekman, MD – MD, J. Doorduijn, MD – MD, P. Lugtenburg, MD – MD;

Author address:

Erasmus Univ. Med. Ctr., Rotterdam, Netherlands.

Full conference title:

52nd Annual ICAAC

Date: 9 September 2014

Abstract:

Background: In 2008, we showed in a randomized placebo controlled trial that inhaled L-AmB can prevent IA in pts with prolonged neutropenia. AML/MDS pts are at particularly high risk for IA and therefore inhalation of L-AmB 12.5mg per day, 2 days week became the standard of care in these pts at Erasmus MC in Rotterdam at the end of 2008. The goal of this observational study was to measure the effectiveness of L-AmB inhalation in these patients in real life. Methods: All pts with unexplained neutropenic fever for 5 days underwent High resolution CT of the lungs and BAL for culture and aspergillus antigen detection when infiltrates were seen. The incidence of possible, probable or proven IA 3 months after the last cycle of chemotherapy or transplantation was measured in the pre (2005-2007) and L-AmB inhalation era (2008-2011) using EORTC-MSG definitions. Also the use of antifungal therapy for aspecific pulmonary infiltrates (AT+AR) and empirical antifungal therapy in pts without pulmonary infiltrates (AT) was registered. Inhalation was done with an Adaptive Aerosol Delivery system. Results: See table1. In the L-AmB era, the incidence of possible probable or proven IA decreased from 30 to 14% (p=0.01) and overall use of IV/PO antifungal therapy from 48 to 19% p<0.001). No serious drug-related adverse events were observed. Conclusion: In a real-life setting, L-AmB inhalation effectively reduces the incidence of IA in pts at high risk for this disease.

Abstract Number: M-282

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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