The effectiveness of liposomal amphotericin in the treatment of invasive fungal infections is not affected by prior azole administration: the Ambi-Prof study

Ref ID: 18579

Author:

J. de la Serna, I. Jarque, J. López, R. Mar, V. Gómez-Garcí­a,
J. Serrano, A. Báez, A. Sampol, P. Amat, C. Barrenetxea, R. del
Campo, J. Garcí­a, M. Jurado on behalf of the Study Group of
Liposomal Amphotericin B

Author address:

NULL

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

It is a matter of debate whether mold-active azole prophylaxis may reduce the effectiveness of Liposomal Amphotericin
(L-AmB).
Objectives: This retrospective study was aimed to determine
the non-inferiority of prior azole administration in the treatment
of Invasive Fungal Infections (IFI) with L-AmB in hematologic
and allogeneic HSCT patients.
Methods: Patients who met the EORTC/MSG criteria for IFI and
received treatment with L-AmB were eligible and distributed in
two arms according to: (A) mold-active azole exposure prior to
L-AmB, and (B) fl uconazole or no prior azole. Patients were
stratifi ed according to the type of IFI and evaluated for disease
related risk factors and comorbidities. The primary endpoints
were favorable response and survival at the end of antifungal
therapy, at 4 and 12 weeks.
Results: From Feb/2008 to Sep/2009, 182 consecutive patients
were recruited from 26 institutions. The median age was 45
years (range 1-78). Most had acute leukemia (AL) or myelodysplasia (MDS) (129; 70.0%). Baseline disease was treated
for induction, in remission, or refractory/relapse status in
23.6%, 45.0% and 31.4%, respectively. A 40.1% of patients
had allogeneic HSCT. Severe comorbidity and prior IFI were
present in 20.3% and 14.8%, respectively. Arm A included 100
patients with prior itraconazole 39%, voriconazole 35% and
posaconazole 26%. Arm B included 82 patients with fl uconazole 49% or no azole 51%. Patients characteristics were not
different in both arms, except for more AL or MDS (P = 0.002)
and prolonged neutropenia in arm A (P = 0.021), and more use
of high dose steroids in arm B (P = 0.01). The rates of possible, probable and proven IFI were 52.7%, 28.6% and 18.7%,
respectively (Table 1). Aspergillosis was the proven IFI in 28 of
35 cases. L-AmB was given 3 mg/kg/d for a median of 18 ± 17
days in A and 15 ± 13 in B. The favorable response rate to LAmB was 75% and 74.4% in both groups, with no differences
in the responses at the end of treatment, at 4 weeks or at 12
weeks. The response rates for possible and probable/proven
IFI were similar in both groups (Table 2).
Conclusions: Prior exposure to mold-active azoles does not
affect the effectiveness of L-AmB for the treatment of IFI in
this high risk patient population, indicating that concerns for
sequential administration are no longer justifi ed.

Abstract Number: P735

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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