Problem: Patients undergoing BMT are at particular risk for fungal infection due to the presence of neutropenia post high-dose chemotherapy; in allogeneic BMT slow immune reconstitution further increases the risk. BMT patients are also likely to receive multiple nephrotoxic medications including aminoglycosides and cyclosporine that may potentiate amphotericin-associated nephrotoxicity. In such patients, the lipid-based polyenes may provide particular benefit by reducing nephrotoxicity. Methods: We conducted a retrospective chart review, using a standardized case report form (from the CLEAR' program) of BMT patients who received ABLC from January 1996 to April, 1999. Data collected included underlying condition, infection diagnosis, concomitant medications, serum creatinine, and mycological and clinical outcome at the end of ABLC therapy and/or hospital discharge. Only patients receiving > 4 doses of ABLC were evaluable for the review. Results: Fifty-five BMT patients received ABLC; the majority were s/p allogeneic BMT. All patients underwent aggressive diagnostic work-up, resulting in a diagnosis of mold infection in 25 (46%, including 23 with aspergillosis), confirmed yeast infection in 6 (11%), and a presumed fungal infection in 24 (44%). Most patients received ABLC as second-line therapy following failure of other antifungal therapy (n=30; 55%); other reasons included underlying renal disease (n=20; 36%), and intolerance to other antifungal therapy (n=5; 9%). For patients with primary aspergillosis, ABLC was given for a median duration of 18 days, with a clinical response of 44%. Median pre- and post-therapy creatinine values were 1.8 mg/dl and 2.1 mg/dl respectively. Patients treated empirically were least likely to respond to ABLC; a clinical response rate of 2/24 (8%) suggested a nonfungal etiology. Conclusion: Among BMT patients who were at high risk for fungal infection, in particular aspergillosis, the antifungal agent ABLC was well tolerated and effective. Response was also seen in patients who had failed other antifungal therapy.
Full conference title:
37th Annual Meeting of the Infectious Diseases Society of America (IDSA), November 18-21.
- IDSA 37th