Primary Antifungal Prophylaxis with Low-Dose Intravenous Amphotericin B in Hematological Malignancies. Results of a Pilot Study

2000 ◽  
Vol 23 (2) ◽  
pp. 145-150 ◽  
Author(s):  
A. Böhme ◽  
D. Hoelzer
Keyword(s):  
Pilot Study ◽  
Amphotericin B ◽  
Low Dose ◽  
Hematological Malignancies ◽  
Antifungal Prophylaxis ◽  
Intravenous Amphotericin

scholarly journals Candida albicansEpididymo-Orchitis and Fungemia in a Patient with Chronic Myelogenous Leukemia

1996 ◽  
Vol 7 (5) ◽  
pp. 332-334
Author(s):  
Mark Pimentel ◽  
Lindsay E Nicolle ◽  
Salman Qureshi
Keyword(s):  
Amphotericin B ◽  
Chronic Myelogenous Leukemia ◽  
Low Dose ◽  
Case Reports ◽  
Myelogenous Leukemia ◽  
Current Case ◽  
Characteristic Features ◽  
Immunocompromised State ◽  
Intravenous Amphotericin ◽  
Ultrasonographic Appearance

The fourth reported case of candidal epididymo-orchitis in the literature and the first reported case successfully cured with only low dose amphotericin B is described. A 75-year-old male with chronic myelogenous leukemia presented with acute testicular and epididymal swelling and pain. Subsequent investigations suggested the diagnosis of epididymo-orchitis due toCandida albicans. This was successfully treated with intravenous amphotericin B (total dose of 500 mg). Based on the three previous case reports and the current case several characteristic features that increased the suspicion of this entity were identified. These features include an immunocompromised state, candiduria, specific epididymal ultrasonographic appearance, as well as typical clinical features of epididymo-orchitis.

Antifungal Prophilaxis with Low Dose Amphotericin B Lipid Complex In Patients with Acute Myeloid Leukaemia: A Single Centre Experience

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4303-4303
Author(s):  
Barbara Veggia ◽  
Francesca Saltarelli ◽  
Enrico Montefusco ◽  
Esmeralda Conte ◽  
Giusy Antolino ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Low Dose ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
Intensive Chemotherapy ◽  
Newly Diagnosed ◽  
Lipid Complex ◽  
Amphotericin B Lipid Complex ◽  
Acute Myeloid

Abstract Abstract 4303 INTRODUCTION Invasive fungal infections (IFI) represent an important cause of mortality and morbidity in patients with Acute Myeloid Leukemia (AML) undergoing intensive chemotherapy. A prophylactic antifungal therapy is often administered during intensive chemotherapy, however the optimal antifungal prophylaxis protocol is still unknown. Amphotericin B lipid complex (Abelcet®) has been commonly used as a standard treatment for IFIs caused by Aspergillus and Candida, but its effectiveness in prophilaxis has not been clearly estabilished. METHODS From September 2010 to April 2011 we treated six patients with newly diagnosed AML using low dose amphotericin B lipid complex as antifungal prophilaxis. Patients observed were three females and 3 males, median age was 54 years (range 21–74 years) and they were all fit to receive intensive chemotherapy. Three patients older than 60 years received Fludarabine based chemotherapy regimen during both induction and consolidation. Three patients aged less than 60 years old were treated using a chemotherapy protocol based on Citarabine, Daunorubicin and Ethoposide association. One patient in this group also underwent BuCy conditioned autologous stem cell transplant. Amphotericin B lipid complex was administered intravenously at 100 mg once a day. Antifungal prophilaxis was started when the absolute neutrophil count was ≤ 500 cells/μ l and was continued until neutrophils recovery was ≥ 500 cells/μ l, without any evidence of IFI. RESULTS Five patients did not experience any proven fungal infection during all treatment. Anyway one patient died during induction due to a severe bacterial lung infection. One patients discontinued antifungal prophylaxis due to extensive skin rash during the second infusion of the drug. Amphotericin B lipid complex was otherwise well tolerated by patients. One patient was diagnosed with lung aspergillosis infection by evidence of galattomannan positivity on BAL and a lung CT scan showing a single nodular escavated lesion on left upper lobe; subsequentely he was successfully treated with voriconazole. CONCLUSIONS In our experience, Amphotericin B lipid complex showed to be an effective and safe antifungal prophylaxis for newly diagnosed AML patients. Further clinical studies are certainly required to obtain definitive data. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Antifungal prophylaxis during remission induction therapy for acute leukemia fluconazole versus intravenous amphotericin B

Cancer ◽  
1994 ◽  
Vol 73 (8) ◽  
pp. 2099-2106 ◽  
Author(s):  
Gerald P. Bodey ◽  
Elias J. Anaissie ◽  
Linda S. Elting ◽  
Elihu Estey ◽  
Susan O'Brien ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Amphotericin B ◽  
Induction Therapy ◽  
Antifungal Prophylaxis ◽  
Remission Induction ◽  
Intravenous Amphotericin

Frequency of Invasive Fungal Infections in Patients Undergoing Allogeneic Stem Cell Transplantation Conditioned with Reduced BUCY2 and Antifungal Prophylaxis with Low Dose Amphotericin B

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5457-5457
Author(s):  
Flor Maria Armillas Canseco ◽  
Monica M Rivera Franco ◽  
Eucario Leon Rodriguez ◽  
Ricardo Antonio Terrazas Marin
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Amphotericin B ◽  
Cell Transplantation ◽  
Myeloid Leukemia ◽  
Low Dose ◽  
Fungal Infections ◽  
Conditioning Regimen ◽  
Antifungal Prophylaxis ◽  
Low Incidence

Abstract Introduction: Invasive fungal infection (IFI) is a major cause of morbidity and mortality in patients with allogeneic stem cell transplantation (allo-SCT). One well-known risk factor for fungal infection includes bowel mucosal damage due to conditioning chemotherapy regimens. The use of reduced-intensity conditioning may favorably impact the epidemiology of IFI after allo-SCT. Data for IFI in this population are scarce. On the other hand, despite the low incidence of IFI with the use of the new antifungal drugs, the costs remain to be high and sometimes unaffordable for the patients. Objective: To analyze the frequency of invasive fungal infections in patients who underwent stem cell transplantation conditioned with reduced BUCY2, at INCMNSZ, from November 1998 to December 2014. Material and methods: A retrospective analysis was performed in 58 patients receiving reduced BUCY2 as part of their SCT conditioning regimen. Most of the patients received antifungal prophylaxis with low dose of amphotericin B (˂20 mg/day) during the neutropenia following transplant. Results: Fifty eight patients undergoing allo-SCT with conditioning regimen reduced BUCY2, from November 1998 to December 2014, were included. Patients (male, 57%) had a median age of 39 years (range 17-67). The median follow-up was 90 months. The patients had a following range of underlying diseases: myelodysplastic syndrome (n=14, 24.1%), chronic myeloid leukemia (CML, n=14, 24.1%), acute myeloid leukemia (AML, n=12, 21%), acute lymphoblastic leukemia (LLA, n=10, 17%), lymphomas (n=3, 5.2%), myelofibrosis (n=2, 3.4%), or others (n=3, 5.2%). All patients were conditioned with 12mg/kg of busulfan and 80mg/kg of cyclophosphamide. 22% of patients presented mucositis grade III-IV. 85% (50/59) of patients received fungal prophylaxis with low dose amphotericin B. Four patients (6.8%) presented IFI during the first 100 days post-transplant, and one (1.7%) presented late IFI. The mortality secondary to IFI was 5%. Transplant related mortality (TRM) was 17%. Conclusion: From the beginnings of our transplant program we have had a low incidence of IFI and low TRM, with the prophylactic use of low dose amphotericin B and the modified conditioning regimen reduced BUCY2, compared to the reported literature. The use of reduced BUCY2 and low dose amphotericin B can be cost-effective in medical centers in developing countries. Disclosures No relevant conflicts of interest to declare.

scholarly journals Epidemiology of Fungemia in Hematological Malignancies: Preliminary Report of Seifem-2015 Survey

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4887-4887
Author(s):  
Marianna Criscuolo ◽  
Maurizio Sanguinetti ◽  
Giulia Dragonetti ◽  
Chiara Cattaneo ◽  
Antonio Giordano ◽  
...  
Keyword(s):  
Prospective Study ◽  
Amphotericin B ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Fungal Infections ◽  
Immunosuppressive Treatment ◽  
Antifungal Prophylaxis ◽  
Female Ratio ◽  
Advanced Phase ◽  
Relapsed Disease

Abstract Introduction: Incidence of fungal infections is reducing in the last years due to wider use of effective antifungal prophylaxis. On this basis, we evaluated clinical characteristics and outcome of patients (pts) with hematological malignancies (HMs) and fungal bloodstream infections (FBSI). Patient and Methods: This retrospective/prospective study gathered consecutive documented FBSI observed among HMs diagnosed between January 2011 and June 2015 in 19 Italian Hematology Departments that refer to SEIFEM (Sorveglianza Epidemiologica Infezioni Fungine Emopatie Maligne) group. Results: We collected overall 100 patients including retrospective pts and those observed in the first six months of the prospective study with FBSI among 16 centers; further 3 centers reported no cases of FBSI. Regarding patients' characteristics male/female ratio was 1, median age was 55 yeras. (IQR 18-88). Two-third of FBSI were detected in AML (43 - 43%) and NHL (27 - 27%); the remaining pts were affected by ALL (9 - 9%), MM (6 - 6%), MDS (5 - 5%), MDS/MPN (5 - 5%), CLL (3 - 3%) and HL (2 - 2%). Thirty-five pts had FBSI at the onset of HM or after the first induction, 47 after treatment for refractory/relapsed disease, 13 when in remission, 28 pts during transplant procedures (17 from allogeneic donor, 11 from autologous cells). Fifty-nine pts were receiving antifungal prophylaxis at FBSI breakthrough: 26 posaconazole, 16 fluconazole, 6 itraconazole, 3 amphotericin B, 3 caspofungin, 1 voriconazole, and 4 combination of amphotericin B/azoles; 4 pts were treated with secondary prophylaxis after previous fungal infection. Eighty-nine pts had a central venous catheter. Eighty-four pts presented a neutrophils count < 500/mmc for a median time of 7 days before FBI onset (0-70 d); 50 pts received steroids and other 17 immunosuppressive treatment for allo-HSCT. Yeasts were the most common agent detected. Candida spp. represent the most represented yeast, counting for 77% of all infections; (21 albicans and 56 non albicans); 8% of FBI were due to 8% Geotrichum, 3% Trichosporon and 2% Rhodotorula, Molds were rare but not infrequent: 8% were caused by Fusarium and 1% by Scedosporium. Three patients died before starting any antifungal. Fifty-two received echinocandins (49 caspofungin and 3 anidulafungin), 22 liposomal amphotericin B (L-AmB), 15 azoles (7 fluconazole, 3 posaconazole, 3 voriconazole and 2 itraconazole) and 8 pts combo therapy (5 posa+L-AmB, 2 Caspo+L-AmB, 1 vori+caspo). Thirty-eight pts died within 30 days from FBSI diagnosis, 28 (74%) of whom due to infection. Among these 12 (43%) suffered from AML (1 in induction, 1 in CR, 10 had refractory/relapsed disease), 2 (7.2%) from ALL (all with refractory/relapsed disease), 7 (25%) from NHL (2 in induction, 2 in CR, 3 with refractory/relapsed disease), 4 (14%) from refractory/relapsed MM, 1 (3.6%) from MDS in remission, 2 (7.2%) from newly diagnosed MDS/MPN. In 8 pts (21%) for whom we cannot discriminate if death was subsequent to FBSI only or to uncontrolled HMs, fungal isolates were all rare yeast or molds except 2. Mortality was related only with advanced phase of underlying HM (p<0.0001), molds fungemia (p<0.06) and rare fungi isolation (p<0.06). There is no difference in overall mortality rate among pts treated with echinocandins or azole or amphotericin B compounds or combo. Conclusions: Nowadays FBSI represents a rare complication of HMs, as a consequence of wider availability of effective antifungal prophylaxis. Candidemia still represents the most important cause of FBSI, although about 25% of FBSI are due to rare yeast or molds. Regardless a lowering incidence, the observed mortality remains high even with target treatment. Disclosures No relevant conflicts of interest to declare.

Low-dose liposomal amphotericin B for antifungal prophylaxis in paediatric allogeneic haematopoietic stem cell transplantation

2020 ◽  
Author(s):  
Natalia Mendoza-Palomar ◽  
Elena Soques ◽  
María Isabel Benitez-Carabante ◽  
Miriam Gonzalez-Amores ◽  
Aurora Fernandez-Polo ◽  
...  
Keyword(s):  
High Risk ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Low Dose ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Antifungal Prophylaxis ◽  
Haematopoietic Stem Cell ◽  
Liposomal Amphotericin B ◽  
Candida Spp

Abstract Background Primary antifungal prophylaxis in paediatric allogeneic HSCT recipients is mainly based on azoles, which can have related toxicity and drug interactions. Low-dose liposomal amphotericin B (L-AmB) is an attractive intravenous alternative because of its low toxicity and lower risk of interactions. Objectives To evaluate the effectiveness and safety of L-AmB (1 mg/kg/day) for primary antifungal prophylaxis in pre-engraftment paediatric HSCT patients. Patients and methods Retrospective, observational study including all consecutive patients aged ≤18 years who underwent HSCT and received antifungal prophylaxis with intravenous L-AmB (1 mg/kg/day, from day −1 to 48 h before discharge) between January 2012 and December 2016. Results In total, 125 HSCT procedures in 118 patients were included, median age 7.2 years (IQR 4.2–11.5). Haematological malignancies were the main underlying condition (63.6%), and 109 (87.2%) were considered at high risk for invasive fungal infection (IFI). Ten patients (7.7%), all high risk, developed breakthrough IFI (three Candida spp., seven invasive mould infections) and tended to have higher overall mortality. The only statistically significant risk factor for IFI was cytomegalovirus co-infection. Adverse events, all grade I, occurred in 25 (20%), requiring L-AmB withdrawal in one case. Overall survival at 30 days was 99.2%. At study completion, one patient had died of IFI. Conclusions The incidence of breakthrough IFI was comparable to that of previous reports, with a very low rate of significant toxicity. Thus, prophylactic L-AmB may be a safe, effective option for antifungal prophylaxis in the pre-engraftment phase for children undergoing HSCT, even those at high risk.

scholarly journals Continuous infusion of amphotericin B: preliminary experience at Faculdade de Medicina da Fundação ABC

2005 ◽  
Vol 123 (5) ◽  
pp. 219-222 ◽  
Author(s):  
Roberto Palermo Uehara ◽  
Victor Hugo Lara de Sá ◽  
Érika Tae Koshimura ◽  
Fernanda Vilas Boas Prudente ◽  
Luciana Tomanik Cardozo de Mello Tucunduva ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Amphotericin B ◽  
Hematological Malignancies ◽  
Efficacy And Safety ◽  
Median Dose ◽  
Liposomal Formulations ◽  
Amphotericin B Deoxycholate ◽  
Neutropenic Patients ◽  
Intravenous Amphotericin ◽  
De Medicina

CONTEXT AND OBJECTIVE: Intravenous amphotericin B deoxycholate (AmB-D) infusions, usually given over 4 hours, frequently induce nephrotoxicity and undesirable infusion-related side effects such as rigors and chills. There is evidence in the literature that the use of AmB-D in the form of continuous 24-hour infusion is less toxic than the usual four-hour infusion of this drug. Our objective was to evaluate the efficacy and safety of continuous infusion of AmB-D for the treatment of persistent fever in neutropenic patients with hematological malignancies after chemotherapy. DESIGN AND SETTING: Observational retrospective analysis of our experience with continuous infusion of AmB-D, at Faculdade de Medicina da Fundação ABC and Hospital Estadual Mário Covas in Santo André. METHODS: From October 2003 to May 2004, 12 patients with hematological malignancies and chemotherapy-induced neutropenia received 13 cycles of continuous infusion of AmB-D. RESULTS: The median dose of AmB-D was 0.84 mg/kg/day (0.33 to 2.30 mg/kg/day). Concomitant use of nephrotoxic medications occurred in 92% of the cycles. Nephrotoxicity occurred in 30.76% of the cycles, hypokalemia in 16.67%, hepatotoxicity in 30% and adverse infusion-related events in 23%. All patients survived for at least seven days after starting continuous infusion of AmB-D, and clinical resolution occurred in 76% of the cycles. CONCLUSIONS: Continuous infusion of AmB-D can be used in our Institution as an alternative to the more toxic four-hour infusion of AmB-D and possibly also as an alternative to the more expensive liposomal formulations of the drug.

Oral Voriconazole Versus Intravenous Low Dose Amphotericin B for Primary Antifungal Prophylaxis in Pediatric Acute Leukemia Induction

2011 ◽  
Vol 33 (8) ◽  
pp. e333-e341 ◽  
Author(s):  
Sushil Mandhaniya ◽  
Chetanya Swaroop ◽  
Sanjay Thulkar ◽  
Sreenivas Vishnubhatla ◽  
Sushil K. Kabra ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Amphotericin B ◽  
Low Dose ◽  
Antifungal Prophylaxis
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