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Aerosolized amphotericin B lipid complex as adjunctive treatment for fungal lung infection in patients with cancer-related immunosuppression and recipients of hematopoietic stem cell transplantation.

AbstractSTUDY OBJECTIVE:
Aerosolized amphotericin B lipid complex (aeABLC) has been successfully used to prevent fungal disease. Experience with aeABLC as treatment of fungal lung disease is limited.
DESIGN:
We evaluated the safety and efficacy of aeABLC adjunct therapy for fungal lung disease in a retrospective study of 32 immunosuppressed adults. All values are given as ± standard deviation.
SETTING:
National Cancer Institute-designated Comprehensive Cancer Center.
PATIENTS:
Acute leukemia (69%) and severe neutropenia (63%) were common. Fifty-six percent of patients had undergone allogeneic hematopoietic stem cell transplantation 185 ± 424 days prior to aeABLC was commenced.
MEASUREMENT AND MAIN RESULTS:
High-dose corticosteroids were administered during aeABLC in 28% of patients. Fungal lung disease was proven or probable in 41% of patients. Most patients (78%) received concurrent systemic antifungal therapy for a median of 14 ± 18 days before aeABLC. The median cumulative aeABLC dose was 1050 ± 2368 mg, and the median duration of aeABLC therapy was 28 ± 130 days. Most patients (78%) received 50 mg aeABLC twice daily. Partial or complete resolution of fungal lung disease was noted in 50% of patients. In three patients (9%) modest cough, mild bronchospasm, and transient chest pain with accompanying nausea and vomiting resolved completely after discontinuation of aeABLC. No patient required hospitalization for drug toxicity or had a serious (grade III or IV) drug-related adverse event.
CONCLUSION:
Treatment with aeABLC was tolerated without serious toxicity and may be considered in the setting of severe immunosuppression, cancer, and/or hematopoietic stem cell transplantation in patients with difficult-to-treat fungal lung disease.
AuthorsAmar Safdar, Gilhen H Rodriguez
JournalPharmacotherapy (Pharmacotherapy) Vol. 33 Issue 10 Pg. 1035-43 (Oct 2013) ISSN: 1875-9114 [Electronic] United States
PMID23784915 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
Copyright© 2013 Pharmacotherapy Publications, Inc.
Chemical References
  • Antifungal Agents
  • Glucocorticoids
  • liposomal amphotericin B
  • Amphotericin B
Topics
  • Adult
  • Aged
  • Amphotericin B (administration & dosage, adverse effects, therapeutic use)
  • Antifungal Agents (administration & dosage, adverse effects, therapeutic use)
  • Female
  • Glucocorticoids (administration & dosage, therapeutic use)
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Immunocompromised Host
  • Lung Diseases, Fungal (etiology, prevention & control)
  • Male
  • Middle Aged
  • Neoplasms (pathology)
  • Neutropenia (epidemiology)
  • Retrospective Studies
  • Severity of Illness Index
  • Young Adult

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