1221 Amphotericin B lipid complex (ABLC) for fungal sepsis in high-risk immunocompromised patients

Abstract

Sixteen pts with hematologic malignancies, neutropenic after allogeneic marrow (n = 6) or autologous stern cell (n = 3) transplants, or chemotherapy (n = 7), received ABLC (5 mg/kg/d) for presumed (n = 14; fever unresponsive to multiple antibiotics) or proven (n = 2) fungal sepsis. ABLC was used due to renal dysfunction, or lack ofefficacyofor intolerance to amphotericin B. Four pts received only 1 dose of ABLC due to disease-related death (n = 1), fever and rigor (n = 2; no premedication), or sweating (n = 1). Twelve pts received ABLC for 2–28 d (med 6), and 10 were evaluable for response (ABLC for ≥; 4 d). A tuberculous-aspergillus lung cavity which was enlarging on 4-drug antituberculous therapy resolved within 2 weeks on ABLC. There was radiologic improvement in another aspergillosis pt but ABLC was discontinued due to further elevation in serum creatinine. Five ofthe remaining 8 pts responded clinically. Overall response rate was 70% amongst evaluable pts. Over the therapy period, serum creatinine declined in 1 pt, remained unchanged in 2, and increased in 7 (5 of whom were also receiving other nephrotoxic drugs). ABLC was stopped due to nephrotoxicity in only 1 pt. We conclude that ABLC is effective in the therapy of fungal infections in immunocompromised patients and warrants further assessment.