Aspergillosis treatment in haematological malignancy.

Abstract

Liposomal amphotericin B (LAB) in combination with caspofungin resolves aspergillosis infection better than high-dose LAB monotherapy in immunosuppressed patients with haematological malignancies (Cancer, published online Oct 16, 2007; DOI 10.1002/cncr.23109). “LAB is one of the therapeutic options for aspergillosis in these patients”, explains fi rst author Denis Caillot (University Hospital of Dijon, France), “but rodent studies and case reports suggest combination therapy with caspofungin may provide better results. We compared this strategy with another new strategy, high dose LAB”. Thirty immunocompromised patients undergoing treatment for haemato logical malignancies, and all with aspergillosis, were randomly assigned to standard intravenous LAB (3 mg/kg per day) plus standard intravenous caspofungin treatment (70 mg on day 1, 50 mg daily thereafter), or high-dose intravenous LAB (10 mg/kg per day) monotherapy. “At the end of treatment, 67% of patients receiving the combination therapy showed complete or partial responses compared to just 27% in the monotherapy arm”, explains Caillot, “and at 12 weeks survival was 100% and 80% respectively”. Patients tolerated treatment well; only one serious drug-related adverse event was noted (an increase in serum creatinin to 300 mmol) in the monotherapy group. “LAB plus caspofungin is already sometimes used as a secondline combination therapy, although no trials have been performed on its effi cacy and safety; the present results suggest we should consider it as fi rstline treatment.” “This was a small trial so we need to exercise caution when interpreting the results”, says Oliver Cornely (University Clinic of Cologne, Germany), “but the fact that the patients in the combination group had suff ered longer neutropenia than those in the monotherapy group and still came out ahead suggests this combination should be studied further”.