Abstract

Immunocompromised patients carry a high risk for invasive fungal disease (IFD), which is associated with high mortality. This is a retrospective chart review of a 4-year experience of amphotericin B lipid complex (ABLC) utilization for the management of suspected IFD at the Hematology/Oncology and Bone Marrow Transplantation unit at Makassed General Hospital, Beirut, Lebanon between January 2011 and December 2014. We focused on treatment strategy, response rate, and adverse drug events associated with ABLC therapy. We also reviewed ABLC indications in international guidelines beyond its Food and Drug Administration approval. A total of 89 patients received ABLC therapy for suspected fungal infection. Forty-eight percent were treated for a possible fungal infection, 19% for a problable fungal infection, 12% based on hospital guidelines, and 20% based on treating physician's recommendations. The overall response rate was 71%. Nephrotoxicity occurred in 24% of patients and serum creatinine improved in 10% of these patients. Moderate hypokalemia was observed in 61% of the patients and severe hypokalemia in 10% but was corrected in both cases. Hepatotoxicity was observed in 12% of the patients throughout ABLC therapy. Infusion-related reactions were observed in 36% of the patients. There was a decrease in the incidence of these reactions upon using combination of premedication drugs. In this study, ABLC proved to be an effective and safe option in the management of suspected IFD in immunocompromised patients failing previous therapies.

Highlights

  • amphotericin B lipid complex (ABLC) in Suspected Fungal Infections. Immunocompromised patients, including those on cytotoxic chemotherapy and immunosuppressive regimens, which result in severe and prolonged neutropenia in addition to hematopoietic stem cell transplantation (HSCT) recipients, carry a high risk for invasive fungal disease (IFD), which is associated with a high mortality rate [1, 2]

  • The extensive clinical experience obtained with this drug has shown that it is associated with a high risk of treatment limiting toxicity, including infusion-related reactions (IRRs), such as fever and chills, and nephrotoxicity [3]

  • We looked for the strategy of initiating ABLC therapy with respect to clinical characteristics and risk factors for IFD, clinical response to ABLC therapy, all-cause mortality, along with adverse events associated with the use of ABLC

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Summary

Introduction

Immunocompromised patients, including those on cytotoxic chemotherapy and immunosuppressive regimens, which result in severe and prolonged neutropenia in addition to hematopoietic stem cell transplantation (HSCT) recipients, carry a high risk for invasive fungal disease (IFD), which is associated with a high mortality rate [1, 2]. Diagnosis and aggressive therapeutic approaches to IFD represent important strategies to reduce complications and mortality of these infections [1, 2]. Amphotericin B deoxycholate (conventional amphotericin B) is a polyene with a broad-spectrum activity. It is active against most yeasts, filamentous, and dimorphic fungi. It has been considered the gold standard therapy against most systemic fungal infections [3]. Concerns about its toxicity have led to the development of lipid-based formulations with reduced toxicity, increased therapeutic utility, and significant advance in drug delivery [4]

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