An epidemic of invasive fungal infection in a stem cell transplant unit; response to high-dose liposomal amphotericin B

2004 ◽  
Vol 5 (6) ◽  
pp. 548-551 ◽  
Author(s):  
Clodagh Ryan ◽  
Siobhan McNicholsan ◽  
Brian O'Connell ◽  
Stephanie Forde ◽  
Mary Keoghan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Invasive Fungal Infection ◽  
Liposomal Amphotericin ◽  
Stem Cell Transplant ◽  
Unit Response ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Cell Transplant

scholarly journals Inhaled Amphotericin B as Aspergillosis Prophylaxis in Hematologic Disease: An Update

2019 ◽  
Vol 12 ◽  
pp. 117863611986993 ◽  
Author(s):  
Madison J Duckwall ◽  
Mark A Gales ◽  
Barry J Gales
Keyword(s):  
Stem Cell ◽  
Relative Risk ◽  
Invasive Aspergillosis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Stem Cell Transplant ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Liposomal Amphotericin B ◽  
Cell Transplant

This review summarizes the literature on inhaled amphotericin B for invasive aspergillosis prophylaxis in patients with neutropenia secondary to hematologic malignancy treatment or stem cell transplant. Six trials, 2 randomized controlled and 4 with historical controls, were identified. Three inhaled amphotericin B deoxycholate trials found a reduced invasive aspergillosis incidence, 1 reaching statistical significance. Three inhaled liposomal amphotericin B trials demonstrated similar reductions with 2 finding statistical significance. Relative risk reductions for invasive aspergillosis were routinely 40-60%. Both formulations were without reported systemic or severe adverse effects. The most common adverse events were cough, bad taste, and nausea. Discontinuation rates ranged from 0-45%. The only randomized, placebo-controlled trial utilized inhaled liposomal amphotericin B reported a nearly 60% relative risk reduction. Inhaled liposomal amphotericin B 12.5 mg twice weekly is an alternative for invasive aspergillosis prophylaxis in high risk neutropenic patients with hematologic malignancies and stem cell transplant recipients when recommended azole agents are contraindicated or should not be used.

scholarly journals Invasive Fungal Infections While on Voriconazole, Liposomal Amphotericin B, or Micafungin for Antifungal Prophylaxis in Pediatric Stem Cell Transplant Patients

2019 ◽  
Vol 24 (3) ◽  
pp. 220-226
Author(s):  
Annie Bui ◽  
Veronica Nguyen ◽  
Christina Hsu ◽  
Ben Hyde ◽  
Tiffany Simms-Waldrip
Keyword(s):  
Stem Cell ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Stem Cell Transplant ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Cell Transplant ◽  
Hematopoietic Stem

OBJECTIVE This study aimed to report the incidence of invasive fungal infections (IFIs) in pediatric hematopoietic stem cell transplant (HSCT) patients who received voriconazole, liposomal amphotericin B (L-AMB), or micafungin for primary antifungal prophylaxis (PAP). METHODS Using data retrospectively collected from institution's electronic records, this study analyzed the incidence of IFIs in pediatric HSCT patients between November 2012 and November 2016. RESULTS A total of 103 patients were screened. Of the 84 patients who met inclusion criteria, 76.2%, 29.8%, and 19% patients received voriconazole, L-AMB, and micafungin, respectively. The incidence of overall IFIs was 2.08 per 1000 prophylaxis days. There were 2 mold infections identified in 2 patients. Among 3 antifungal agents, the rates of IFIs were 2.67 per 1000 prophylaxis days in L-AMB group, 2.08 per 1000 prophylaxis days in micafungin group, and 1.17 per 1000 prophylaxis days in voriconazole group. CONCLUSION Patients who received L-AMB or micafungin had higher rates of IFIs than those who received voriconazole for PAP.

scholarly journals Pharmacokinetics and Buccal Mucosal Concentrations of a 15 Milligram per Kilogram of Body Weight Total Dose of Liposomal Amphotericin B Administered as a Single Dose (15 mg/kg), Weekly Dose (7.5 mg/kg), or Daily Dose (1 mg/kg) in Peripheral Stem Cell Transplant Patients

2009 ◽  
Vol 53 (9) ◽  
pp. 3664-3674 ◽  
Author(s):  
Paul O. Gubbins ◽  
Jarrett R. Amsden ◽  
Scott A. McConnell ◽  
Elias J. Anaissie
Keyword(s):  
Body Weight ◽  
Stem Cell ◽  
Single Dose ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Stem Cell Transplant ◽  
Plasma Concentrations ◽  
Cell Transplant ◽  
Mucosal Tissue ◽  
Tissue Concentrations

ABSTRACT The pharmacokinetics and safety of extended-interval dosing of prophylactic liposomal amphotericin B (L-AMB) in peripheral stem cell transplant recipients were evaluated. The patients received L-AMB daily at 1 mg/kg of body weight or weekly at 7.5 mg/kg or received L-AMB as a single dose (15 mg/kg). The buccal mucosal tissue concentrations of L-AMB were measured. Of the 24 patients enrolled, 5 withdrew after the initial dose due to an infusion-related reaction (n = 2) or significant increases in the serum creatinine (Scr) levels (n = 3). Weekly L-AMB dosing (7.5 mg/kg) produced mean plasma concentrations of >0.300 μg/ml for the first 7 days and >0.220 μg/ml for 7 days after the second dose. A single L-AMB dose (15 mg/kg) produced mean plasma concentrations of >0.491 μg/ml for at least 7 seven days. These concentrations are within the range of the MICs reported in the literature for susceptible strains of Candida and are at the lower limits of the MICs for Aspergillus spp. Extended-interval dosing produced buccal mucosal tissue concentrations well in excess of the MICs reported in the literature for susceptible strains of Candida and Aspergillus spp. Infusion-related reactions occurred in 24% of the patients. Baseline and end-of-study Scr, electrolyte (K+, Mg2+, PO4), and serum transaminase levels were similar across the dosage groups. Five (31%) patients met the nephrotoxicity definition prior to completion of the study. Patients in the weekly or single-dose groups experienced nephrotoxicity significantly faster than the patients in the daily dosing cohort. A weekly L-AMB dose (7.5 mg/kg) or a single L-AMB dose (15 mg/kg) produced sufficient concentrations in plasma and highly vascular tissue to warrant further studies of the safety, efficacy, and practicality of the weekly prophylactic administration of L-AMB.

Haemopoietic Cell Transplantation of Patients with a History of Deep or Invasive Fungal Infection during Prophylaxis with Liposomal Amphotericin B

2005 ◽  
Vol 113 (2) ◽  
pp. 104-108 ◽  
Author(s):  
William H. Krüger ◽  
Bettina Rüssmann ◽  
Maike de Wit ◽  
Nicolaus Kröger ◽  
Helmut Renges ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Amphotericin B ◽  
Cell Transplantation ◽  
Invasive Fungal Infection ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
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