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.

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.

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 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 211Pharmacokinetics of IV Busulfan (IV BU) in pediatric infants (< 10-kilogram body weight) undergoing stem cell transplant

2003 ◽  
Vol 9 (2) ◽  
pp. 126-127
Author(s):  
J. Dalle ◽  
D. Wall ◽  
M. Duval ◽  
Y. Theoret ◽  
C. Taylor ◽  
...  
Keyword(s):  
Body Weight ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant

scholarly journals Busulfan Pharmacokinetics Using 25% Adjusted Body Weight in Obese Stem Cell Transplant Patients

2020 ◽  
Vol 26 (3) ◽  
pp. S386
Author(s):  
Sila D Shalhoub ◽  
Breanna J Taylor ◽  
Katrina M Piedra ◽  
Amer Beitinjaneh ◽  
Shreya A Shah
Keyword(s):  
Body Weight ◽  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Transplant Patients

Implications of Body Weight Calculations for Autologous Peripheral Blood Stem Cell Transplantation.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 5445-5445
Author(s):  
Lijo Simpson ◽  
Robert C. Wolfe ◽  
Dennis A. Gastineau ◽  
William J. Hogan ◽  
Shaji Kumar
Keyword(s):  
Body Weight ◽  
Stem Cell ◽  
Actual Body ◽  
Stem Cell Transplant ◽  
Ideal Body Weight ◽  
The Body ◽  
Cell Transplant ◽  
Actual Body Weight ◽  
Cell Dose ◽  
Ideal Body

Abstract Background: Obesity is a prevalent health problem and significant heterogeneity is seen in the body weight and BMI among adult patients undergoing autologous stem cell transplantation (SCT). At least two critical steps of the SCT are influenced by the body weight. Stem cell collection targets are usually determined based on the actual body weight and conditioning chemotherapy doses are usually determined based on corrected ideal body weight. One could hypothesize that since the stem cells home to bone marrow, the ideal body weight (IBW) being based on the height may be a better indicator of the stem cell numbers required rather than the actual body weight (ABW). Since chemotherapy doses are calculated based on corrected ideal body weight, and the volume of distribution is higher in obese patients, these patients may have decreased drug exposure and hence a higher risk of progression. Methods: We retrospectively evaluated the engraftment kinetics and response outcome of 306 SCTs done at our institution between March 1998 and October 2001. These included patients who had undergone SCT for multiple myeloma (46%), NHL (34%), HD (6%) and AL amyloidosis (14%). Body weight, height, stem cell dose and engraftment data was obtained from medical records. The stem cell dose received was calculated based on their ABW as well as IBW and correlated with the time to white cell and platelet engraftment. We also evaluated the effect of BMI on the progression free survival after the stem cell transplant using various cut offs. Results: The mean (range) for the ABW, IBW and BMI were 46.6 kg to 189 Kg; 45.5 kg to 94 kg; and 17.5 to 55.8 respectively. Using logistic regression, we estimated the ability of CD34 cell dose by actual and ideal body weight to predict the likelihood of platelet engraftment (50,000) by day 21 post transplant. The coefficients using both the doses were very similar (.391 for ideal and 0.361 for actual). Using Receiver operating characteristic analysis (ROC analysis); we determined the stem cell dose cutoff that best predicted for failure to engraft neutrophils by 21 days post transplantation, median CD34 dose by ABW of 3.6 million/Kg and by IBW of 4.2 million/Kg. Similarly, for failure to engraft platelets by day 30 the cutoffs were 2.89 million/Kg by actual weight and 3.77 million/kg by ideal weight. Among the individuals with actual body weight more than 25% of ideal body weight (n=122, 40%), we calculated the optimal total CD34 dose required and compared to the actual dose infused using both the cutoff sets (286 million vs. 446 million, P < 0.001 using ANC cutoff and 251 million vs. 446 million using the platelet cutoff, P < 0.001). We then examined the effect of BMI on progression free and overall survival from transplant. The progression free and overall survival post transplant was similar for patients with BMI over 30 kg/m2 compared to those below this cutoff. There was no difference when patients with myeloma or lymphoma were studied separately. Conclusion: This study, as in previous studies, confirms that stem cell dose determined on the basis of ideal body weight is comparable to that by actual body weight in terms of engraftment kinetics. In patients significantly above the ideal body weight, it is reasonable to use a target based on ideal body weight which will allow for collection of less numbers of CD34 cells, thus conserving resources. Among patient undergoing stem cell transplant, the practice of using corrected ideal body weight does not appear to compromise the outcome of stem cell transplant.

Sign in / Sign up

Export Citation Format

Share Document