Antifungal prophylaxis with Amphotericin B deoxycholate emulsified in lipids for acute myeloid leukemia patients treated in low economy countries

2015 ◽  
Vol 57 (2) ◽  
pp. 474-476
Author(s):  
Bishesh Sharma Poudyal ◽  
Bishal Gyawali ◽  
Binaya Sapkota ◽  
Sampurna Tuladhar ◽  
Gentle Sunder Shrestha ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Amphotericin B ◽  
Myeloid Leukemia ◽  
Antifungal Prophylaxis ◽  
Amphotericin B Deoxycholate ◽  
Acute Myeloid

scholarly journals Prospective Phase II Single-Center Study of the Safety of a Single Very High Dose of Liposomal Amphotericin B for Antifungal Prophylaxis in Patients with Acute Myeloid Leukemia

2013 ◽  
Vol 57 (6) ◽  
pp. 2596-2602 ◽  
Author(s):  
Luciana Annino ◽  
Anna Chierichini ◽  
Barbara Anaclerico ◽  
Erica Finolezzi ◽  
Marianna Norata ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Amphotericin B ◽  
Myeloid Leukemia ◽  
Liposomal Amphotericin ◽  
Antifungal Prophylaxis ◽  
High Dose ◽  
Mean Values ◽  
The Mean ◽  
Grade 3 ◽  
Acute Myeloid

ABSTRACTSome preclinical and pharmacokinetic studies suggested the variable safety and the potential efficacy of an antifungal prophylaxis with a single high dose of liposomal amphotericin B (L-AmB) in high-risk patients. An open-label, prospective study was conducted with 48 adults receiving induction chemotherapy for acute myeloid leukemia (AML). Patients received a single infusion of 15 mg/kg of body weight L-AmB and, eventually, a second dose after 15 days of persistent neutropenia. The primary objective was tolerability and safety. Efficacy was also evaluated as a secondary endpoint. A pharmacokinetic study was performed with 34 patients in order to evaluate any association of plasma L-AmB levels with toxicity and efficacy. Overall, only 6 patients (12.5%) reported Common Toxicity Criteria (CTC) grade 3 hypokalemia, which was corrected with potassium supplementation in all cases, and no patient developed clinically relevant nephrotoxicity. Mild infusion-related adverse events occurred after 6 of 53 (11.3%) total infusions, with permanent drug discontinuation in only one case. Proven invasive fungal disease (IFD) was diagnosed in 4 (8.3%) patients. The mean AmB plasma levels at 6 h, 24 h, and 7 days after L-AmB administration were 160, 49.5, and 1 mg/liter, respectively. The plasma AmB levels were higher than the mean values of the overall population in 3 patients who developed CTC grade 3 hypokalemia and did not significantly differ from the mean values of the overall population in 3 patients who developed IFD. Our experience demonstrates the feasibility and safety of a single 15-mg/kg L-AmB dose as antifungal prophylaxis in AML patients undergoing induction chemotherapy.

Mucormycosis in a Patient with Acute Myeloid Leukemia Successfully Treated with Liposomal Amphotericin B Associated with Deferasirox and Hyperbaric Oxygen

2013 ◽  
Vol 175 (3-4) ◽  
pp. 295-300 ◽  
Author(s):  
Eduardo Flavio Oliveira Ribeiro ◽  
Vitorino Modesto dos Santos ◽  
Guilherme Teixeira Guimarães Paixão ◽  
Leonardo Rodrigues Cruz ◽  
Milena Zamian Danilow ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Amphotericin B ◽  
Hyperbaric Oxygen ◽  
Myeloid Leukemia ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Acute Myeloid

scholarly journals Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

2021 ◽  
Vol 7 (9) ◽  
pp. 761
Author(s):  
Anastasia I. Wasylyshyn ◽  
Kathleen A. Linder ◽  
Carol A. Kauffman ◽  
Blair J. Richards ◽  
Stephen M. Maurer ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Proportional Hazards ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Acute Myeloid

This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients.

Micafungin as primary antifungal prophylaxis in patients presenting with acute myeloid leukemia

2016 ◽  
Vol 46 (4) ◽  
pp. 226-229 ◽  
Author(s):  
G. Venton ◽  
H. Adam ◽  
J. Colle ◽  
Y. Labiad ◽  
C. Mercier ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Antifungal Prophylaxis ◽  
Acute Myeloid

scholarly journals Incidence Density of Invasive Fungal Infections during Primary Antifungal Prophylaxis in Newly Diagnosed Acute Myeloid Leukemia Patients in a Tertiary Cancer Center, 2009 to 2011

2013 ◽  
Vol 58 (2) ◽  
pp. 865-873 ◽  
Author(s):  
Marisa Z. R. Gomes ◽  
Victor E. Mulanovich ◽  
Y. Jiang ◽  
Russell E. Lewis ◽  
Dimitrios P. Kontoyiannis
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Cancer Center ◽  
Remission Induction ◽  
Content Type ◽  
First Remission ◽  
Tertiary Cancer Center ◽  
Acute Myeloid

ABSTRACTAlthough primary antifungal prophylaxis (PAP) is routinely administered in patients with acute myeloid leukemia (AML) during remission-induction and consolidation chemotherapy, the impact of PAP on the incidence of invasive fungal infections (IFIs) is not well described. We retrospectively analyzed the incidence of IFIs in 152 patients with AML who had been admitted to a tertiary cancer center between August 2009 and March 2011 and received PAP within 120 days after first remission-induction chemotherapy. We excluded patients who had undergone stem cell transplantation. Patients received a PAP drug with anti-Aspergillusactivity during 72% (7,660/10,572) of prophylaxis-days. The incidence of documented IFIs (definite or probable according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) was 2.0/1,000 prophylaxis-days (95% confidence interval [CI], 1.23 to 3.04). IFIs due to molds were more common than IFIs due to yeasts (1.5/1,000 prophylaxis-days versus 0.4/1,000 prophylaxis-days;P= 0.01). Echinocandin-based PAP (8.6 and 7.1/1,000 prophylaxis-days, respectively) was associated with higher rates of documented IFIs than anti-Aspergillusazoles (voriconazole or posaconazole) (2.4 and 1.1/1,000 prophylaxis-days, respectively) at both 42 days (P= 0.03) and 120 days (P< 0.0001) after first remission-induction chemotherapy. The incidence of overall (documented and presumed) IFIs (P< 0.001), documented IFIs (P< 0.01), and empirical antifungal therapies (P< 0.0001) was higher during the first 42 days than after day 42. Despite the broad use of PAP with anti-Aspergillusactivity, IFIs, especially molds, remain a significant cause of morbidity and mortality in AML patients, predominantly during the remission-induction phase. Patients receiving echinocandin-based PAP experienced higher rates of IFIs than did those receiving anti-Aspergillusazoles.

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