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Titolo:
Liposomal amphotericin B for empirical therapy in patients with persistentfever and neutropenia
Autore:
Walsh, TJ; Finberg, RW; Arndt, C; Hiemenz, J; Schwartz, C; Bodensteiner, D; Pappas, P; Seibel, N; Greenberg, RN; Dummer, S; Schuster, M; Holcenberg, JS;
Indirizzi:
NCI, Div Clin Sci, Bethesda, MD 20892 USA NCI Bethesda MD USA 20892NCI, Div Clin Sci, Bethesda, MD 20892 USA Dana Farber Canc Inst, Div Infect Dis, Boston, MA 02115 USA Dana Farber Canc Inst Boston MA USA 02115 nfect Dis, Boston, MA 02115 USA Brigham & Womens Hosp, Boston, MA 02115 USA Brigham & Womens Hosp Boston MA USA 02115 mens Hosp, Boston, MA 02115 USA Mayo Clin & Mayo Fdn, Dept Pediat, Sect Pediat Hematol Oncol, Rochester, MN Mayo Clin & Mayo Fdn Rochester MN USA 55905 Hematol Oncol, Rochester, MN H Lee Moffitt Canc Ctr, Div Bone Marrow Transplantat, Tampa, FL USA H Lee Moffitt Canc Ctr Tampa FL USA e Marrow Transplantat, Tampa, FL USA Johns Hopkins Med Inst, Div Pediat Hematol Oncol, Baltimore, MD 21205 USA Johns Hopkins Med Inst Baltimore MD USA 21205 ol, Baltimore, MD 21205 USA Univ Kansas, Med Ctr, Kansas City, KS 66103 USA Univ Kansas Kansas City KS USA 66103 , Med Ctr, Kansas City, KS 66103 USA Univ Alabama, Div Infect Dis, Birmingham, AL USA Univ Alabama Birmingham AL USA abama, Div Infect Dis, Birmingham, AL USA Childrens Hosp, Natl Med Ctr, Div Hematol Oncol, Washington, DC 20010 USA Childrens Hosp Washington DC USA 20010 ol Oncol, Washington, DC 20010 USA Vanderbilt Univ, Div Infect Dis, Nashville, TN USA Vanderbilt Univ Nashville TN USA Univ, Div Infect Dis, Nashville, TN USA Hosp Univ Penn, Div Infect Dis, Philadelphia, PA 19104 USA Hosp Univ PennPhiladelphia PA USA 19104 Dis, Philadelphia, PA 19104 USA Childrens Hosp & Med Ctr, Seattle, WA 98105 USA Childrens Hosp & Med Ctr Seattle WA USA 98105 Ctr, Seattle, WA 98105 USA
Titolo Testata:
NEW ENGLAND JOURNAL OF MEDICINE
fascicolo: 10, volume: 340, anno: 1999,
pagine: 764 - 771
SICI:
0028-4793(19990311)340:10<764:LABFET>2.0.ZU;2-S
Fonte:
ISI
Lingua:
ENG
Soggetto:
INVASIVE FUNGAL-INFECTIONS; IMMUNOCOMPROMISED PATIENTS; RISK-FACTORS; TOXICITY; AMBISOME; MANAGEMENT; INFUSION; GRANULOCYTOPENIA; EXPERIENCE; EFFICACY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Walsh, TJ NCI, Div Clin Sci, Bldg 10,Rm 13N-240, Bethesda, MD 20892 USA NCI Bldg 10,Rm 13N-240 Bethesda MD USA 20892 hesda, MD 20892 USA
Citazione:
T.J. Walsh et al., "Liposomal amphotericin B for empirical therapy in patients with persistentfever and neutropenia", N ENG J MED, 340(10), 1999, pp. 764-771

Abstract

Background In patients with persistent fever and neutropenia, amphotericinB is administered empirically for the early treatment and prevention of clinically occult invasive fungal infections. However, breakthrough fungal infections can develop despite treatment, and amphotericin B has substantial toxicity. Methods We conducted a randomized, double-blind, multicenter trial comparing liposomal amphotericin B with conventional amphotericin B as empirical antifungal therapy. Results The mean duration of therapy was 10.8 days for liposomal amphotericin B (343 patients) and 10.3 days for conventional amphotericin B (344 patients). The composite rates of successful treatment were similar (50 percent for liposomal amphotericin B and 49 percent for conventional amphotericinB) and were independent of the use of antifungal prophylaxis or colony-stimulating factors. The outcomes were similar with liposomal amphotericin B and conventional amphotericin B with respect to survival (93 percent and 90 percent, respectively), resolution of fever (58 percent and 58 percent), and discontinuation of the study drug because of toxic effects or lack of efficacy (14 percent and 19 percent). There were fewer proved breakthrough fungal infections among patients treated with liposomal amphotericin B (11 patients [3.2 percent]) than among those treated with conventional amphotericin B (27 patients [7.8 percent], P = 0.009). With the liposomal preparation significantly fewer patients had infusion-related fever (17 percent vs. 44 percent), chills or rigors (18 percent vs. 54 percent), and other reactions, including hypotension, hypertension, and hypoxia. Nephrotoxic effects (defined by a serum creatinine level two times the upper limit of normal) weresignificantly less frequent among patients treated with liposomal amphotericin B (19 percent) than among those treated with conventional amphotericinB (34 percent, P<0.001). Conclusions Liposomal amphotericin B is as effective as conventional amphotericin B for empirical antifungal therapy in patients with fever and neutropenia, and it is associated with fewer breakthrough fungal infections, less infusion-related toxicity, and less nephrotoxicity. (N Engl J Med 1999;340:764-71. ) (C)1999, Massachusetts Medical Society.

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Documento generato il 26/09/20 alle ore 23:11:21