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Titolo:
Primary antifungal prophylaxis with low-dose intravenous amphotericin B inhematological malignancies. Results of a pilot study
Autore:
Bohme, A; Hoelzer, D;
Indirizzi:
Univ Frankfurt, Med Klin 3, Hamatol Onkol Abt, D-60590 Frankfurt, Germany Univ Frankfurt Frankfurt Germany D-60590 Abt, D-60590 Frankfurt, Germany
Titolo Testata:
ONKOLOGIE
fascicolo: 2, volume: 23, anno: 2000,
pagine: 145 - 150
SICI:
0378-584X(200004)23:2<145:PAPWLI>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
INVASIVE FUNGAL-INFECTIONS; MARROW TRANSPLANT RECIPIENTS; NEUTROPENIC PATIENTS; ACUTE-LEUKEMIA; DOUBLE-BLIND; IMMUNOSUPPRESSED PATIENTS; FLUCONAZOLE PROPHYLAXIS; MULTICENTER TRIAL; CANCER-PATIENTS; ITRACONAZOLE;
Keywords:
fungal infection; antifungal prophylaxis; amphotericin B; leukemia;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
32
Recensione:
Indirizzi per estratti:
Indirizzo: Bohme, A Univ Frankfurt, Med Klin 3, Hamatol Onkol Abt, Theodor Stern Kai 7, D-60590 Frankfurt, Germany Univ Frankfurt Theodor Stern Kai 7 FrankfurtGermany D-60590 any
Citazione:
A. Bohme e D. Hoelzer, "Primary antifungal prophylaxis with low-dose intravenous amphotericin B inhematological malignancies. Results of a pilot study", ONKOLOGIE, 23(2), 2000, pp. 145-150

Abstract

Background: Systemic fungal infections are a main cause for morbidity and mortality in patients with hematological malignancies. Up to now, the benefit of antifungal prophylaxis is not satisfactory. Patients and Methods: In patients with hematological malignancies and expected neutropenia less thanor equal to 500/mu l lasting 10 or more days, the efficacy and tolerability of low-dose intravenous conventional amphotericin B (cAmB) 0.5 mg/kg 3x week was investigated. The incidence of system ic mycoses was com pa red to a historical group of patients with equally severe neutropenia receiving itraconazole solution for antifungal prophylaxis. For this comparison only patients with neutropenia less than or equal to 100/mu l of 10 days and longer were considered. The known side effects of cAmB were minimized by an intensive protective program. Results: So far, 41 patients with 61 neutropenic episodes entered the study. In 4/43 episodes which are evaluable for prophylactic efficacy, probable Aspergillus pneumonia occurred (9.3%). In 39 patients with very severe neutropenia (less than or equal to 100/mu l greater than or equal to 10 days) the rate was 10.2%. In the historical patient group with 72 episodes of the same minimum duration and severity of neutropenia, the incidence of proven systemic mycoses was 16.7%, of probable mycoses 8.3%, totally 25% (vs. 10.2%; p=0.04), all due to mould infection. For side effects, 49 episodes, in which the full protective treatment was given, were evaluable. Prophylaxis had to be stopped in 5/49 (10%) episodes due to therapy-resistant chili or severe rash. In 3 of the 44 remaining episodes intermittent pretreatment with corticosteroids was necessary, and in 5 patients cAmB was delayed for 1-2 days because of in increase of serum creatinine level (WHO grade I). In all patients serum creatinine later normalized. Conclusion: So far, the incidence of invasive fungal infections decreased under prophylaxis with low-dose cAmB compared with a historical patient group receiving itraconazole solution. Acute infusion-related reactions as well asnephrotoxicity seem to be tolerable with an intensive protective program.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/09/20 alle ore 07:42:03