Abstract
BACKGROUND.
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients with hematologic malignancy (HM). There are 2 lipid formulations of amphotericin B (AMB) currently in widespread use: AMB lipid complex (ABLC) and liposomal AMB (LโAMB). There are limited data comparing the efficacy and safety of these 2 agents in the treatment of IA in patients with cancer.
METHODS.
The authors retrospectively studied 381 consecutive patients with HM who had proven or probable IA (according to European Organization for Research and Treatment of Cancer/Mycosis Study Group of the National Institute of Allergy and Infectious Diseases criteria) between June 1993 and December 2005. Of these patients, 158 received primary antifungal therapy with either LโAMB (n = 106) or ABLC (n = 52). The number of salvage antifungal regimens given were 51 LโAMB regimens and 30 ABLC regimens. It should be noted that the population described in this report was not typical of the hematologic cancer population with IA because of the advanced stage and the severity of the underlying diseases.
RESULTS.
Risk factors for IA, such as underlying malignancy, neutropenia, steroid use, admission to an intensive care unit, and the presence of graftโversusโhost disease, were comparable among the study drug group in the primary or salvage setting. Likewise, comparable distribution of types of Aspergillus species and the presence of disseminated IA were observed. Response to primary or salvage therapy was equally poor in both drug study groups regardless of treatment modality (range, 7.7โ15.8% response). In the primary therapy group, ABLC was associated with significantly higher nephrotoxicity than LโAMB (P < .001).
CONCLUSIONS.
Among patients with HM, primary therapy and salvage therapy for IA with either ABLC or LโAMB as single agent were associated equally with poor outcome. LโAMB appeared to be less nephrotoxic in the primary therapy setting. Cancer 2008. ยฉ 2008 American Cancer Society.