Incidence and Management of Proven and Probable Fungal Infections in Patients with Acute Leukemia: A Single Center Experience

Abstract

The incidence of fungal infections and the role of liposomal amphotericin B (Ambisome) in proven and probable infections were evaluated in acute leukemic patients, intolerant to conventional amphotericin B. During 1999-2002, 307 febrile episodes occurred in 231 patients. Fungi were responsible for 3% of bloodstream infections. Ambisome was employed in 5 fungal sepsis (1 Candida albicans, 1 C. famata, 1 C. tropicalis, 1 C. krusei, 1 Geotrichum capitatum) 2 Aspergillosis, 2 probable fungal pneumonia cases. A favorable response was achieved in 78% of patients (4 fungemia, 2 aspergillosis, 1 probable), an unfavorable response in 1 C. krusei fungemia and in 1 probable pneumonia. Our antimicrobial pattern documented a high resistance rate to azoles. We concluded that Ambisome is an effective and well tolerated agent and its introduction has changed the outcome for many patients, although in some refractory diseases other strategies must be considered.

Empiric Antifungal Strategies for Acute Leukemia Patients

“…Overall, 58% of patients responded favorably to AmBisome in this series, of which 75% were possible fungal pneumonia and 50% FUO. In this same experience 8 , the efficacy of AmBisome in proven/probable fungal infection was better than the empirical approach and a favorable response was obtained in 78% of patients. On the other hand, an empirical approach does not allow an appropriate assessment of a drug because the vast majority of the persisting fever cases do not represent a fungal infection whatsoever.…”

“…In the assessable episodes the average dose of conventional amphotericin B was 561 mg (350-780) given over 8 days (7)(8)(9)(10)(11)(12), of AmBisome was 1437 mg (800-1980) given over 10 days (8)(9)(10)(11)(12)(13)(14)(15).…”