Practice Guidelines for Lipid-Based Amphotericin B in Stem Cell Transplant Recipients

Quilitz, Rod; Arnold, Alana; Briones, Gabriel R; Dix, Suzanne P.; Ippoliti, Cindy; Kennedy, LeAnne; Lucich, Jeanne L; Mehta, Jayesh; Peters, Byron G.; Tice, David S

doi:10.1345/aph.10041

Cited by 10 publications

(5 citation statements)

References 42 publications

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“…Cis-platinum induces a reduction of GFR and magnesium wasting in a dose-dependent manner. A liposomal preparation of amphotericin B may be considered because of its weaker nephrotoxic potential [91,92,93], but this has not been proven in children. Most oncology protocols have suggested a clear cutoff in renal function for the replacement of cis-platinum by the much less nephrotoxic carboplatinum [1,87].…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Renal function following hematological stem cell transplantation in childhood

et al. 2003

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Renal function greatly influences mortality rates in the early phase following hematological stem cell transplantation (HSCT) in childhood, as well as the quality of life in long-term survivors. Nevertheless, the number of studies in pediatric populations is limited and some important aspects of kidney function after HSCT have only been elucidated in adults. The incidence of acute renal failure (ARF) immediately after HSCT in pediatric patients is between 25% and 50%, with 5%-10% of children requiring renal replacement therapy. Doubling of serum creatinine is associated with a twofold increase in mortality. However, the need for dialysis leads to a further increase in mortality rates to 80%-90%. Specific renal syndromes appear at different times following HSCT, revealing a similar pattern in children and adult patients. In both children and adults, impaired renal function associated with liver impairment (hepatorenal syndrome) is the most important cause for ARF. Therapeutic approaches have not been able to reduce the frequency or to improve outcome so far. In adults surviving long term, bone marrow transplant (BMT) nephropathy is the most frequent renal complication, although a considerable variation in incidence (up to 70%) has been published, partly due to various definitions and manifestations. Little is known about the long-term outcome of renal function in patients treated with HSCT in childhood. However, chronic renal failure has been reported in 0%-28%, but no end-stage renal failure has been published so far. Tubular function following HSCT is rarely investigated, although its impact on long-term survivors of BMT in childhood might be of some importance, especially for growth and bone metabolism.

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Section: Therapeutic Approachesmentioning

confidence: 99%

Renal function following hematological stem cell transplantation in childhood

et al. 2003

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“…Due to the high rate of attrition of patients who were switched from AmB-d to an LFAB, we have restricted our conclusions in Figure 3 to the first 3 weeks of therapy following the switch. Although switching patients to an LFAB when signs of nephrotoxicity appear is promoted by some as conventional practice, 14 our results clearly indicate that this strategy is likely not achieving optimal outcomes for HSCT patients.…”

Section: Discussionmentioning

confidence: 69%

“…Quilitz et al 14 have recently developed an algorithm for the treatment of HSCT patients with proven or probable fungal infections. They suggest that patients at high risk of AmB-d-induced nephrotoxicity or fungal morbidity and mortality be initiated on an LFAB while those at lower risk be initiated on AmB-d therapy.…”

Section: Discussionmentioning

confidence: 99%

Lipid formulations of amphotericin B preserve and stabilize renal function in HSCT recipients

Miller

Waller

Klingemann

et al. 2004

Bone Marrow Transplant

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The current study assessed renal function based on medical records in adult hematopoietic stem cell transplant (HSCT) recipients with proven or probable invasive fungal infection (IFI) transplanted between 1995 and 2000. We confirm that amphotericin B deoxycholate (AmB-d) is nephrotoxic in a large percentage of HSCT recipients. Due to nephrotoxicity, defined as serum creatinine (SCr) >2.5 mg/dl or a 100% increase in SCr from baseline, 88% of patients treated with AmB-d were switched to a lipid formulation of amphotericin B (LFAB). In total, 53% of patients initiated on AmB-d were switched within the first week of therapy. Significantly more patients (70.6%) treated with AmB-d experienced a 100% increase in SCr from baseline compared to patients treated with either AmBisome (44.4%) or Abelcet (41.2%). A Cox Proportional Hazards Model revealed that, compared to patients initiated on AmBisome or Abelcet, the risk of nephrotoxicity (RR=1.5 vs AmBisome; RR=1.7 vs Abelcet), dialysis (RR=2.4 vs AmBisome; RR=1.4 vs Abelcet), and death (RR=2.0 vs AmBisome; RR=1.1 vs Abelcet) were all increased for patients initiated on AmB-d. Study results suggest that renal function improves and mortality declines when an LFAB is given to HSCT patients as initial therapy rather than as second-line therapy, the current practice.

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“…The median daily dose was 2.6 mg/kg; no studies have evaluated the efficacy of lower doses. Consensus guidelines for secondary prophylaxis have recommended 1–3 mg/kg (54).…”

Section: Management Peri‐transplant/chemotherapymentioning

confidence: 99%

Minimizing the risk of recurrent or progressive invasive mold infections during stem cell transplantation or further intensive chemotherapy

Grigg

Slavin

2007

Transplant Infectious Dis

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The risk of recurrence or progression of prior invasive fungal infection, predominantly due to molds, is 11-33% during subsequent stem cell transplantations or myelosuppressive chemotherapy, with a high mortality. Risk factors at the time of transplant include active infection and having received <6 weeks of antifungal therapy, while after transplant prolonged neutropenia and graft-versus-host disease requiring aggressive immunosuppression are important. The use of peripheral blood stem cells has been associated with a lower risk. Minimal data are available regarding the role of preventative strategies such as surgical resection of pulmonary lesions and prophylactic granulocyte transfusions during neutropenia, the optimal duration of antifungal prophylaxis, and the appropriate monitoring strategy. This article critically evaluates these issues and provides recommendations for the secondary prophylaxis of invasive mold infections.

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Practice Guidelines for Lipid-Based Amphotericin B in Stem Cell Transplant Recipients

Abstract: Practical guidelines are provided for the use of lipid-based AmB formulations in SCT patients who have documented or probable invasive fungal infections, are experiencing neutropenic fever, or require secondary prophylaxis for fungal infections.

Cited by 10 publications

References 42 publications

Renal function following hematological stem cell transplantation in childhood

Renal function following hematological stem cell transplantation in childhood

Lipid formulations of amphotericin B preserve and stabilize renal function in HSCT recipients

Minimizing the risk of recurrent or progressive invasive mold infections during stem cell transplantation or further intensive chemotherapy

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