THE PROPHYLACTIC USE OF LOW-DOSE AMPHOTERICIN-B IN BONE-MARROW TRANSPLANT PATIENTS

PURPOSE: TO evaluate the efficacy of prophylactic low-dose amphoterici n B (0.1 mg/kg per day) (LDA) in preventing fungal infections in patie nts who have had a bone marrow transplant (BMT). MATERIALS AND METHODS : Double-blind randomized, controlled trial in which patients undergoi ng bone marrow transplantation received intravenous LDA or similar-app earing placebo from the onset of neutropenia until the absolute neutro phil count remained >0.5 x 10(9)/L, or until high-dose amphotericin B was initiated. Weekly surveillance cultures were obtained from all pat ients. RESULTS: Five of 18 patients (28%) randomized to placebo develo ped documented systemic fungal infections within the first 30 days aft er transplantation, compared to none of 17 patients who received LDA ( P = 0.045). LDA recipients received fewer days of high-dose amphoteric in B (P = 0.04) and fewer days of antibiotics (P = 0.008). There were trends towards fewer days of hospitalization (P = 0.14) and improved s urvival (P = 0.08); these differences were statistically significant a mong recipients of allogeneic BMT. No adverse effects occurred with LD A therapy. CONCLUSIONS: LDA appears to be safe and to reduce early sys temic fungal infections in BMT recipients. Improved survival was obser ved among LDA recipients, but this was not directly attributable to th e prevention of fungal infection.