INTRAVENOUS AMPHOTERICIN-B AS PROPHYLAXIS OF DEEP MYCOSIS IN ALLOGENIC BONE-MARROW TRANSPLANTATION

BACKGROUND: To evaluate the efficacy of I.v. amphotericin B (AmB) as p rophylaxis of deep mycosis (DM) In allogenic bone marrow transplantati on (BMT). METHODS: From July 1991 to May 1993, 45 consecutive patients treated by allogenic BMT with no previous history of systemic mycosls and with normal renal function were administered prophylactic AmB at a dosis of 0.5 mg/kg/48 h from day +1 BMT until hemoperipheral recover y (group A). These were compared with an historic control group made u p of 45 consecutive patients submitted to BMT from January 1990 to Jun e 1991 who did not receive prophylactic AmB (group B). During the neut ropenic phase all the patients remained in isolation units with lamina r flow of filtered air and were administered oral non absorbable antib iotic therapy and diet of low bacterial content. The incidence of DM a nd the dosis of AmB administered during the first 120 days post BMT we re evaluated. RESULTS: In the first 30 days following BMT 3 (7%) cases of DM were observed in group A and 3 (7%) in group B, Four (9%) addit ional cases were found from days 30 to 120 in group A and 3 (7%) in gr oup B. In 3 (7%) patients of the group which received prophylaxis and in 4 (9%) of the control group Candida spp. was isolated. In 3 (7%) pa tients from group A and 1 (2%) patient from group B the Infection was due to Aspergillus Although the patients from group A received therape utic AmB less frequently (78% vs 91%) and later (13 [SD +/- 5.9] vs 9. 2 [SD +/- 4.6] days) than those of group B (p < 0.002) the mean dose o f AmB per patient treated was similar in both groups (11.3 [SD +/- 8.8 ] vs 11.8 [SD +/- 7] mg/kg). CONCLUSIONS: The prophylactic use of syst emic amphotericin during the neutropenic phase of bone marrow transpla ntation does not reduce either the incidence of deep mycosis or the me an dose of amphotericin administered.