LOW INCIDENCE OF INVASIVE FUNGAL-INFECTIONS AFTER BONE-MARROW TRANSPLANTATION IN PATIENTS RECEIVING AMPHOTERICIN-B INHALATIONS DURING NEUTROPENIA

The incidence of invasive fungal infections after bone marrow transpla ntation (BMT) was analyzed in 303 consecutive marrow graft recipients (allogeneic n=271, autologous n=27, syngeneic n=5). All patients recei ved inhalations with amphotericin B (10 mg twice daily) during neutrop enia. The overall incidence of invasive fungal infections within the f irst 120 days after transplant was 3.6% (11/303; aspergillosis: 6; yea st infection: 5). Four of the 11 cases occurred early, and seven cases were observed after neutrophil recovery and discontinuation of amphot ericin B inhalation treatment. Late infection was significantly associ ated with the development of acute graft-versus-host disease. Four of the 11 infections (early 2/4; late: 2/7) were observed in patients wit h a history of previous fungal infection. Other patient and treatment characteristics were not helpful in defining potential risk factors. I n particular, the incidence of invasive fungal infections did not diff er between patients with more or less strict reverse isolation measure s. Occasional side effects such as initial mild cough and bad taste we re rare, usually disappeared during continued administration, and were in no case the reason for discontinuation of treatment. These data su ggest that aerosolized amphotericin B may be a useful, convenient, and efficient prophylactic antifungal regimen in BMT.