AMPHOTERICIN-B LIPID COMPLEX FOR THE TREATMENT OF PRESUMED OR CONFIRMED FUNGAL-INFECTIONS IN IMMUNOCOMPROMISED PATIENTS WITH HEMATOLOGIC MALIGNANCIES

Amphotericin B lipid complex (ABLC(TM), Abelcet(R)) allows delivery of higher doses oi: amphotericin with a better toxicity profile compared with the parent drug. Fifty-three adult patients with hematologic mal ignancies received 57 courses of ABLC at the daily dose of 5 mg/kg for presumed (n = 41) or proven (n = 16) fungal infection. The usual indi cation for the use of ABLC was failure of previous antifungal therapy with or without renal dysfunction. Forty-six treatment courses in 42 p atients comprising 4-58 doses (median 10.5) were considered evaluable (24 doses). Fifteen courses administered for confirmed infections resu lted in 8 complete responses, 2 almost complete responses, 1 partial r esponse and 4 failures (73% response rate). Thirty-one empiric courses resulted in 13 complete responses, 6 partial responses and 12 failure s (61% response rate). The overall response rate was 65%. Response was seen in 5 of 7 patients with aspergillus pneumonia. Response rates we re comparable for chemotherapy, autograft and allograft recipients. Th e serum creatinine increased by greater than or equal to 50% during 16 evaluable courses of therapy, but 12 of these were associated with co ncomitant nephrotoxic therapy, and renal dysfunction necessitated disc ontinuation of ABLC in only 3 patients. We conclude that ABLC is effec tive for the treatment of presumed or confirmed fungal infections in i mmunocompromised patients who have failed therapy with conventional am photericin or fluconazole, or whose renal function is compromised.