AMPHOTERICIN-B LIPID COMPLEX (ABLC) FOR THE TREATMENT OF CONFIRMED ORPRESUMED FUNGAL-INFECTIONS IN IMMUNOCOMPROMISED PATIENTS WITH HEMATOLOGIC MALIGNANCIES

Sixty-four adult patients (median age 43) with hematologic malignancie s who were immunocompromised after allogeneic (n = 23) or autologous ( n = 9) blood/marrow transplantation, or chemotherapy (n = 32) received 68 courses of amphotericin B lipid complex (ABLC, Abelcet) at the dai ly dose of 5 mg/kg for presumed (n = 52) or proven (n = 16) fungal inf ection, The major indications for ABLC were failure of previous antifu ngal therapy and/or renal dysfunction, Fifty-three treatment courses i n 49 patients comprising 4-58 doses (median 10) were considered evalua ble, Fourteen courses administered for confirmed infections resulted i n nine complete and one partial responses, and four failures (71% resp onse), Thirty-nine empiric courses resulted in 18 complete and six par tial responses, and 14 failures (64% response), The overall response r ate was 66%, Five of seven evaluable patients with aspergillus pneumon ia responded, Response rates were comparable for chemotherapy, autogra ft and allograft recipients, The change in serum creatinine from the b eginning to the end of therapy was -284 to +277 mu mol/l (median +24), The creatinine doubled during seven evaluable courses of therapy, fiv e of which were associated with concomitant nephrotoxic therapy, Nephr otoxicity was comparable for transplant and chemotherapy patients, Ren al dysfunction necessitated discontinuation of ABLC in only four patie nts, These data suggest that ABLC is effective in presumed or confirme d fungal infections in immunocompromised patients after transplantatio n or chemotherapy.