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ctt-journal > Vavilov et al. (Abstract)

Vavilov et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract74

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

Preliminary Program

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Efficacy of Amphotericin B in invasive fungal infection therapy after hematopoietic stem cell transplantation

Vladimir N. Vavilov1, Marina O. Popova1, Alisa G. Volkova1, Ludmila S. Zubarovskaya1, Nikolay N. Klimko2, Boris V. Afanasyev1

1R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia; 2Dept. of Clinical Mycology, St. Petersburg Medical Academy of Postgraduate Education, Russia

Correspondence: Vladimir N. Vavilov, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str., St. Petersburg, 197022, Russia, E-mail: vladimir_vavilov@spam is badmail.ru

Abstract

Background: Invasive fungal infections (IFI) are one of the most important causes of morbidity and mortality after hematopoietic stem cell transplantation (HSCT). IFI can also increase the risk of deterioration of other comorbidities, inpatient stay, and the cost of treatment.

Methods: We included 356 adult patients after allogeneic (n=237, age 18–66, median 27 years) and autologous (n=119, age 18–67, median 33 years) hematopoietic stem cell transplantation to analyze the efficacy of antifungal drug therapy of fungal infectious complications. Only the cases of probable and proven IFI according to EORTC/MSG 2008 criteria were included.

Results: The risk of IFI after HSCT was 19.1% (23.3% after allogeneic (alloHSCT) and 10.9 after autologous (autoHSCT) transplantation, p<0.001). Invasive aspergillosis (IA) was the most common cause of IFI (81.5% and 84.5% from all IFI in auto and allografted patients, respectively). Less frequently, invasive candidiasis (10.7% and 15.6%, respectively) and invasive zygomycosis (5.6% of IFI in allogeneic transplanted patients only) were observed.

Empirical antifungal therapy with caspofungin of amphotericin B was provided in 23.6% of alloHSCT and in 10% of autoHSCT recipients. Voriconazole (54.5%) and AmB (46.1%) were used for targeted treatment of probable and proven invasive aspergillosis or zygomycosis.

In 83% (35 cases) of patients, voriconazole therapy of IA achieved a complete or partial response. Nevertheless, 17% of patients (n=6) revealed progression of IA or zygomycosis (n=4) or toxicity (n=2) under voriconazole treatment and were switched to AmB or caspofungin therapy. In these cases, the use of AmB lipid complex was not associated with additional toxicity. In 33% of patients the initial antifungal therapy was changed because of AmB-deoxycholate nephrotoxicity. Those patients who received treatment with AmB-lipid complex did not have any significant adverse events connected with antifungal drugs.

Conclusions: AmB is still a very effective, high-broad antifungal drug, especially in patients who have undergone autologous HSCT. The toxicity of AmB in HSCT recipients can be decreased by using lipid formulations (lipid complex etc.)

Keywords: Hematopoietic stem cell transplantation, invasive fungal diseases therapy, invasive aspergillosis, Amphotericin B lipid complex