Response to empiric amphotericin B during antileukemic therapy-induced granulocytopenia

We analyzed the initial and overall responses to empiric therapy with amphotericin B as they related to the rate of occurrence and the type of fungal infection and colonization during 264 consecutive episodes of prolonged, profound, chemotherapy-induced bone marrow aplasia (greater than 30 days, less than 100 polymorphonuclear leukocytes/mm3) in 160 adults with acute leukemia. Amphotericin B was administered during 248 (94%) of these granulocytopenic episodes; in 68 cases the drug was given because of documented infection with yeasts or filamentous fungi (DFI), and in 180 cases it was given because of refractory fever without DFI. The frequency of an initial response in patients with DFI (60%) was similar to that in non-DFI-infected patients (61%). Both the initial response rate and the overall survival rate were significantly decreased when therapy with amphotericin B was not initiated empirically before documentation of filamentous DFI. Given the comparatively high rates of initial and overall response (the latter being 74% and 71% for DFI and non-DFI, respectively) and the lack of alternative fungicidal agents, our data support prompt empiric treatment with amphotericin B for refractory fever in adults with acute leukemia who are compromised by severe, therapy-induced granulocytopenia.