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Low-dose amphotericin B prophylaxis against invasive Aspergillus infections in allogeneic marrow transplantation
S R Rousey1, S Russler, M Gottlieb
1Department of Medicine, Medical College of Wisconsin, Milwaukee 53226.
Purpose:
Invasive Aspergillus infections cause significant morbidity and mortality in marrow transplant patients. In this study, we examined whether administration of intravenous low-dose prophylactic amphotericin B could reduce the incidence and mortality associate with invasive aspergillosis in patients undergoing allogenic marrow transplantation.
Patients And Methods:
The subjects of this analysis were 186 consecutive patients undergoing allogeneic marrow transplantation in an adult bone marrow transplant unit between July 1, 1985, and September 30, 1990, utilizing consistent disease-specific chemoirradiation and graft-versus-host disease protocols. The incidence, morbidity, and case fatality of invasive aspergillosis in the study group receiving amphotericin chemoprophylaxis were compared with that in two historic cohorts managed without prophylactic amphotericin B. Univariate and multivariate statistical analyses were performed to examine whether an apparent protective effect could be attributed to differences in patient and treatment variables among the cohorts and to determine potential toxicities of the chemoprophylaxis regimen.
Results:
There was a significant reduction in both the incidence (p = 0.003) and mortality (p = 0.03) of invasive aspergillosis in patients receiving amphotericin B chemoprophylaxis as compared with those not receiving chemoprophylaxis. The prophylactic amphotericin B schedule, as employed here, was not associated with increased renal or hepatic toxicity as compared with that in historically managed patients.
Conclusion:
These data suggest that the risks of invasive aspergillosis in allogeneic marrow transplant recipients can be reduced by administration of prophylactic amphotericin B during the pretransplant and peritransplant periods.
Insights
Prophylactic low-dose amphotericin B significantly reduced invasive aspergillosis incidence and mortality in allogeneic marrow transplant patients. This antifungal strategy proved safe, offering a valuable approach to prevent serious infections post-transplant.
Area of Science:
- Hematology
- Infectious Diseases
- Mycology
Background:
- Invasive aspergillosis presents a significant threat to marrow transplant recipients.
- High morbidity and mortality rates are associated with these infections.
Purpose of the Study:
- To evaluate the efficacy of intravenous low-dose amphotericin B prophylaxis.
- To determine if this regimen reduces invasive aspergillosis incidence and mortality in allogeneic marrow transplant patients.
Main Methods:
- A cohort of 186 allogeneic marrow transplant patients received amphotericin B prophylaxis.
- Compared outcomes with historical cohorts not receiving prophylaxis.
- Utilized univariate and multivariate statistical analyses to assess efficacy and toxicity.
Main Results:
- A significant reduction in invasive aspergillosis incidence (p = 0.003) was observed.
- A significant reduction in invasive aspergillosis mortality (p = 0.03) was noted.
- The prophylactic regimen did not increase renal or hepatic toxicity compared to historical controls.
Conclusions:
- Prophylactic amphotericin B administration can decrease the risks of invasive aspergillosis.
- This strategy is beneficial during the pretransplant and peritransplant periods for allogeneic marrow transplant recipients.