Inhaled Amphotericin B as Aspergillosis Prophylaxis in Hematologic Disease: An Update

Area of Science:

• Mycology
• Hematology
• Pharmacology

Background:

• Invasive aspergillosis is a serious risk for neutropenic patients with hematologic malignancies or after stem cell transplant.
• Prophylaxis is crucial to reduce morbidity and mortality in these high-risk populations.

Purpose of the Study:

• To review the literature on inhaled amphotericin B for invasive aspergillosis prophylaxis.
• To evaluate the efficacy and safety of inhaled amphotericin B formulations in neutropenic patients.

Main Methods:

• Systematic review of six trials (2 randomized controlled, 4 historical controls) evaluating inhaled amphotericin B.
• Analysis of invasive aspergillosis incidence, risk reduction, and adverse events.

Main Results:

• Both inhaled amphotericin B deoxycholate and liposomal formulations showed reductions in invasive aspergillosis incidence.
• Relative risk reductions of 40-60% were observed, with statistical significance in some trials.
• Adverse events were generally mild (cough, bad taste, nausea), with no reported systemic or severe effects.

Conclusions:

• Inhaled liposomal amphotericin B (12.5 mg twice weekly) is a viable alternative for invasive aspergillosis prophylaxis.
• It is recommended for high-risk neutropenic patients with hematologic malignancies and stem cell transplant recipients when azole agents are contraindicated or not tolerated.