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Clinical value of empirical amphotericin B in patients with acute myelogenous leukemia
Abstract:
From August 1977 to October 1978, 23 patients with acute myelogenous leukemia (AML) received induction therapy at Vanderbilt University Hospital. Six patients died of documented fungal infection, predominantly aspergillus pneumonia; the complete remission rate was only 40%. Based on this experience we began using amphotericin B empirically in any AML patient remaining febrile or having recurrent fever after a week of broad spectrum antibiotics. Of 22 patients treated from October 1978 to August 1980, none died of fungal infection during induction therapy; the remission rate increased significantly to 77%. Chemotherapy and supportive care were otherwise unchanged during this period. While the first group was older, the improvement in remission rate was also seen in patients younger than 60 years of age. Since fungal infection may be difficult to document, this study suggests that empirical amphotericin B is reasonable therapy in leukemic patients remaining febrile or having a recurrent fever following a week of broad spectrum antibiotics, if the institution has a high incidence of fungal infections.
Insights
Empirical amphotericin B significantly improved remission rates in acute myelogenous leukemia (AML) patients with persistent fever. This antifungal strategy reduced deaths from fungal infections during induction therapy.
Area of Science:
- Oncology
- Infectious Diseases
- Pharmacology
Background:
- Acute myelogenous leukemia (AML) induction therapy historically had a high mortality rate due to fungal infections.
- A significant number of AML patients experienced fungal infections, particularly aspergillus pneumonia, leading to treatment failures.
Purpose of the Study:
- To evaluate the impact of empirical amphotericin B on fungal infection mortality and complete remission rates in AML patients.
- To determine if empirical antifungal therapy improves outcomes in febrile AML patients unresponsive to antibiotics.
Main Methods:
- Retrospective analysis of two patient cohorts undergoing AML induction therapy.
- The first cohort (n=23) received standard care; the second (n=22) received empirical amphotericin B for persistent fever after antibiotics.
Main Results:
- The fungal infection-related mortality rate decreased from 26% to 0% after introducing empirical amphotericin B.
- Complete remission rates increased from 40% to 77% with the addition of empirical amphotericin B.
- Improved outcomes were observed across different age groups.
Conclusions:
- Empirical amphotericin B is a reasonable and effective strategy for managing febrile AML patients at high risk for fungal infections.
- This approach can reduce mortality and improve remission rates in AML induction therapy.
- The study highlights the importance of empirical antifungal use when fungal infections are difficult to diagnose.