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Efficacy of amphotericin B lipid complex injection (ABLC) in bone marrow transplant recipients with life-threatening
1University of Florida, Gainesville, FL, USA.
Abstract:
Bone marrow transplant (BMT) recipients are at increased risk of invasive fungal disease as a result of the profound neutropenia associated with transplantation. Amphotericin B lipid complex injection (ABLC, ABELCET) was developed to preserve the broad spectrum and fungicidal activity of conventional amphotericin B while avoiding its associated nephrotoxicity. ABLC was made available to physicians in an emergency-use program to treat seriously ill patients with advanced fungal infections who had failed to respond to previous systemic antifungal therapy (mostly amphotericin B), had experienced nephrotoxicity or severe acute toxicity due to amphotericin B or other drugs, or had pre-existing renal disease. Of 59 clinically evaluable BMT recipients with presumed or confirmed fungal infections, 31 (53%) responded to treatment: 23 (39%) were cured and eight (14%) improved. For 38 mycologically evaluable patients, pathogens were eradicated in 19 (50%). For 30 patients who began ABLC treatment with a serum creatinine > 221 mumol/l, significant reductions were observed at weeks 1 to 3 (P < 0.01) and 6 (P < 0.001). Trends in serum creatinine during ABLC therapy between autologous and allogeneic transplant recipients were similar. In summary, the results of this evaluation indicate that ABLC appears to be less nephrotoxic than conventional amphotericin B as well as an effective treatment for BMT recipients with presumed or confirmed fungal infections.
Insights
Amphotericin B lipid complex injection (ABLC) effectively treated invasive fungal infections in bone marrow transplant (BMT) recipients. This antifungal agent demonstrated reduced nephrotoxicity compared to conventional amphotericin B.
Area of Science:
- Mycology and Infectious Diseases
- Hematology and Stem Cell Transplantation
Background:
- Bone marrow transplant (BMT) recipients face a high risk of invasive fungal disease due to severe neutropenia.
- Conventional amphotericin B, while effective, is associated with significant nephrotoxicity, limiting its use in vulnerable patients.
Purpose of the Study:
- To evaluate the efficacy and safety of Amphotericin B lipid complex injection (ABLC) in bone marrow transplant recipients with invasive fungal infections.
- To assess ABLC's impact on renal function compared to traditional amphotericin B.
Main Methods:
- Retrospective analysis of 59 clinically evaluable BMT recipients treated with ABLC under an emergency-use program.
- Inclusion criteria: presumed or confirmed fungal infections, failure of prior antifungal therapy, or intolerance/renal disease.
- Mycological evaluation in 38 patients; assessment of serum creatinine levels in patients with pre-existing renal impairment.
Main Results:
- Overall response rate of 53% (31/59), with 39% (23/59) achieving cure and 14% (8/59) showing improvement.
- Pathogen eradication achieved in 50% (19/38) of mycologically evaluable patients.
- Significant reduction in serum creatinine observed in patients with elevated baseline levels (n=30) during ABLC therapy.
Conclusions:
- ABLC is an effective treatment option for invasive fungal infections in BMT recipients, including those with renal compromise.
- ABLC demonstrates a favorable nephrotoxicity profile compared to conventional amphotericin B in this patient population.