Refractory Aspergillus pneumonia in patients with acute leukemia: successful therapy with combination caspofungin and liposomal amphotericin.

摘要: BACKGROUND Pulmonary aspergillosis and other invasive fungal infections (IFIs) commonly complicate the management of patients with acute leukemia. Standard amphotericin-based therapies may be ineffective for many available salvage agents (itraconazole caspofungin) are reported to possess only moderate activity against resistant infections. Laboratory evidence suggests a synergistic interaction between amphotericin caspofungin. The authors treated group amphotericin-refractory IFIs combination caspofungin (or liposomal amphotericin). METHODS A retrospective evaluation amphotericin-resistant was conducted. Diagnosis based on clinical, radiographic, when available, microbiologic data. Response antifungal therapy graded as either favorable or unfavorable. Favorable responses included improvement both clinical radiographic signs pneumonia. All were unfavorable. RESULTS Thirty in this analysis. Twenty-six had Based recently published criteria, classified proven 6 patients, probable 4 possible 20 patients. median duration dose monotherapy 12 days (range, 4–65 days) 7.8 mg/kg 4.2–66.1 mg/kg), respectively. 24 3–74 days). Eighteen (60%) experienced response. Twenty leukemia received pneumonias arising during intensive chemotherapy treatments. observed 15 these (75%), response did not depend underlying Survival hospital discharge significantly better (P < 0.001) having Mild nephrotoxicity noted 50% necessitating substitution amphotericin. elevation alkaline phosphatase levels occurred 30% Caspofungin temporarily withheld from one patient who developed but reversible biochemical hepatotoxicity. CONCLUSIONS The can administered safely high-risk hematologic malignancies. Although an absolute assessment efficacy is limited by design study, encouraging outcomes plan evaluate regimen further randomized trial. Cancer 2003;97:1025–32. © 2003 American Society. DOI 10.1002/cncr.11115