amphotericin-b and Leukemia--Myelomonocytic--Acute

We retrospectively analyzed the antifungal usage in children with acute myeloid leukemia (AML). Overall, 211 of 304 patients (69.4%) received a total of 389 antifungal treatment episodes. In 234 episodes, initial antifungal treatment consisted of amphotericin B [as monotherapy, n = 193; median dosage (range) of amphotericin B deoxycholate 0.6 mg/kg per day (0.02-1.5 mg/kg per day) and of liposomal amphotericin B 3.0 mg/kg per day (0.6-30 mg/kg per day)], in 149 episodes of fluconazole [as monotherapy, n = 143; 5 mg/kg per day (1-29 mg/kg per day)], in 40 of flucytosine [as monotherapy, n = 1; 150 mg/kg per day (40-370 mg/kg per day)], and in 9 of itraconazole [as monotherapy, n = 8; 6 mg/kg per day (1.6-20 mg/kg per day)]. We conclude that the majority of children with AML receives at least one episode of antifungal therapy. Inappropriate dosing and combination of antimycotics need to be addressed in future educational measures.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Child; Female; Fluconazole; Flucytosine; Humans; Infant; Infant, Newborn; Itraconazole; Leukemia, Myelomonocytic, Acute; Male; Retrospective Studies

Echinococcosis, also known as hydatid disease or hydatidosis, is a zoonotic illness caused by the larval form of Echinococcus spp. It is highly prevalent in areas where the parasite is endemic such as the Mediterranean region. However, occurrence of echinococcosis and cancer together is rare. We treated and followed approximately 1200 patients with different hematologic neoplastic diseases between 1985 and 2003, and only one of these individuals had concomitant acute leukemia and liver hydatidosis. This report describes the case of a 19-year-old man who had both primary refractoriness of acute leukemia (AML-M4) and liver hydatidosis. Management is discussed. The patient had cystic echinococcosis (CE) of the liver that was classified as CE1 according to the system established by the World Health Organization's Informal Working Group on Echinococcosis. The patient underwent 3 months of treatment with agents that targeted the leukemia (daunorubicin, idarubicin, cytarabine, fludarabine) and its complications (amphotericin B, amphotericin B lipid complex, liposomal amphotericin B). Throughout this period, the size and the contents of the cyst did not change, Echinococcus titers remained unchanged, and the cyst classification remained CE1.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Echinococcosis, Hepatic; Humans; Leukemia, Myelomonocytic, Acute; Liver; Male

Voriconazole is a new triazole active orally and parenterally that recently proved effective in the treatment of invasive aspergillosis and in empirical antifungal therapy for persistently febrile neutropenic patients. Limited data are available for pediatric patients. We report our experience with voriconazole in seven children with invasive aspergillosis, i.e., four girls and three boys with a median age of 5 (range 2-13) years affected by acute lymphoblastic leukemia (3), acute myeloid leukemia (2), refractory anemia with excess of blasts (1), and severe aplastic anemia (1). First-line therapy in all patients was liposomal amphotericin B (AmBisome) administered at a dosage of 3-5 mg/kg day. Voriconazole was administered for a median 8 (range 2-15) weeks. Response was complete and partial in two patients, respectively, stable in one, and there was no response (failure) in two. The voriconazole treatment was well tolerated. Four patients died-two of progressive aspergillosis. Three patients are alive and well 6, 5, and 4 months after the diagnosis of aspergillosis. Voriconazole appears to be an effective salvage treatment for invasive aspergillosis in pediatric patients, with good responses in patients who recover from neutropenia or are not relapsing.

Topics: Adolescent; Amphotericin B; Anemia, Aplastic; Anemia, Refractory; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Bone Marrow Transplantation; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hematologic Neoplasms; Humans; Leukemia, Myelomonocytic, Acute; Male; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Time Factors; Treatment Outcome; Triazoles; Voriconazole

The management of invasive aspergillosis in patients with hematological malignancies remains controversial. A major problem is how to manage patients who had invasive aspergillosis during remission induction and consolidation therapy and then undergo SCT. Indeed in these patients the mortality rate related to invasive aspergillosis recurrence remains unacceptably high. We report two cases of patients who underwent remission induction for AML, developed invasive aspergillosis during antifungal prophylaxis with itraconazole, failed amphotericin B deoxycholate and liposomal amphotericin B treatment, were successfully treated with voriconazole and eventually underwent SCT with voriconazole prophylaxis without reactivation of invasive aspergillosis.

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bone Marrow Transplantation; Combined Modality Therapy; Cytarabine; Daunorubicin; Deoxycholic Acid; Drug Combinations; Drug Resistance, Fungal; Etoposide; Fatal Outcome; Humans; Immunocompromised Host; Itraconazole; Leukemia, Megakaryoblastic, Acute; Leukemia, Myelomonocytic, Acute; Liposomes; Lung Diseases, Fungal; Male; Middle Aged; Peripheral Blood Stem Cell Transplantation; Pyrimidines; Recurrence; Remission Induction; Salvage Therapy; Transplantation Conditioning; Transplantation, Autologous; Transplantation, Homologous; Triazoles; Voriconazole

Topics: Amphotericin B; Carbidopa; Cytarabine; Dose-Response Relationship, Drug; Female; Humans; Leukemia, Myelomonocytic, Acute; Levodopa; Lung Diseases; Middle Aged; Parkinson Disease, Secondary

A 71 year old man with newly diagnosed acute myelomonocytic leukaemia developed a soft tissue infection of his foot during his first course of chemotherapy. Scedosporium apiospermum was isolated from the lesion, which resolved rapidly on treatment with intravenous amphotericin B despite being resistant in vitro to this agent. This observation suggests that sensitivity testing of S apiospermum should be interpreted with caution and that clinical response may be a better indicator of outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Drug Resistance; Foot Dermatoses; Humans; Leukemia, Myelomonocytic, Acute; Male; Mycetoma; Opportunistic Infections; Pseudallescheria

Topics: Adult; Amphotericin B; Antifungal Agents; Fusarium; Humans; Immunocompromised Host; Leukemia, Myelomonocytic, Acute; Male; Mycoses; Neutropenia; Onychomycosis

Nephrogenic diabetes insipidus (NDI) is a serious side effect of various drugs. Elevated renal prostaglandin E2 levels have been found in patients with lithium-induced NDI and have been implicated in the pathogenesis. We report the case of a patient who developed NDI following treatment with amphotericin B. Prostaglandin levels were elevated. Indomethacin had an antidiuretic effect and normalized prostaglandin levels.

Topics: Amphotericin B; Diabetes Insipidus, Nephrogenic; Diuresis; Female; Humans; Indomethacin; Kidney; Leukemia, Myelomonocytic, Acute; Middle Aged; Prostaglandins; Tobramycin; Vasopressins