amphotericin-b and Leukemia--Promyelocytic--Acute

Pulmonary zygomycosis, also referred to as mucormycosis, is a fungal infection of lungs caused by fungi of the order Mucorales in the class of Zygomycetes. It is usually associated with high morbidity and mortality. Here, we report the case of a 14-year-old girl with pediatric acute promyelocytic leukemia (APL) on antifungal prophylaxis with posaconazole, who developed pulmonary Lichtheimia corymbifera (formerly Absidia corymbifera) zygomycosis. She was successfully treated by means of liposomal amphotericin B (L-AmB) and surgery. To our knowledge, this is the first published report on pediatric APL and pulmonary zygomycosis in the English language literature. At present, the patient is in complete remission of her APL and without any signs of recurrence of zygomycosis. This report suggests that efficient diagnostics, increased physician awareness, and reliance on adjunctive surgical therapy can result in a favorable outcome of pulmonary zygomycosis in immunocompromised children with hematological malignancies.

Topics: Absidia; Adolescent; Amphotericin B; Antifungal Agents; Female; Humans; Immunocompromised Host; Leukemia, Promyelocytic, Acute; Lung Diseases, Fungal; Mucormycosis; Pneumonectomy; Triazoles

Trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. Amphotericin B did not appear effective in treating these dermatophyte infections.

Topics: Adolescent; Adult; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Female; Fluconazole; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Naphthalenes; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Steroids; Terbinafine; Tinea; Treatment Outcome; Trichophyton

Topics: Agranulocytosis; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Fusarium; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Promyelocytic, Acute; Male; Middle Aged; Mycoses; Opportunistic Infections

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Female; Humans; Leukemia, Promyelocytic, Acute; Liver Diseases; Splenic Diseases

Cytologic studies were done on fine needle aspirates of the lymph node and imprints of splenic biopsies from a patient with acute promyelocytic leukemia who was febrile while being treated with chemotherapy. Examination of the lymph node aspirates revealed pus and numerous pseudohyphae which were later identified as Candida tropicalis. When multiple nodular lesions were detected in the spleen by abdominal sonography and CT scan, needle biopsy of the spleen was done. Cytologic examination of touch imprints of the biopsy disclosed intracellular fungal blastospores. The patient was treated with and responded well to amphotericin B and 5-fluorocytosine. As a result of our experience with this patient we emphasize the importance of close incorporation of clinical information and diagnostic cytology. With such a cooperation, cytologic studies become a most useful method for diagnosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy, Needle; Candida; Candidiasis; Flucytosine; Humans; Leukemia, Promyelocytic, Acute; Lymph Nodes; Male; Spleen; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Candidiasis; Humans; Leukemia, Promyelocytic, Acute; Liposomes; Male

We report a young woman with acute promyelocytic leukemia who showed primary resistance to chemotherapy and who responded to ATRA treatment. During the neutropenic period she developed Curvularia sp infection and was finally successfully consolidated with autologous bone marrow transplantation.

Topics: Adolescent; Amphotericin B; Bone Marrow Transplantation; Female; Humans; Leukemia, Promyelocytic, Acute; Mitosporic Fungi; Mycoses; Transplantation, Autologous

Mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the cases of two leukaemic patients in whom pulmonary mucormycosis was diagnosed. Prompt diagnosis, therapy with amphotericin B and surgery when possible, are the cornerstones in the treatment of this fungal infection. Although infrequent, this infection must be suspected in oncohaematological patients with lung infiltrates.

Topics: Adult; Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Fatal Outcome; Granulocyte Colony-Stimulating Factor; Humans; Immunologic Factors; Itraconazole; Leukemia, Promyelocytic, Acute; Lung Diseases, Fungal; Male; Mercaptopurine; Methotrexate; Mitoxantrone; Mucormycosis; Neutropenia; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Patients with previous invasive fungal infections (IFI) are at high risk of reactivation of the infection during BMT, even after an apparently curative antifungal treatment. We report four patients who suffered an IFI after intensive chemotherapy for acute leukemia and were later submitted for BMT. One patient had developed a chronic systemic candidiasis during consolidation chemotherapy and received prophylactic oral or iv fluconazole (200 mg daily) throughout BMT. Two patients developed an invasive pulmonary aspergillosis after intensive chemotherapy, one of them after salvage therapy for post-allogeneic BMT relapse and the other after consolidation therapy. The former patient underwent partial lobectomy after treatment with amphotericin B before a second allogeneic BMT was performed. Both patients received prophylactic itraconazole (400 mg daily by mouth) throughout the BMT procedure. The fourth patient had pneumonia caused by Scedosporium apiospermum (the anamorph form of the fungus Pseudallescheria boydii) during consolidation chemotherapy which was successfully treated with itraconazole. During BMT he also received oral itraconazole (400 mg daily) as prophylaxis against reactivation of the infection. All four patients had successful BMT and none had clinical, radiological or microbiological evidence of reactivation of IFI during BMT.

Topics: Administration, Oral; Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus; Bone Marrow Transplantation; Candida; Candidiasis; Female; Fluconazole; Humans; Incidence; Itraconazole; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Lung Diseases; Male; Mycetoma; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pseudallescheria; Recurrence; Risk Factors

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Coccidioidomycosis; Female; Humans; Leukemia, Promyelocytic, Acute; Lung Diseases, Fungal; Male; Middle Aged; Multiple Myeloma; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma

A 40-year-old female was admitted in August 1989 with a diagnosis of acute promyelocytic leukemia (AML; M3). One course of modified-DCMP regimen induced complete remission in September, but she developed spiking fever at a nadir period of WBC after induction chemotherapy. CT revealed multiple hepato-splenic abscesses presumably due to candida infection. She was treated with intravenous administration of amphotericin B (AMPH-B) and other antifungal agents. Despite the hematological remission and prolonged use of these antifungal agents, high fever persisted. A catheter was inserted into the portal vein under ultrasonic-guidance. AMPH-B was administered through the catheter: the initial dose was 3 mg/day and was soon increased to 20 mg/day. Her fever subsided in 1 week, and the sizes of liver abscesses on CT reduced markedly. Chill and hypokalemia were observed during this therapy. The catheter was removed from the portal vein after 29 days. Partial portal vein thrombosis was noted around the catheter tip. This case suggests the usefulness of intraportal administration of AMPH-B in patients with hematological malignancy developing multiple liver abscesses.

Topics: Abscess; Adult; Amphotericin B; Catheterization; Female; Humans; Leukemia, Promyelocytic, Acute; Liver Abscess; Portal Vein; Splenic Diseases

The combinations of amphotericin B (AmB) with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) or 2-cyclohexyl isocyanate, the carbamoylating decomposition product of CCNU, were more potent in lysing HL-60 cells than the combinations of AmB with 1,3-bis-(2-chloroethyl)-1-nitrosourea (BCNU) or 2-chloroethyl isocyanate, the carbamoylating decomposition product of BCNU. The noncarbamoylating nitrosoureas 1-(2-chlorethyl)-3-(2,6-dioxo-3-piperydyl)-1-nitrosourea and 2-[3-(2-chloroethyl)-3-nitrosoureido]-D-glucopyranose did not alter AmB effects on HL-60 cells. These results indicate that the potentiating action of CCNU and BCNU on the lytic effects of AmB is associated with the carbamoylating activity of these nitrosoureas. It is likely that the greater carbamoylating activity of CCNU, compared to BCNU, is responsible for the differences in potency of the two AmB-drug combinations.

Topics: Amphotericin B; Carmustine; Cell Line; Drug Therapy, Combination; Glutathione; Humans; L-Lactate Dehydrogenase; Leukemia, Promyelocytic, Acute; Lomustine; Nitrosourea Compounds

A 36-year-old male with acute promyelocytic leukemia in second relapse was admitted to receive reinduction therapy in June, 1985, and entered into third complete remission, but he developed spiky fever after chemotherapy. Ultrasonic tomography revealed multiple liver abscesses and culture of the aspirates demonstrated Candida albicans in the abscesses. He was treated with intravenous administration of amphotericin B (AMPH-B) but the effect on the liver abscesses was unsatisfactory and consolidation therapy was difficult to start. AMPH-B (30 mg/day) was administered by percutaneous transhepatic intraportal administration (PTIA). About two months later, multiple liver abscesses disappeared. No remarkable complications such as severe fever, chill and renal dysfunction were recognized during PTIA of AMPH-B. So PTIA of AMPH-B is considered to be useful and safe for the management of fungal liver abscesses.

Topics: Adult; Amphotericin B; Candidiasis; Catheterization; Cytarabine; Humans; Leukemia, Promyelocytic, Acute; Liver Abscess; Male; Portal System

The effects on intra- and extracellular pH of two polyenic derivatives of amphotericin B, N-fructosyl amphotericin B and N-fructosyl amphotericin B methyl-ester, were tested on HL-60 promyelocytic leukemia cells. Both derivatives raised the internal pH and reduced the external pH in weakly buffered medium. These results support the idea that both derivatives induce outward proton movement from the cell to the external solution. In this respect, the non-esterified derivative proved to be more powerful that the esterified one. Under the present conditions, there was little or no regulation of pH in HL-60 cells, which exhibited an almost constant pH gradient between the external and internal pH (acid inside relative to outside). This deficiency in pH homeostasis might be due to the immature state of the HL-60 cells.

Topics: Amphotericin B; Extracellular Space; Fluoresceins; Hydrogen-Ion Concentration; Intracellular Fluid; Leukemia, Promyelocytic, Acute; Spectrometry, Fluorescence; Tumor Cells, Cultured