amphotericin-b and Precursor-B-Cell-Lymphoblastic-Leukemia-Lymphoma

Children with hematologic malignancies are at an increased risk of invasive fungal infections and a greater risk has been seen with exposure to building construction. Prophylaxis with high-dose (IV) liposomal amphotericin B (L-AmB) 10 mg/kg once weekly was initiated in our high risk children based on previous pharmacokinetic studies. This treatment regimen was associated with a 26% incidence of adverse infusion reactions.

Topics: Adolescent; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Child; Child, Preschool; Female; Humans; Leukemia, Lymphoid; Male; Mycoses; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma

Topics: Administration, Intranasal; Adolescent; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Humans; Male; Mucormycosis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma

Curvularia is a saprophytic dematiaceous mold and a rare human pathogen. Here, we report three severely immunocompromised pediatric patients who developed invasive Curvularia infection. Diagnosis was achieved or confirmed in all cases by fungal ribosome sequencing, which hastened species identification and targeted treatment for the patients reported. There are no treatment guidelines for invasive Curvularia infection, though we report three patients who were cured of their infection through a combination of surgical resection and various anti-fungal therapies, indicating a relatively low virulence and good prognosis in comparison to other angioinvasive molds.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Child; Dermatomycoses; Female; Humans; Immunocompromised Host; Male; Opportunistic Infections; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; RNA, Ribosomal, 28S; Sequence Analysis, DNA; Voriconazole

A 17-year-old girl developed invasive rhinocerebral mucormycosis during intensive re-induction chemotherapy for relapsed pre-B acute lymphoblastic leukemia. Due to the high case fatality rate for invasive mucormycosis in profoundly immunosuppressed patients, an aggressive treatment regimen was pursued. In addition to the standard of care treatments with intravenous amphotericin and aggressive surgical debridements, she received intraventricular amphotericin to the brain via an Ommaya reservoir, hyperbaric oxygen treatments, filgrastim, intravenous immunoglobulin and antifungal in vitro synergy testing to allow for more targeted antifungal therapy with the addition of micafungin. After a 3-month treatment course, it was determined that her mucormycosis was under appropriate control, allowing her to continue treatment for her leukemia with hematopoietic stem cell transplant with a plan for continued intravenous antifungal therapy through engraftment.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Brain; Brain Diseases; Combined Modality Therapy; Drug Therapy; Female; Humans; Hyperbaric Oxygenation; Immunocompromised Host; Mucormycosis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Treatment Outcome

Primary cutaneous aspergillosis is a rare cutaneous disease that usually affects immunodepressed patients of any age. The most common associated disorders in children are leukemias and lymphomas although it can also occur in neonates and preterms due to their intrinsic immunological immaturity. We report the case of a 4-year-old boy diagnosed of acute lymphoblastic leukemia that, during chemotherapy, developed an ulceronecrotic inflammatory cutaneous lesion in the venopuncture area of the left forearm, and whose microbiological culture was positive for Aspergillus flavus.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus flavus; Child, Preschool; Dermatomycoses; Humans; Immunocompromised Host; Male; Neutropenia; Opportunistic Infections; Phlebotomy; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Skin Ulcer; Wound Infection

A 46-year-old previously healthy woman was diagnosed with acute lymphoblastic leukaemia. The induction phase was complicated by alpha-haemolytic streptococcal bacteremia which responded to antibacterial therapy. Subsequently, the patient developed pneumonie due to Chlamydiapneumoniae which responded to macrolides. Following this infection the patient developed recurrent fever and new pulmonary infiltrates were noted. Bronchoscopy was performed and treatment was administered with liposomal amphotericin B (L-AmB, AmBisome) for two days, but was complicated by acute renal failure. Aspergillus fumigatus was cultured from bronchoalveolar lavage fluid [corrected] L-AmB was discontinued and voriconazole and caspofungin were administered. Despite aggressive antifungal therapy the patient developed progressive invasive infection, with central nervous system involvement as well as lesions appearing in the kidneys and liver. The patient died one week following the diagnosis of aspergillosis.

Topics: Acute Kidney Injury; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bacteremia; Caspofungin; Chlamydophila Infections; Chlamydophila pneumoniae; Doxorubicin; Drug Resistance, Multiple, Fungal; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Female; Humans; Immunocompromised Host; Lipopeptides; Liposomes; Lung Diseases, Fungal; Medical Futility; Methotrexate; Middle Aged; Neuroaspergillosis; Peptides, Cyclic; Pneumonia, Bacterial; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Streptococcal Infections; Triazoles; Vincristine; Voriconazole

This report describes the case of fungal sinusitis in severely immunocompromised 32-year-old male with common-type acute lymphoblastic leukemia who relapsed after autologous peripheral blood transplantation. Empirical therapy with antibiotics and conventional amphotericin B failed to resolve the infection. Following therapy with AmBisome his symptoms abated and significantly improved scan picture was seen.

Topics: Adult; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Combined Modality Therapy; Cytarabine; Cytomegalovirus Infections; Enterococcus faecalis; Fatal Outcome; Humans; Idarubicin; Immunocompromised Host; Immunoglobulins, Intravenous; Liposomes; Male; Mycoses; Peripheral Blood Stem Cell Transplantation; Pneumonia; Postoperative Complications; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pseudomonas putida; Pulmonary Edema; Pyrimidines; Sinusitis; Staphylococcus epidermidis; Transplantation, Autologous; Triazoles; Voriconazole

We describe in detail a 67-yr-old woman who was treated with a cytostatic combination chemotherapy for newly diagnosed common-acute lymphoblastic leukaemia. At the end of induction therapy, the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin B was initiated along with surgical excision of the fungal brain abscess. Intrathecal instillation of amphotericin B deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and the ventricle. Full dose cytostatic chemotherapy was continued with little delay. A computerised tomography scan of the chest performed 2 months later revealed no fungal abscesses. Magnetic resonance imaging of the brain did not reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphotericin B were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathological examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility and successful application of combined antileukaemic, antifungal and surgical therapy in a patient with acute leukaemia.

Topics: Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Abscess; Combined Modality Therapy; Craniotomy; Deoxycholic Acid; Drug Combinations; Fatal Outcome; Female; Humans; Immunocompromised Host; Infusions, Intravenous; Injections, Spinal; Liposomes; Lung Abscess; Lung Diseases, Fungal; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neuroaspergillosis; Pneumonia, Pneumococcal; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Tomography, X-Ray Computed

We would like to report the use of liposomal amphotericin in eradicating mucormycosis in two patients who had relapsed acute leukaemia. The first patient with relapsed acute myeloid leukaemia developed a rapidly expanding solitary necrotic neck lesion associated with opacity of maxilliary sinus at a time when he was profoundly pancytopenic following high dose chemotherapy. The second patient was a 3-year-old boy with pre-B acute lymphoblastic leukaemia who developed a central nervous system relapse whilst on his first line treatment and was treated with more aggressive chemotherapy on the Medical Research Council Relapse Protocol. During a period of profound pancytopenia following re-induction therapy, including high dose steroids and prolonged course of antibiotics for proven septicaemia, he developed periorbital swelling and proptosis and a clinical diagnosis of rhinocerebral mucormycosis was made. Both patients were treated with high doses of liposomal amphotericin (Ambisome Nexstar). The doses were escalated to 10 and 15 mg/kg/day, resulting in successful eradication of the mucormycosis.

Topics: Absidia; Adolescent; Amphotericin B; Antifungal Agents; Child, Preschool; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Mucormycosis; Opportunistic Infections; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Zygomycosis

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Female; Humans; Lung Diseases, Fungal; Mucormycosis; Pneumonia; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma