thioguanine-anhydrous and Mycoses

Topics: Agranulocytosis; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Depression, Chemical; Hematopoiesis; Humans; Leukemia, Myeloid, Acute; Leukemia, Myelomonocytic, Acute; Life Tables; Mitoxantrone; Mycoses; Thioguanine; Thrombocytopenia

The clinical courses of 54 consecutive adult patients with acute myelogenous leukemia (AML) who underwent 67 courses of intensive remission induction therapy were analyzed to assess factors associated with development of serious fungal and bacterial infections. Fever developed in 65 of 67 remission induction attempts and was due to bacterial, bacterial-fungal, and fungal etiologies in 49%, 14%, and 9% of cases, respectively. No etiology of fever was found in 28% of cases. Bacteremia occurred in 54% of remission induction attempts. Invasive fungal disease (IFD) occurred in 22% of cases with an overall mortality of 60%, including 45% of the patients who died during treatment. Using multivariate logistic regression analysis, a mathematical model was constructed which correlated with the risk of IFD. Major factors associated with patients who ultimately develop IFD included the duration of chemotherapy, the number of sites colonized with fungi and the number of fungal species isolated on certain surveillance cultures, particularly Aspergillus species. These studies define characteristics of patients at high risk for development of IFD for whom early initiation of empiric antifungal therapy is strongly recommended.

Topics: Adolescent; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Cytarabine; Daunorubicin; Female; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Risk; Sepsis; Statistics as Topic; Thioguanine

Hepatotoxicity is regarded as a rare side effect of amphotericin B therapy. A patient with acute myelogenous leukemia who had normal liver function was treated with amphotericin B for fungal pneumonia. While he was receiving the drug at high dosages asymptomatic elevation of the levels of alkaline phosphatase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, lactic dehydrogenase and bilirubin was noted. The levels returned to normal when the drug was discontinued. Rechallenge with a lower dosage prompted a rapid rise in the levels, with subsequent return to normal when the medication was withdrawn.

Topics: Amphotericin B; Chemical and Drug Induced Liver Injury; Cytarabine; Humans; Leukemia, Myeloid, Acute; Liver; Male; Middle Aged; Mycoses; Pneumonia; Thioguanine

Topics: Adolescent; Adult; Bone Marrow Transplantation; Child; Cyclophosphamide; Cytarabine; Daunorubicin; Drug Therapy, Combination; Graft vs Host Disease; HLA Antigens; Humans; Leukemia; Middle Aged; Mycoses; Neoplasm Recurrence, Local; Thioguanine; Transplantation, Homologous

Although definite improvement in the treatment of acute myelogenous leukemia has taken place, the outlook for patients remains grim. The current aggressive approach to treatment, entailing a program of chemotherapy which almost invariably produces bone marrow aplasia and considerable toxicity, has been the subject of some controversy. Selected aspects of management are discussed.

Topics: Adrenal Cortex Hormones; Anti-Bacterial Agents; Antineoplastic Agents; Blood Transfusion; Cell Division; Cyclophosphamide; Cytarabine; Drug Evaluation; Drug Synergism; Drug Therapy, Combination; Humans; Infection Control; Kinetics; Leukemia, Myeloid, Acute; Mercaptopurine; Methotrexate; Mycoses; Prednisone; Pseudomonas Infections; Remission, Spontaneous; Thioguanine; Vincristine

Topics: Adolescent; Blood Cell Count; Bone Marrow Examination; Cytarabine; Eosinophilia; Female; Humans; Karyotyping; Leukemia, Lymphoid; Mercaptopurine; Mycoses; Sulfamethoxazole; Thioguanine; Trimethoprim; Vincristine