Document Detail


Does combination of lipid formulation of amphotericin B and echinocandins improve outcome of invasive aspergillosis in hematological malignancy patients?
MedLine Citation:
PMID:  20665889     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In vitro and in vivo studies suggested that combination of lipid formulation of amphotericin B (L-AMB) and echinocandins may have a synergistic or additive effect against Aspergillus. Furthermore, clinical studies suggested that this combination may improve response of invasive aspergillosis (IA).
METHODS: Between August 1993 and June 2008, the authors identified a total of 159 patients with hematological malignancies who received salvage therapy for IA, with L-AMB alone, echinocandins alone, or a combination of L-AMB and echinocandins. Clinical characteristics, response to salvage therapy, and death up to 12 weeks after initiation of salvage therapy were retrospectively determined for all patients.
RESULTS: Seventy patients received salvage therapy with L-AMB, 18 patients received echinocandins alone (89% of whom received caspofungin), and 71 patients received the combination therapy of amphotericin B and echinocandins (90% of who received caspofungin). The 3 salvage treatment groups were comparable in regard to clinical characteristics; graft versus host disease was more frequently encountered in the echinocandin group, whereas more patients in the L-AMB and combination groups had neutropenia and received immunotherapy. The response to salvage therapy was better in the echinocandin group (9% L-AMB, 28% echinocandins, and 21% for combination therapy). The 3 groups had a comparable rate of Aspergillus-related death (58%-64%) and overall mortality (61%-67%).
CONCLUSIONS: The combination of L-AMB and echinocandins offered no advantage in terms of improving response or reducing mortality over either drug alone. Hence, this combination will only add to the cost of therapy without any improvement in outcome in patients with hematological malignancies.
Authors:
Coralia N Mihu; Christelle Kassis; Elizabeth R Ramos; Ying Jiang; Ray Y Hachem; Issam I Raad
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Cancer     Volume:  116     ISSN:  0008-543X     ISO Abbreviation:  Cancer     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-08     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374236     Medline TA:  Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  5290-6     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 American Cancer Society.
Affiliation:
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA. cnmihu@mdanderson.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Amphotericin B / administration & dosage*,  adverse effects
Antifungal Agents / administration & dosage*
Aspergillosis / complications*,  drug therapy*,  mortality
Child
Drug Therapy, Combination / adverse effects
Echinocandins / administration & dosage*,  adverse effects
Female
Hematologic Neoplasms / complications*
Humans
Male
Middle Aged
Salvage Therapy
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Echinocandins; 0/liposomal amphotericin B; 1397-89-3/Amphotericin B

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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