Aerosolized amphotericin B lipid complex as adjunctive treatment for fungal lung infection in patients with cancer-related immunosuppression and recipients of hematopoietic stem cell transplantation.

Safdar A, Rodriguez GH.

Pharmacotherapy. 2013 Oct;33(10):1035-43.

STUDY OBJECTIVE: Aerosolized amphotericin B lipid complex (aeABLC) has been
successfully used to prevent fungal disease. Experience with aeABLC as treatment
of fungal lung disease is limited.
DESIGN: We evaluated the safety and efficacy of aeABLC adjunct therapy for fungal
lung disease in a retrospective study of 32 immunosuppressed adults. All values
are given as ± standard deviation.
SETTING: National Cancer Institute-designated Comprehensive Cancer Center.
PATIENTS: Acute leukemia (69%) and severe neutropenia (63%) were common.
Fifty-six percent of patients had undergone allogeneic hematopoietic stem cell
transplantation 185 ± 424 days prior to aeABLC was commenced.
MEASUREMENT AND MAIN RESULTS: High-dose corticosteroids were administered during
aeABLC in 28% of patients. Fungal lung disease was proven or probable in 41% of
patients. Most patients (78%) received concurrent systemic antifungal therapy for
a median of 14 ± 18 days before aeABLC. The median cumulative aeABLC dose was
1050 ± 2368 mg, and the median duration of aeABLC therapy was 28 ± 130 days. Most
patients (78%) received 50 mg aeABLC twice daily. Partial or complete resolution
of fungal lung disease was noted in 50% of patients. In three patients (9%)
modest cough, mild bronchospasm, and transient chest pain with accompanying
nausea and vomiting resolved completely after discontinuation of aeABLC. No
patient required hospitalization for drug toxicity or had a serious (grade III or
IV) drug-related adverse event.
CONCLUSION: Treatment with aeABLC was tolerated without serious toxicity and may
be considered in the setting of severe immunosuppression, cancer, and/or
hematopoietic stem cell transplantation in patients with difficult-to-treat
fungal lung disease.