ABSTRACT
The liposomal formulation of amphotericin B [LAmB] has been shown to cause few and mild infusion-related reactions, while achieving high plasma and tissue concentrations compared with conventional amphotericin B. We investigated the efficacy and safety of high-dose LAmB [7.5 mg/kg once weekly] prophylaxis of fungal infections in allogeneic stem-cell transplanted [allo-SCT] patients with graft-versus-host disease [GvHD]. Retrospective, comparative, single-center. Forty-two patients receiving high-dose prednisone for GvHD after allo-SCT had LAmB prophylaxis; 83 patients in the control group received other antifungal prophylaxis. In the LAmB prophylaxis group, the median duration of treatment was 7 weeks. The cumulative incidence of invasive fungal infection was 8% at 1 year after transplantation, 8% at 2 years and 16% at 3 years in the LAmB group vs. 36% at 1 year, 44% at 2 years and 49% at 3 years in the other prophylaxis group [P=.008]. Fungal infection-related mortality after transplantation was observed in none of the patients in the LAmB prophylaxis group vs. 12 patients [14%] at 1 year, 14 patients [17%] at 2 years and 16 patients [19%] at 3 years in the control group [P = .005]. The tolerance of the treatment was good with only 5 patients [12%] having a reversible nephrotoxicity leading to temporary treatment discontinuation. High-dose LAmB prophylaxis seems effective and well tolerated in this short series of allo-SCT patients with GvHD. Prospective clinical studies are required to confirm these results