Amphotericin B lipid complex for the treatment of presumed or confirmed fungal infections in immunocompromised patients with hematologic malignancies

Amphotericin B lipid complex (ABLC(TM), Abelcet®) allows delivery of higher doses of amphotericin with a better toxicity profile compared with the parent drug. Fifty-three adult patients with hematologic malignancies received 57 courses of ABLC at the daily dose of 5 mg/kg for presumed (n = 41) or proven (n = 16) fungal infection. The usual indication for the use of ABLC was failure of previous antifungal therapy with or without renal dysfunction. Forty-six treatment courses in 42 patients comprising 4-58 doses (median 10.5) were considered evaluable (24 doses). Fifteen courses administered for confirmed infections resulted in 8 complete responses, 2 almost complete responses, 1 partial response and 4 failures (73% response rate). Thirty-one empiric courses resulted in 13 complete responses, 6 partial responses and 12 failures (61% response rate). The overall response rate was 65%. Response was seen in 5 of 7 patients with aspergillus pneumonia. Response rates were comparable for chemotherapy, autograft and allograft recipients. The serum creatinine increased by ≤ 50% during 16 evaluable courses of therapy, but 12 of these were associated with concomitant nephrotoxic therapy, and renal dysfunction necessitated discontinuation of ABLC in only 3 patients. We conclude that ABLC is effective for the treatment of presumed or confirmed fungal infections in immunocompromised patients who have failed therapy with conventional amphotericin or fluconazole, or whose renal function is compromised.