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Post-Transplant Events

High-dose weekly liposomal amphotericin B antifungal prophylaxis following reduced-intensity conditioning allogeneic stem cell transplantation

Bone Marrow Transplantation volume 39, pages 301–306 (2007)Cite this article

Abstract

The use of high-dose corticosteroids for graft-versus-host disease (GVHD) treatment represents a major risk factor for long-term invasive fungal infections. The aim of this study was to investigate the safety and tolerance of weekly prophylactic administration of once-weekly high-dose (7.5 mg/kg) of liposomal amphotericin B (L-AmB) therapy in 21 adult patients receiving high-dose prednisone (2 mg/kg/day) for acute GVHD therapy after reduced intensity conditioning (RIC) allogeneic stem cell transplantation (allo-SCT). Patients received a median of 4 (range, 1–8) infusions of L-AmB. Seven patients (33%; 95% confidence intervals (CI), 13–53%) discontinued taking the study drug owing to study drug-related adverse events, including elevated serum creatinine (>1.5 times from baseline values; n=5), hypotension and pain (n=1), and violent chest pain and arrhythmia (n=1). The overall frequency of infusion-related reactions was 29% (n=6; 95% CI, 10–48%), but these reactions were always transient and relieved by stopping the infusion. This safety data provide support for an efficacy study of this prophylaxis strategy, because this may help further improving the outcome of RIC or nonmyeloablative allo-SCT.

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Acknowledgements

‘GILEAD Sciences’ (Paris, France; Dr L Mahi and Dr F Monchecourt) provided some support for this study, but did not participate in study design, definition or data analysis. We thank the nursing staff for providing excellent care for our patients, and the physicians of the Haematology and Oncology Departments at the Institut Paoli-Calmettes for their important study contributions and dedicated patient care. We also thank the ‘Association pour la Recherche sur le Cancer (ARC; ARECA Pole)’, the ‘Ligue Nationale contre le Cancer’, the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’, and the ‘Association Laurette Fuguain’ for their generous and continuous support for our clinical and basic research work. Our group is supported by several grants from the French ministry of health as part of the ‘Programme Hospitalier de Recherche Clinique (PHRC)’.

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Authors and Affiliations

  1. Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France

    J El-Cheikh, C Faucher, S Fürst, D Blaise & M Mohty

  2. Département d'Hématologie, Institut Paoli-Calmettes, Marseille, France

    J El-Cheikh, C Faucher, S Fürst, N Vey, A-M Stoppa, R Bouabdallah, J-A Gastaut, D Blaise & M Mohty

  3. Pharmacie Centrale, Institut Paoli-Calmettes, Marseille, France

    S Duran

  4. Département de Microbiologie, Institut Paoli-Calmettes, Marseille, France

    P Berger

  5. Université de la Méditerranée, Marseille, France

    J-A Gastaut, P Viens, D Blaise & M Mohty

  6. Département d'Oncologie Médicale, Institut Paoli-Calmettes, Marseille, France

    P Viens

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  1. J El-Cheikh
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Correspondence to M Mohty.

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El-Cheikh, J., Faucher, C., Fürst, S. et al. High-dose weekly liposomal amphotericin B antifungal prophylaxis following reduced-intensity conditioning allogeneic stem cell transplantation. Bone Marrow Transplant 39, 301–306 (2007). https://doi.org/10.1038/sj.bmt.1705592

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  • DOI: https://doi.org/10.1038/sj.bmt.1705592

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