412. Does the Combination of Lipid Formulation of Amphotericin B (L-AmB) and Echinocandins (ECH) Improve the Outcome of Invasive Aspergillosis (IA) in Hematologic Malignancy Patients (HMP)?
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: In vitro and in vivo studies suggested that the combination of L-AMB and ECH may have a synergistic or additive effect against Aspergillus. Furthermore, clinical studies suggested that the combination may improve response of IA.
Methods: Between August 1993 and June 2008 we identified a total of 554 HMP who received salvage therapy. Definite or probable IA was based on EROTC/MSG criteria. Clinical characteristics, response to salvage therapy and death up to 12 weeks after initiation of therapy were retrospectively determined on all patients.
Results: There were 88 HMP who received salvage therapy with L-AmB for IA, 28 patients received ECH alone (82% of whom received caspofungin) and 85 HMP received the combination (Combo) therapy of L-AmB+ECH (88% of whom received caspofungin). The three salvage treatment groups were comparable in terms of age, gender, pulmonary involvement, dissemination, underlying leukemia, history of stem cell transplantation (HSCT), graft-versus-host disease, duration of neutropenia and persistence of neutropenia. The response to salvage therapy was comparable for the three groups (16% L-AmB, 21% ECH, 25% for Combo). Furthermore, the three groups had a comparable rate of Aspergillus-related death (59%-65%) and overall death (73%-83%). In addition, death within 12 weeks of initiation of salvage therapy was comparable for all three groups (68% L-AmB, 54% ECH, and 60% Combo).
Conclusions: The combination of L-AmB and ECH 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 the HMP population.
Anne-Marie Chaftari, MD1, Ray Hachem, MD2, Christelle Kassis, MD1, Dimitrios Kontoyiannis, MD, ScD, FIDSA3, Coralia Mihu, MD1, Issam Raad, MD, Elizabeth Ramos, MD1 and  R. Hachem, None..
C. Mihu, None..
E. R. Ramos, None..
C. Kassis, None..
A. Chaftari, None. 
D. P. Kontoyiannis,
Merck, Inc. Role(s): Consultant, Investigator, Scientific Advisor (Review Panel or Advisory Committee), Speaker's Bureau, Received: Research Grant, Research Support, Speaker Honorarium, Consulting Fee.
Pfizer Pharmaceuticals, Inc. Role(s): Speaker's Bureau, Received: Speaker Honorarium.
Schering-Plough Research Institute Role(s): Consultant, Scientific Advisor (Review Panel or Advisory Committee), Received: Consulting Fee.
Enzon Role(s): Grant Investigator, Investigator, Speaker's Bureau, Received: Grant Recipient, Research Support, Speaker Honorarium.
Astellas Role(s): Investigator, Speaker's Bureau, Received: Grant Recipient, Speaker Honorarium.
I. I. Raad,
Cook, Inc. Role(s): Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Received: Educational Grant, Licensing Agreement or Royalty, Consulting Fee., (1)University of Texas, M.D. Anderson Cancer Center, Houston, TX, (2)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (3)The University of Texas M.D. Anderson Cancer Center, Houston, TX

Disclosures:

A. M. Chaftari, None

R. Hachem, None

C. Kassis, None

D. Kontoyiannis, None

C. Mihu, None

I. Raad, None

E. Ramos, None