415. Feasibility of Aerolized Amphotericin B Lipid Complex (ae-ABLC) Therapy in Cancer Patients with Pulmonary Fungal Infections
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: In severely immunosuppressed patients with cancer or post stem cell transplantation (SCT) pulmonary fungal infections (PFI) remain as life-threatening complication. Although ae-ABLC has been effective in preventing PFI in patients undergoing heart-lung transplantation; its role in the treatment of such infections in cancer patients remains uncertain. We sought to evaluate feasibility of ae-ABLC in our tertiary cancer center.
Methods: Thirty-two patients who had received ≥2 doses of ae-ABLC therapy during 2006 - 2008 were evaluated. Safety and efficacy were considered at the end of therapy (EOT). Outcome was defined as complete/ partial clinical response (CR/PR) and failure (FL). Values are given as median ± s.d.
Results: Age was 56 ± 16 years; 75% had Leukemia (AML 56%) and 53% were in complete remission or stable disease. Seventeen (53%) received an Allogeneic-HSCT [185 ± 424 days]. Thirteen (41%) had history of renal failure and 12 (38%) had received high-dose of systemic steroids for 10 ±14 days before ae-ABLC. Neutropenia prior ae-ABLC was seen in 63% and APACHE II score was 15 ± 4. For type of Infections see table. Twenty-five (75%) patients received non-inhaled antifungal therapy prior ae-ABLC for 21±19 days. ae-ABLC was given in 75% of the patients as 50mg twice a day and cumulative dose was 1050 ± 2368 mg at EOT. ae-ABLC therapy duration was 15 ± 43 days and was given in combination with others antifungal drugs (Amphotericin B - 9 [28%]; Azoles and /or Echinocandins - 23 [72%]). High-dose of systemic steroids during treatment was given to 28% of the patients. Sixteen (50%) of the cases achieved CR/PR at EOT. Three (9%) reported side effects (cough, wheezing, nauseas, vomit and chest pain) that resulted in discontinuation of ae-ABLC.
Conclusions: Aerolized ABLC was tolerated without serious adverse events. It may provide an alternative route of drug administration in cancer patients.
Type of Infections
Total (%)32 (100)
Possible fungal pneumonia19 (59)
Probable fungal pneumonia9 (28)
Aspergillus spp.6 (19)
Basidiomycetes spp.1 (3)
Rhizomucor1 (3)
S. prolificans / Fusarium spp.1 (3)
Proven fungal sinusitis/pneumonia:Aspergillus spp/ Fusarium spp2 (6)
Disseminated Fungemias:C. parapsilopsis / C. glabrata2 (6)
Vijayashri Rallapalli, MD, University of Texas, Houston / M.D. Anderson Center, Houston, TX, Gilhen Rodriguez, MD, Amar Safdar, MD, MD Anderson Cancer Center, Houston, TX and  G. Rodriguez, None..
V. Rallapalli, None..
A. Safdar, None.