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AmBisome (amphotericin B liposomal complex, L-Amb) is highly effective for the treatment of invasive fungal infections (IFI) and may be an important prophylactic drug in patients undergoing hematopoietic stem cell transplant (HSCT) . Several new anti-fungal drugs have become available over the past few years leading to various prospective studies aiming to assess the role of prophylaxis and treatment in IFI in HSCT. But drug related factors such as safety, efficacy, toxicity profile in the setting of pre-existing organ dysfunction and potential drug interaction, need to be considered.
Ambisome is a liposomal formulation containing amphotericin B and is comparatively found to cause fewer infusional reactions and achieve superior plasma and tissue concentrations.
To determine the optimal approach for prophylactic antifungal therapy, we prospectively analysed the efficacy and safety of low dose Ambisome, which is 1mg per kg body weight on alternate days in nineteen patients who underwent haematopoietic stem cell transplant at our institute, for the prophylaxis of IFI. This was a heterogeneous study group, having varied indications for transplant.
Results:- The low dose regimen of 1mg/kg body weight on alternate days was well tolerated. Four out of nineteen patients developed manageable hypokalaemia. No renal toxicity or infusional reactions were documented. However, a test dose was always administered. Only one patient having a T replete Haploidentical transplant for follicular lymphoma developed probable IFI requiring anti-fungal therapy.
Conclusion:- We conclude that low dose L-Amb may provide useful protection against invasive fungal infections in patients undergoing hematopoietic stem cell transplant.