Table 2.
Characteristics of Liposomal Amphotericin B Prophylaxis Courses
| Characteristic | Total Coursesa, n = 273 (%) |
|---|---|
| Status of Hematological Disease at Start of L-AMB Prophylaxis | |
| New diagnosis, no prior treatment | 123 (45) |
| Active diseaseb | 110 (40) |
| Relapsed disease | 40 (15) |
| Presence of neutropenia (<0.5 × 109/L) at start of L-AMB prophylaxis | 237 (87) |
| Neutrophil count, mean ± SD | 0.2 ± 0.15 |
| Of Those Neutropenic, Duration of Neutropenia | |
| >5 weeks | 46 (19) |
| 3–5 weeks | 62 (26) |
| 7 days–3 weeks | 103 (43) |
| <7 days | 26 (11) |
| L-AMB continued despite neutrophil count recovery | 23 (8.4) |
| Additional days of L-AMB prophylaxis, median (IQR) | 10 (5–19) |
| Indication for L-AMB prophylaxis (may be >1) | |
| Chemotherapy regimens contraindicating azole use | 206 (75) |
| ALL on vincristine in 93, dasatinib in 1 | 94 (46) |
| Enrolled in clinical trialc | 80 (39) |
| APML in cycle 1 | 16 (7.8) |
| Burkitt’s lymphoma on CODOX-M/IVAC | 6 (2.9) |
| NHL on hyperCVAD regimen | 6 (2.9) |
| CML on vincristine (n = 2) or dasatinib (n = 1) | 3 (1.5) |
| Blastic plasmacytoid dendritic cell neoplasm on hyperCVAD | 1 (0.5) |
| Gastrointestinal absorption concerns | 35 (13) |
| Gastrointestinal GVHD | 28 (82) |
| Mucositis | 6 (18) |
| CMV colitis | 1 (2.9) |
| Liver function derangement | 24 (8.8) |
| Allergy or intolerance to azolesd | 7 (2.6) |
| Drug interaction outside cytotoxic therapies | 3 (1.1) |
| Secondary prophylaxis for IFDe | 2 (0.73) |
| Dose and duration of prophylaxis courses | |
| Duration in days of L-AMB prophylaxis per course, median (IQR) | 16 (10–27) |
| Number of doses of L-AMB per course, median (IQR) | 7 (5–11) |
| Cumulative L-AMB dose per course adjusted for patient weight (mg/kg), median (IQR) | 8.6 (5.4 – 14) |
Abbreviations: ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; APML, acute promyelocytic leukemia; CML, chronic myeloid leukemia; L-AMB, liposomal amphotericin B; CMV, cytomegalovirus; CODOX-M/IVAC, cyclophosphamide, vincristine, doxorubicin, high-dose methotrexate; GVHD, graft versus host disease; hyperCVAD, cyclophosphamide, vincristine, doxorubicin, dexamethasone, methotrexate, cytarabine; IFD, invasive fungal disease; IQR, interquartile range; IVAC, ifosfamide, etoposide, high-dose cytarabine; NHL, non-Hodgkin lymphoma; SD, standard deviation.
aCourse defined as receipt of at least 3 alternate day doses of L-AMB for prophylaxis.
bActive disease defined as partial remission, progressive or refractory disease.
cUnderlying hematological malignancy in trial episodes: AML n = 74, ALL and myelodysplasia n = 2 each, CML and multiple myeloma n = 1 each.
dHallucinations to voriconazole in 4, unspecified allergy in 2, nausea in 1 course.
eTwo patients had 2 courses of L-AMB as secondary prophylaxis for previous possible and proven IFD, respectively. Neither of these patients developed breakthrough IFD while on L-AMB prophylaxis.