Clinical Experience With Amphotericin B in Acute Myelogenous Leukemia

Rs, Stein; Jp, Greer; Ferrin, W; R, Lenox; Mr, Baer; Jm, Flexner

doi:10.1097/00007611-198607000-00020

Cited by 17 publications

(4 citation statements)

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“…The rationale is to start treatment before it is too late—that is, before death is inevitable—as it is difficult to diagnose an invasive fungal infection with certainty 4 6. Studies with historical controls have shown a positive effect of antifungal agents on mortality,3 7 but such non-randomised comparisons substantially overestimate the effect of cancer treatments 8. Randomised studies have yielded varying results, and the power of most of them has been very low.…”

Section: Introductionmentioning

confidence: 99%

Meta-analysis of prophylactic or empirical antifungal treatment versus placebo or no treatment in patients with cancer complicated by neutropenia

Gøtzsche

Johansen

1997

BMJ

105

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Objective: To assess the impact of handling patients and indicators of individual susceptibility on risk of low back pain in nurses. Design: Prospective cohort study with follow up by repeated self administered questionnaires every three months over two years. Setting: NHS university hospitals trust. Subjects: 961 female nurses who had been free from low back pain for at least one month at the time of completing a baseline questionnaire. Main outcome measures: Incidence of new low back pain during follow up and of pain leading to absence from work.

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Section: Introductionmentioning

confidence: 99%

Meta-analysis of prophylactic or empirical antifungal treatment versus placebo or no treatment in patients with cancer complicated by neutropenia

Gøtzsche

Johansen

1997

BMJ

105

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“…Invasive pulmonary aspergillosis is a potentially lifethreatening complication among immunocompromised patients, especially neutropenic patients with leukemia and lymphoma and bone marrow transplant recipients (2,3,11,16,19,22). Despite efforts to improve diagnosis (5,10,14,23,26) and treatment (8,12,13,17) over the past few decades, early diagnosis is still difficult and treatment often fails.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who develop aspergillosis may experience a recurrence of the infection during a subsequent period of immunosuppression. This is most often seen in patients with leukemia who require serial courses of induction chemotherapy (8,16,18,22).…”

mentioning

confidence: 99%

Model of recurrent pulmonary aspergillosis in rats

et al. 1991

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Male Sprague-Dawley rats were treated with cortisone acetate and fed a low-protein diet for 3 weeks. At the end of week 2, animals were infected intratracheally with 10(5) conidia of Aspergillus fumigatus H11-20. Despite discontinuation of steroids and the low-protein diet 1 week after the infection, 94% of controls died of invasive pulmonary aspergillosis within 3 weeks postinfection. When rats were treated with a single dose of 1.6 mg of aerosolized amphotericin B per kg of body weight 48 h prior to the infection, mortality was reduced to 11% within 3 weeks postinfection. Despite apparent good health and rapid weight gain, all survivors showed multiple lesions in histopathological sections of the lungs, and 10(3) to 10(4) CFU of aspergilli was recovered from cultures of their lungs. With discontinuation of immunosuppression, the infection was slowly cleared; however, when cortisone acetate was restarted during week 5, reactivation of progressive invasive pulmonary aspergillosis was observed. On the basis of these results, we conclude that a single low dose of aerosolized amphotericin B prophylaxis is effective in preventing an exogenous aspergillus infection of the lung. Additional therapy is needed to prevent recurrent infection caused by endogenous aspergilli when immunosuppression is resumed.

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“…Studies with historical controls have shown a positive e ect of antifungal agents on mortality (Stein 1986;Walsh 1991) but such non-randomised comparisons have been shown to overestimate the e ect of cancer treatments considerably (Berlin 1989). We performed a meta-analysis of trials in which commonly used antifungal agents were compared with an untreated control group.…”

Section: B a C K G R O U N Dmentioning

confidence: 99%