Early investigation and initiation of therapy for invasive pulmonary aspergillosis in leukaemic and bone marrow transplant patients

Barnes, A.J.; Oppenheim, B.A.; Chang, James; Morgenstern, G. R.; Scarffe, J. H.

doi:10.1046/j.1439-0507.1999.00483.x

Cited by 10 publications

(2 citation statements)

References 37 publications

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“…With regards to the poor prognosis, early diagnosis and treatment are mandatory [38]. All patients in this study had infiltrates detectable by conventional CXR.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Invasive Pulmonary Aspergillosis in Neutropenic Patients by Additional Bronchoscopic Amphotericin B Instillation

Winkler¹,

Müller²,

Nenoff³

et al. 2007

Respiration

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Background: Invasive pulmonary aspergillosis (IPA) remains a life-threatening condition despite systemic antifungal therapy. Objectives: This retrospective analysis investigated whether additional bronchoscopic instillation of amphotericin B (amB) would improve efficacy of antifungal treatment in patients with haematological malignancies suffering from IPA. Methods: Twenty patients (40.6 ± 14.2 years, 14 male) with preceding chemotherapy, bone marrow or stem cell transplantation complicated by severe IPA who did not respond sufficiently to systemic antifungal therapy were additionally treated by repeated bronchoscopic instillations of amB solution (91 instillations, on average 4.6 ± 2.2 instillations per patient over a period of 24.1 ± 21.0 days). Therapeutic response to this combined treatment regimen was monitored by chest X-ray and CT scan. Results: The mean infiltration sizes during systemic antifungal therapy alone (mean duration 11.9 ± 9.9 days) did not change significantly. However, after additional bronchoscopic instillation of amB solution infiltration sizes were reduced significantly (p < 0.05). A total resolution of infiltrates was seen in 3 and a partial reduction in 13 of 20 patients. Mean duration of total antifungal treatment was 50.1 ± 24.0 days. The mean follow-up period was 34.1 ± 31.2 months. The IPA-related mortality rate was 18.8% (3 of 16 patients). Conclusions: Additional bronchoscopic instillation of amB may improve the efficacy of systemic antifungal therapy in patients with haematological malignancies complicated by severe IPA. Bronchoscopic instillation of amB should be considered as an additional treatment option in cases with IPA unresponsive to systemic therapy.

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“…With regards to the poor prognosis, early diagnosis and treatment are mandatory [38]. All patients in this study had infiltrates detectable by conventional CXR.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Invasive Pulmonary Aspergillosis in Neutropenic Patients by Additional Bronchoscopic Amphotericin B Instillation

Winkler¹,

Müller²,

Nenoff³

et al. 2007

Respiration

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“…Gesicherte invasive Aspergillose ("proven") Die Kuhlman et al 1985Horvath et al 1996Blum et al 1994Caillot et al 1997Barnes et al 1999 Yeghen et al Typische CT bzw. MR-Befunde können bei einer zerebralen Aspergillose erhoben werden (Boes et al 1994, vgl …”

Section: Anhang _____________________________________________________unclassified

Aspergillose - Stand des Wissens zu Diagnose, Therapie, Umweltbedingungen - Ein Assessment. Endbericht

Wilhelm¹,

Jonas²,

Traunmüller³

et al. 2012

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Refractory Aspergillus pneumonia in patients with acute leukemia

Aliff

Maslak

Jurcic

et al. 2003

Cancer

214

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BACKGROUNDPulmonary aspergillosis and other invasive fungal infections (IFIs) commonly complicate the management of patients with acute leukemia. Standard amphotericin‐based therapies may be ineffective for many patients and the available salvage agents (itraconazole and caspofungin) are reported to possess only moderate activity against resistant infections. Laboratory evidence suggests a synergistic interaction between amphotericin and caspofungin. The authors treated a group of patients with amphotericin‐refractory IFIs with the combination of caspofungin and amphotericin (or liposomal amphotericin).METHODSA retrospective evaluation of patients with amphotericin‐resistant IFIs was conducted. Diagnosis was based on clinical, radiographic, and when available, microbiologic data. Response to combination antifungal therapy was graded as either favorable or unfavorable. Favorable responses included improvement of both clinical and radiographic signs of fungal pneumonia. All other responses were graded as unfavorable.RESULTSThirty patients were included in this analysis. Twenty‐six patients had acute leukemia. Based on recently published criteria, the IFIs were classified as proven in 6 patients, probable in 4 patients, and possible in 20 patients. The median duration and dose of amphotericin monotherapy were 12 days (range, 4–65 days) and 7.8 mg/kg (range, 4.2–66.1 mg/kg), respectively. The median duration of combination therapy was 24 days (range, 3–74 days). Eighteen patients (60%) experienced a favorable antifungal response. Twenty patients with acute leukemia received combination therapy for fungal pneumonias arising during intensive chemotherapy treatments. Favorable responses were observed in 15 of these patients (75%), and antifungal response did not depend on the response of the underlying leukemia. Survival to hospital discharge was significantly better (P < 0.001) in patients having a favorable response. Mild to moderate nephrotoxicity was noted in 50% of patients, necessitating the substitution of liposomal amphotericin. Mild elevation of alkaline phosphatase levels occurred in 30% of patients. Caspofungin was temporarily withheld from one patient who developed moderate but reversible biochemical hepatotoxicity.CONCLUSIONSThe antifungal combination of caspofungin and amphotericin can be administered safely to high‐risk patients with hematologic malignancies. Although an absolute assessment of efficacy is limited by the design of this study, encouraging outcomes were noted for many patients. The authors plan to evaluate this regimen further in a randomized clinical trial. Cancer 2003;97:1025–32. © 2003 American Cancer Society.DOI 10.1002/cncr.11115

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Early investigation and initiation of therapy for invasive pulmonary aspergillosis in leukaemic and bone marrow transplant patients

Cited by 10 publications

References 37 publications

Treatment of Invasive Pulmonary Aspergillosis in Neutropenic Patients by Additional Bronchoscopic Amphotericin B Instillation

Treatment of Invasive Pulmonary Aspergillosis in Neutropenic Patients by Additional Bronchoscopic Amphotericin B Instillation

Aspergillose - Stand des Wissens zu Diagnose, Therapie, Umweltbedingungen - Ein Assessment. Endbericht

Refractory Aspergillus pneumonia in patients with acute leukemia

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