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Efficacy and feasibility of aerosolized amphotericin B lipid complex therapy in caspofungin breakthrough pulmonary zygomycosis

Bone Marrow Transplantation volume 34, pages 467–468 (2004)Cite this article

Mucorales infections have recently re-emerged as serious, life-threatening (∼80% mortality) opportunistic complications in patients with leukemia, severe prolonged granulocytopenia, and in recipients of allogeneic hematopoietic stem cell transplants (HSCT).1, 2 High-dose amphotericin B, surgical excision of necrotic infected tissue when possible, and most importantly, restoration of immune dysfunction are critical for satisfactory resolution of infection. Treatment options for patients unable to receive amphotericin B are limited, albeit preliminary clinical experience with the investigational agent posaconazole (SCH-56592) was recently reported as promising.3 We present a patient with pulmonary zygomycosis, who developed nephrotoxicity with polyene-based antifungal therapy and responded to inhaled amphotericin B.

A 61-year-old man with refractory chronic lymphocytic leukemia (CLL) developed fever, productive cough, and modest respiratory distress while receiving salvage therapy (IDEC-152, a monocolonal antibody to CD23). Prior therapy included chlorambucil, fludarabine and cyclophosphamide. At 30 months prior to presentation, he underwent allogeneic nonmyeloablative stem cell transplantation from a HLA-identical donor. Pre-transplant conditioning consisted of fludarabine (30 mg/m2), cyclophosphamide (750 mg/m2), each given daily for 3 days. In addition, rituximab (375 mg/m2) was given 13 days prior to stem cell transfusion, followed by 1000 mg/m2 in weekly three doses. At 16 months post transplant, the patient received donor lymphocyte infusion for persistent disease; this was complicated by graft-versus-host diseases of skin and gastrointestinal tract, and responded to systemic corticosteroid therapy.

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  1. The University of Texas, MD, Anderson Cancer Center, Houston, USA

    A Safdar, S O'Brien & I F Kouri

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  3. I F Kouri
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Safdar, A., O'Brien, S. & Kouri, I. Efficacy and feasibility of aerosolized amphotericin B lipid complex therapy in caspofungin breakthrough pulmonary zygomycosis. Bone Marrow Transplant 34, 467–468 (2004). https://doi.org/10.1038/sj.bmt.1704552

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