NEW ORLEANSHigh doses of liposomal amphotericin B are no more
effective than low doses in the treatment of invasive aspergillosis
in neutropenic patients, European researchers reported at the
Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Michael Ellis, of the HCI Internal Medicine Center, Glasgow, gave
an interim analysis of the first 70 of 119 neutropenic cancer
patients from 18 European institutions.
Patients received either low-dose (1 mg/kg) or high-dose (4 mg/kg)
liposomal amphotericin B for a median of 20 and 19 days, and a total
of 1,260 mg and 4,020 mg of drug, respectively.
Age, sex, performance status, and underlying disease were similar for
the two groups. Definite invasive disease was present in 31% of
low-dose and 23% of high-dose patients; all other cases were
presumptive. Aspergillus fumigatus was the most common pathogen, and
the lung was the most common site of infection, usually showing
multiple bilateral lesions.
At the end of treatment, a partial or complete clinical response was
seen in 68% of low-dose and 49% of high-dose patients. Radiologic
response was noted for 63% and 54%, respectively. Overall survival
was similar, as was mortality due to invasive aspergillosis (33%
low-dose; 28% high-dose). Mortality caused by underlying disease was
twice as high in the high-dose group, he said.