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Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients

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Abstract

To determine the value of aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis (IPA), we initiated a prospective randomized multicenter trial. The scheduled intent-to-treat interim analysis included 115 patients (30%) with prolonged neutropenia after chemotherapy for acute myeloid leukemia, acute lymphoblastic leukemia/high-grade non-Hodgkin's lymphoma, or solid tumors undergoing autologous stem cell transplantation. Sixty-five patients had been randomized to receive prophylactic aerosol amphotericin B inhalations at a dose of 10 mg twice daily (group A); for the remaining 50 patients no aerosol amphotericin B prophylaxis was used (group B). No serious side effects from amphotericin B inhalations occurred, but coughing (54%), bad taste (51%), and nausea (37%) caused early cessation of aerosol amphotericin B prophylaxis in 23% (15/65) of courses. In group A, the incidence of proven, probable, or possible IPA was 5% (3/65) as compared with 12% (6/50) in group B (p>0.05). Microbiologically documented bacterial pneumonias were observed in 5/65 (8%) patients in group A and in 1/50 (2%) patients in group B (p>0.05). Thus, no reduction in incidence of IPA from use of prophylactic aerosol amphotericin B inhalations was found in this interim analysis. As there were no serious side effects from aerosol amphotericin B prophylaxis, accrual in the study will continue for a total of 380 patients.

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Author notes

  1. G. F. Behre

    Present address: Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts University School of Medicine and New England Medical Center, 750 Washington St., Box 68, 02111, Boston, MA, USA

Authors and Affiliations

  1. Department of Hematology/Oncology, University Hospital Göttingen, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany

    G. F. Behre, W. Treder & W. Hiddemann

  2. Department of Hematology/Oncology, University Hospital Benjamin-Franklin, Hindenburgdamm 30, D-12200, Berlin, Germany

    S. Schwartz

  3. Department of Hematology/Oncology, University Hospital Rudolf-Virchow, Spandauer Damm 130, D-14050, Berlin, Germany

    K. Lenz, O. Boenisch, W. Siegert & J. Beyer

  4. Department of Hematology/Oncology, Robert Rössle Clinic, University Hospital Rudolf-Virchow, Lindenburger Weg 80, D-13122, Berlin, Germany

    W. -D. Ludwig

  5. Department of Hematology/Oncology, Community Hospital Nuremberg, Flurstrasse 17, D-90340, Nuremberg, Germany

    H. Wandt

  6. Department of Hematology/Oncology, Community Hospital Neukölln, Rudower Strasse 48, D-12313, Berlin, Germany

    E. Schilling

  7. Department of Hematology/Oncology, University Hospital Großhadern, Marchioninistrasse 15, D-81366, Munich, Germany

    V. Heinemann

  8. Department of Hematology/Oncology, Hannover Medical School, Konstanty Gutschow Strasse 8, D-30623, Hannover, Germany

    H. Link

  9. Department of Hematology/Oncology, University Hospital Charité, Schumannstrasse 20-21, D-10117, Berlin, Germany

    A. Trittin

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  1. G. F. Behre
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  2. S. Schwartz
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  3. K. Lenz
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  5. H. Wandt
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  6. E. Schilling
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  7. V. Heinemann
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  8. H. Link
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  9. A. Trittin
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  10. O. Boenisch
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  11. W. Treder
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  12. W. Siegert
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  13. W. Hiddemann
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Behre, G.F., Schwartz, S., Lenz, K. et al. Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients. Ann Hematol 71, 287–291 (1995). https://doi.org/10.1007/BF01697981

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  • DOI: https://doi.org/10.1007/BF01697981

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