Laura Ferreras-Antolin (United Kingdom)
ST GEORGE'S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST Paediatric Infectious DiseasesAuthor Of 1 Presentation
ANTIFUNGAL PROPHYLAXIS WITH LIPOSOMAL AMPHOTERICIN B (LAMB) IN PAEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL) DURING INDUCTION PHASE
Abstract
Backgrounds:
LAMB prophylaxis was started for ALL patients during induction chemotherapy in our institution secondary to an increased incidence of IFD (Invasive Fungal Disease). LAMB was chosen in view of the less pharmacological interactions with vincristine and its easy delivery in the community. Our study aimed to review the effectiveness and safety of this measure.
Methods
Retrospective single centre descriptive study from April 2019 to April 2020. ALL paediatric patients (<18 years) started on 2.5mg/kg twice a week intravenous LAMB during the induction phase of chemotherapy (UKALL11) were included. Toxicity, allergic/infusion reactions and breakthrough IFDs were recorded.
Results:
41 patients were included (23 male). Median age was 4.4 years (IQR 3.3-6.9). Disease profile was: B-ALL (34/41), T-ALL (2/41), Ph-ALL (2/41), ABL fusion (1/41), relapsed ALL(1/41). 38/41 patients received LAMB prophylaxis; for the remaining 3/41, LAMB was early discontinued (two cases due to allergic reactions to the testing dose and one case of possible IFD at day three of induction). A total of 23/38 (60.5%) patients presented deranged (grade 3 or 4) biochemistry results while receiving LAMB prophylaxis: hypokalemia (3/38), deranged ALT (23/38) and hyperbilirubinemia (1/38); no patients presented raised creatinine or hypomagnesemia. Only in one case, toxicity was attributed to LAMB and led to drug discontinuation. A total of 5/41(12%) patients presented allergic/infusion reactions: in three, this led to LAMB discontinuation (2/5 after the test dose and one case during the 4th week of prophylaxis). From the 5/41(12%) cases who had LAMB prophylaxis discontinued, 4 were changed to caspofungin and one started on LAMB treatment.
Conclusions/Learning Points:
In our experience prophylactic intravenous LAMB presented a good safety profile. Allergic/infusion reactions wer the main reason for withdrawal. No breakthrough infections were identified.
Presenter of 1 Presentation
ANTIFUNGAL PROPHYLAXIS WITH LIPOSOMAL AMPHOTERICIN B (LAMB) IN PAEDIATRIC PATIENTS WITH ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL) DURING INDUCTION PHASE
Abstract
Backgrounds:
LAMB prophylaxis was started for ALL patients during induction chemotherapy in our institution secondary to an increased incidence of IFD (Invasive Fungal Disease). LAMB was chosen in view of the less pharmacological interactions with vincristine and its easy delivery in the community. Our study aimed to review the effectiveness and safety of this measure.
Methods
Retrospective single centre descriptive study from April 2019 to April 2020. ALL paediatric patients (<18 years) started on 2.5mg/kg twice a week intravenous LAMB during the induction phase of chemotherapy (UKALL11) were included. Toxicity, allergic/infusion reactions and breakthrough IFDs were recorded.
Results:
41 patients were included (23 male). Median age was 4.4 years (IQR 3.3-6.9). Disease profile was: B-ALL (34/41), T-ALL (2/41), Ph-ALL (2/41), ABL fusion (1/41), relapsed ALL(1/41). 38/41 patients received LAMB prophylaxis; for the remaining 3/41, LAMB was early discontinued (two cases due to allergic reactions to the testing dose and one case of possible IFD at day three of induction). A total of 23/38 (60.5%) patients presented deranged (grade 3 or 4) biochemistry results while receiving LAMB prophylaxis: hypokalemia (3/38), deranged ALT (23/38) and hyperbilirubinemia (1/38); no patients presented raised creatinine or hypomagnesemia. Only in one case, toxicity was attributed to LAMB and led to drug discontinuation. A total of 5/41(12%) patients presented allergic/infusion reactions: in three, this led to LAMB discontinuation (2/5 after the test dose and one case during the 4th week of prophylaxis). From the 5/41(12%) cases who had LAMB prophylaxis discontinued, 4 were changed to caspofungin and one started on LAMB treatment.
Conclusions/Learning Points:
In our experience prophylactic intravenous LAMB presented a good safety profile. Allergic/infusion reactions wer the main reason for withdrawal. No breakthrough infections were identified.