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Clinical value of empirical amphotericin B in patients with acute myelogenous leukemia
Author(s) -
Stein Richard S.,
Kayser Jay,
Flexner John M.
Publication year - 1982
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19821201)50:11<2247::aid-cncr2820501102>3.0.co;2-7
Subject(s) - medicine , amphotericin b , incidence (geometry) , pneumonia , antibiotics , leukemia , mortality rate , acute leukemia , chemotherapy , surgery , antifungal , dermatology , physics , microbiology and biotechnology , optics , biology
From August 1977 to October 1978, 23 patients with acute myelogenous leukemia (AML) received induction therapy at Vanderbilt University Hospital. Six patients died of documented fungal infection, predominantly aspergillus pneumonia; the complete remission rate was only 40%. Based on this experience we began using amphotericin B empirically in any AML patient remaining febrile or having recurrent fever after a week of broad spectrum antibiotics. Of 22 patients treated from October 1978 to August 1980, none died of fungal infection during induction therapy; the remission rate increased significantly to 77%. Chemotherapy and supportive care were otherwise unchanged during this period. While the first group was older, the improvement in remission rate was also seen in patients younger than 60 years of age. Since fungal infection may be difficult to document, this study suggests that empirical amphotericin B is reasonable therapy in leukemic patients remaining febrile or having a recurrent fever following a week of broad spectrum antibiotics, if the institution has a high incidence of fungal infections.