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Response to Dr Furebring

Bone Marrow Transplantation volume 25, pages 342–343 (2000)Cite this article

Dr Furebring and co-workers have reported the lowest incidence found to date of side-effects using amphotericin B lipid complex (Abelcet) in 21 mainly Scandinavian patients, where the drug was discontinued in only one (5%) due to painful infusion-related paraesthesia in the hands and arms. In contrast, our study at Huddinge Hospital, Huddinge, Sweden, and at Rigshospitalet, Copenhagen, Denmark, showed that Abelcet had to be discontinued in 14/19 (74% of the patients) due to side-effects. Two patients developed life-threatening toxicity. Most reports have shown fewer side-effects from Abelcet, in accordance with the report from Uppsala.123 This might indicate that Abelcet is a uniformly safe drug with little toxicity. However, severe side-effects have also been noted by other clinicians, although not yet reported. For instance, Dr Mineishi and colleagues from Japan have seen liver failure with Abelcet (personal communication). Since only a few patients have been reported by single centres, the high variability of side-effects from Abelcet may be due to chance. However, recently, a randomized study was presented at ‘The Focus on Fungal Infections’ Meeting in San Diego in March this year.4 The head-to-head study compared 5 mg/kg/day of Abelcet with both 3 mg/kg/day and 5 mg/kg/day of AmBisome in 244 evaluable patients. AmBisome was significantly safer at both dose levels than Abelcet regarding nephrotoxicity and acute, infusion-related reactions, such as chills and rigors, fever and hypoxia. The drug was discontinued due to toxicity in 21 (13%) of the AmBisome-treated patients, compared to 25 (32%) of the Abelcet patients. These 32% are between the 5% reported by the Uppsala group and the 74% in our patients.

Regarding the specific comments about our study, renal toxicity in 12/19 Abelcet patients was defined as an increase of >100% from the pre-Abelcet serum creatinine level. None of our patients had received amphotericin B treatment prior to Abelcet unlike the situation in other reported studies, where most of the patients received conventional amphotericin B before treatment with Abelcet.123 It is probable that this influenced the evaluation of side-effects in the other patients. Compared to the toxicity seen with amphotericin B treatment, side-effects from Abelcet are probably better tolerated by patients and staff. We are used to treatment with AmBisome upfront and compared Abelcet with that experience.56 All of our patients were given a test dose of 1 mg Abelcet, according to the manufacturer's instructions, and no patient reacted to this. Despite this, severe reactions were seen when Abelcet was infused. We did not use a ‘toxic batch’, because the Abelcet batch used by us was re-tested by the Liposome Company and found to be satisfactory.

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References

  1. Mehta J, Kelsey S, Chu P et al. Amphotericin B complex (ABLC) for the treatment of confirmed or presumed fungal infections in immunocompromised patients with hematologic malignancies Bone Marrow Transplant 1997 20: 39–43

    Article  CAS  Google Scholar 

  2. Wingard JR . Efficacy of amphotericin B lipid complex injection (ABLC) in bone marrow transplant recipients with life-threatening systemic mycoses Bone Marrow Transplant 1997 19: 343–347

    Article  CAS  Google Scholar 

  3. Cook G, Franklin IM . Adverse drug reactions associated with the administration of amphotericin B lipid complex (Abelcet) Bone Marrow Transplant 1999 23: 1325–1326

    Article  CAS  Google Scholar 

  4. Wingard JR, White MH, Anaissie EJ et al . A randomized double-blind comparative safety trial of AmBisome and Abelcet in febrile neutropenic patients. Focus on fungal infections, 17–19 March 1999, Abstr. 015

  5. Ringdén O, Andström E, Remberger M et al. Safety of liposomal amphotericin B (AmBisome) in 187 transplant recipients treated with cyclosporin Bone Marrow Transplant 1994 14: (Suppl. 5) S10–S14

    PubMed  Google Scholar 

  6. Ringdén O, Andström E, Remberger M et al. Allergic reactions and other rare side-effects of liposomal amphotericin Lancet 1994 344: 1156–1157

    Article  Google Scholar 

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  1. Centre for Allogeneic Stem Cell Transplantation and Depts of Clinical Immunology and Transplantation Surgery, Huddinge Hospital, F79, Huddinge, SE-141 86, Sweden

    O Ringdén & J Tollemar

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  1. O Ringdén
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Ringdén, O., Tollemar, J. Response to Dr Furebring. Bone Marrow Transplant 25, 342–343 (2000). https://doi.org/10.1038/sj.bmt.1702157

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