Assessment of nephrotoxicity of high-cumulative dose of liposomal amphotericin B in a pediatric patient who underwent allogeneic bone marrow transplantation

• Published in: Pediatric transplantation Vol. 10; no. 2; pp. 255 - 258
• Main Authors: Cesaro, Simone, Zignol, Matteo, Burlina, Alberto B., Tridello, Gloria, Visintin, Gianluca, Messina, Chiara
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01-03-2006; Blackwell
• Subjects: adrenoleucodystrophy; Adrenoleukodystrophy - surgery; AmBisome; Amphotericin B - administration & dosage; Amphotericin B - adverse effects; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antifungal Agents - administration & dosage; Antifungal Agents - adverse effects; Biological and medical sciences; bone marrow transplantation; Bone Marrow Transplantation - immunology; Bone marrow, stem cells transplantation. Graft versus host reaction; Candidiasis - prevention & control; Child; Creatinine - blood; Disease Progression; Epstein-Barr Virus Infections; Errors of metabolism; Fatal Outcome; fungal infection; Graft vs Host Disease - etiology; Graft vs Host Disease - prevention & control; Humans; Kidney - drug effects; Kidney Diseases - chemically induced; Lipids (lysosomal enzyme disorders, storage diseases); liposomal amphotericin B; Liposomes; Lymphoma - therapy; Lymphoma - virology; Male; Medical sciences; Metabolic diseases; Pseudomonas Infections - prevention & control; Shock, Septic - microbiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; T-Lymphocytes, Cytotoxic; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation Conditioning; Endocrinopathy; Sex linked character; Pediatrics; Mycosis; Toxicity; Stem cell; Hematopoietic cell; Homograft; Bone marrow transplantation; Lipids; Sphingolipidosis; Cumulated dose; Enzymopathy; Antiprotozoal agent; Antifungal agent; fungal infection; adrenoleucodystrophy; Adrenal gland diseases; Bone marrow; Lipoidosis; High dose; Child; Human; Kidney disease; liposomal amphotericin B; Nervous system diseases; Urinary system disease; Liposome; Metabolic diseases; Patient; Ambisome; Cerebral disorder; Genetic disease; Infection; Antibiotic; Adrenoleukodystrophy; Amphotericin B; Polyenic compound; Central nervous system disease; Parasiticide
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2005.00434.x

:  We describe a 9‐yr‐old boy who received the highest cumulative dose so far reported of liposomal amphotericin B.The patient underwent an allogeneic bone marrow transplantation (BMT) for adrenoleucodystrophy, after a conditioning regimen with busulfan, thiothepa and cyclophosphamide. Rabbit antithymoglobulin, cyclosporin and prednisone were used as prophylaxis against graft vs. host disease (GVHD). Post‐transplant Epstein–Bar‐virus‐related lymphoma was diagnosed on day +68 and was treated with donor‐derived lymphocytes. The patient developed a severe form of GVHD, and a progressive worsening of his neurological status because of progression of his underlying disease. Death from septic shock occurred 23 months after BMT. During prolonged hospitalization, 19 750 mg of liposomal amphotericin B, about 1000 mg/kg, were given for prophylactic or empirical therapeutic purposes without significant nephrotoxicity. This case suggests that liposomal amphotericin B is safe and well‐tolerated even if is administered for long periods and a cumulative dose fivefold greater than the nephrotoxic threshold of amphotericin B deoxycholate is achieved.