A benefit for renal function after early switch to liposomal amphotericin B from conventional formulation in empirical antifungal treatment

Sir, Despite its nephrotoxicity, conventional amphotericin B (CAB) is commonly prescribed in immunosuppressed patients because of its lower cost. As a consequence, the rate of nephrotoxicity in haematological patients treated with CAB is 61% for allogeneic stem-cell transplantations and 80% for autologous stem-cell transplantations [1,2]. The study of Meunier et al. [3] demonstrated improvement in renal function after switching from CAB to liposomal amphotericin B (L-AmB). However, there is no consensus on the level of nephrotoxicity in haematological patients that would require a switch to other antifungal treatment. We hypothesized that an early switch to the less nephrotoxic L-AmB, at time when nephrotoxicity is still moderate would avoid more severe nephrotoxicity. In patients with neutropenia and increasing creatinine, we compared two strategies for switching drug regimens. Patients were eligible for the study if they were 18–75 years old, received an induction or consolidation chemotherapy treatment for haematological malignancy with an expected neutropenia (<500/mm3) of at least 10 days, treated empirically with CAB, had a sCr <110 µmol/l and a calculated sCr clearance ≥60 ml/min. Patients were excluded in the case of allogeneic stem cell (or solid organ) transplantation or diagnosis of fungal infection.