Objective: To investigate the efficacy and safety of liposomal amphotericin B (L-AmB) for the salvage treatment of invasive fungal disease (IFD) in patients with hematological diseases. Methods: Data were retrospectively collected from 80 patients with hematological issues treated with L-AmB between June 2023 and December 2023 after failure of previous antifungal therapy. Baseline patient information, clinical efficacy, and factors affecting the efficacy of L-AmB were analyzed by logistic regression. Moreover, adverse effects associated with L-AmB were evaluated. Results: Among the 80 patients, 9 (11.2%) had proven IFD, 43 (53.8%) had probable IFD, and 28 (35.0%) had possible IFD. The efficacy rate of L-AmB salvage therapy for IFD was 77.5%, with a median daily dose of 3 (range: 1-5) mg·kg(-1)·d(-1) and a median dosing course of 14 (range: 8-25) days. Multivariate logistic regression analysis showed that the disease remission status (OR=4.337, 95% CI 1.167-16.122, P=0.029) and duration of medication (OR=1.127, 95% CI 1.029-1.234, P=0.010) were independent factors affecting the efficacy of L-AmB. The incidence of infusion reactions associated with L-AmB, including fever and chills, was 5.0%. The incidence of hypokalemia was 28.8% (predominantly grades 1-2), and the incidence of nephrotoxicity was 11.3% (predominantly grades 1-2) . Conclusion: L-AmB is safe and effective in the treatment of patients with IFD who are intolerant to or who have experienced no effect of previous antifungal therapy, with a low rate of adverse reactions.
目的： 探究两性霉素B脂质体（Liposomal amphotericin B，L-AmB）在血液病患者中挽救性治疗侵袭性真菌病（invasive fungal disease，IFD）的疗效及安全性。 方法： 回顾性收集既往抗真菌治疗失败后2023年6月至2023年12月期间于苏州弘慈血液病医院血液科接受L-AmB治疗的80例血液病患者资料。统计患者基本信息、临床疗效，应用Logistic回归分析影响L-AmB疗效的因素。 结果： 80例血液病患者中，确诊IFD 9例（11.2%），临床诊断IFD 43例（53.8%），拟诊IFD 28例（35.0%）。L-AmB挽救性治疗有效率为77.5%，中位每日剂量3（1~5）mg·kg(-1)·d(-1)，中位用药疗程14（8，25）d。多因素Logistic回归分析显示：疾病缓解状态（OR=4.337，95% CI 1.167~16.122，P=0.029）和用药疗程（OR=1.127，95% CI 1.029~1.234，P=0.010）是影响L-AmB疗效的独立因素。L-AmB相关输液反应包括发热和寒战（5.0%）。低钾血症发生率为28.8%，主要为1~2级。肾毒性发生率为11.3%，主要为1~2级。 结论： L-AmB治疗既往抗真菌治疗不耐受或无效的IFD患者安全有效，不良反应率低。.
Keywords: Hematological diseases; Invasive fungal disease; Liposomal amphotericin B.