Tehran University Medical Journal

Background: Amphotericin B is one of the most useful therapeutic modalities for the treatment of patients with invasive fungal infections, in spite of serious side effects, namely kidney injury, electrolyte imbalances, and infusion-related reactions. The goal of this study was to assess the different aspects of premedication practice and the incidence and types of infusion-related reactions in patients receiving amphotericin B.
Methods: This observational study was performed on 70 hospitalized patients who received amphotericin B in different departments of two university hospitals, affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, from January 2017 to February 2018. Information on physicians’ performance regarding premedication administration for amphotericin B, including the types and doses of medications administered prior to amphotericin B infusion, as well as patients’ clinical data including infusion-related side effects were collected and then analyzed in comparison with the standard practice guidelines.
Results: The study population consisted of 70 patients with the mean age of 51.6±18.3 years, who received amphotericin B for 8.2±3.5 days. From 70 evaluated patients, 21 patients (30%) had encountered the infusion-related reactions, including chills, fever, urticaria, headache, and hypotension. These side effects were evident in 19 patients (27%) who received no premedication and 2 patients (3%) who received only one drug as premedication, before amphotericin B administration. Twenty patients (28%) experienced chills, fever and headache, while 7 patients (10%) had nausea and vomiting during amphotericin B infusion. Hydrocortisone 50-200 mg, was the most prescribed agent for premedication (in 67% of patients), while chlorpheniramine 10 mg (in 50% of patients) and promethazine 10 mg (in 35% of patients) were the second and third prescribed ones, respectively.
Conclusion: In this study, the patients who received no or only one drug as premedication experienced infusion-related side effects. This emphasizes the necessity for standard premedication practices to prevent this type of adverse reactions. Considering the higher price of liposomal form of Amphotericin-B, if prescribed correctly, even the conventional form would be an effective and tolerable treatment for invasive fungal infections.

Background: Since numerous chemotherapy regimens for the treatment of patients suffering from acute lymphoid leukemia (ALL) have been recently developed, having basic information about the previous results of using the Hyper-CVAD regimen in order to compare with other common chemotherapy regimens is essential. The aim of this study was to evaluate demographic, clinical and outcome of ALL patients receiving Hyper-CVAD regimen.
Methods: In this retrospective study, nighty eligible ALL patients treated with the Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran during April 2016 till April 2019 were considered. We evaluated the demographic variables, pathological data and other clinical factors by an information sheet designed by main investigator. The main purpose of this study was to evaluate overall survival, progression-free survival, and overall response rate of patients along with patients’ clinical characteristics and other relevant factors using Kaplan-Meier or Cox-regression and other statistical analyses. 

Results: The mean overall survival and the median survival of patients were 44.8±2.93 and 36.7±7.47 months; respectively. Also the mean progression free survival of patients was 44.44±3.30 months. More than 84.4% of patients encountered complete remission (CR) after receiving Hyper-CVAD regimen. Reaching to CR had positive significant effects on patients’ overall survival and median survival. However, the bone marrow transplantation variable alone did not affect the patients’ overall survival. The variables such as being B/T Cell ALL, Philadelphia, myeloid marker, and central nervous system involvement did not affect the overall survival of patients but the relapse index indicated the significant effects. The median survival time is higher in patients with no relapse episode. None of the initial lab data had any significant effects on patients’ overall survival. Conclusion: For the first time in Iran, we have obtained the mean survival outcome of ALL patients after applying the Hyper-CVAD regimen. According to the results, the mean overall survival, progression free survival and other survival items in Iranian patients suffering from ALL and receiving Hyper-CVAD regimen were in consistent with previous studies in the world.