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Abstract
Sir—Dr. Frothingham [1] has asked whether the study drug might have been discontinued at different times for the severely ill patients in the 3 study groups evaluated in our randomized controlled trial [2]. Most patients in our trial discontinued receipt of the study drug at the time that they recovered from neutropenia. This was true for patients in all study arms. Table 1 provides information on the patient deaths that occurred in this trial. Of the 11 deaths that occurred among patients who were taking amphotericin B lipid complex (ABLC; Abelcet [The Liposome Company]), 5 mg/kg/day, 3 were attributed to fungal infection; 4, to nonfungal infection; 2, to progression of malignancy; and 2, to medical complications. Of the 7 deaths that occurred among patients who were taking liposomal amphotericin B (L Amph; AmBisome [Fujisawa Healthcare]), 1 was attributed to fungal infection; 1, to nonfungal infection; 2, to progression of malignancy; and 3, to medical complications. All but 2 of the patients who died during the study period had received antifungal prophylaxis prior to empirical therapy with a lipid formulation of amphotericin.
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