Acute renal toxicity with combined use of amphotericin B and cyclosporine after marrow transplantation.

The role of cyclosporine alone or in combination with amphotericin B in the development of renal toxicity was evaluated in 47 marrow transplant recipients. Cyclosporine alone was given to 21 patients and 10 received cyclosporine plus amphotericin B. These were compared with 16 patients who received methotrexate and amphotericin B. Serum creatinine doubled within 14-30 days in 8 of 21 patients who received only cyclosporine. Of 16 patients given amphotericin B in conjunction with methotrexate, only 3 doubled their serum creatinine within 5 days of starting amphotericin B. In contrast, of 10 patients who received amphotericin B in combination with cyclosporine, 5 doubled and 3 tripled their serum creatinine within 5 days. This increase in creatinine was significantly greater than that seen in patients receiving cyclosporine alone or methotrexate and amphotericin B combined. These results suggest that administration of cyclosporine and amphotericin B simultaneously should be undertaken with caution to avoid severe renal toxicity.