An observational study in Invasive Fungal Infections and Stem Cell Transplant Complications, sponsored by Peter MacCallum Cancer Centre, Australia. Completed at 1 site in Australia. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2024-11-14.
Sponsored by Peter MacCallum Cancer Centre, Australia · Observational
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Among 10 studies in Invasive Fungal Infections with a site in Australia — 2 open to participants now, 2 under way, none of them phase 3. Invasive Fungal Infections · Australia.
Among the 10 studies in Invasive Fungal Infections with a site in Australia, this one is one of 2 that started in 2022, is one of 2 observational ones, and was the 7th registered.
136 studies on the registry are indexed under Invasive Fungal Infections; 33 are open to participants now.
Browse Invasive Fungal Infections studies →2 of the 10 studies in Invasive Fungal Infections with a site in Australia are open now. Recruiting first, the newest first:
Peter MacCallum Cancer Centre, Australia · Sites in Australia
Ages 18+
Melbourne Health · Sites in Australia
Ages 18+
A study can be open while its sites in Australia have not opened yet or have stopped. Only those recruiting at a site in Australia →
Of the 20 Invasive Fungal Infections studies recruiting now, 12 (60%) set no upper age limit and 5 (25%) stop at 75 or younger; 9 take children under 18; 2 take healthy volunteers.
This study: 18 Years and older · all sexes · no healthy volunteers.
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10 studies; the count open now beside each. This study's row is marked.
First in 2007; this study’s year is marked. 2 started in 2022.
This study's enrollment of 300 is above the median of 125 across 66 observational studies indexed under Invasive Fungal Infections.
Median enrollment 174 across the 8 interventional studies, 155 across the 2 observational. Of the 6 that completed or were terminated, 4 (67%) have results posted.
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6 of 10 have an industry lead sponsor. The 8 most frequent:
Peter MacCallum Cancer Centre, Australia is the lead sponsor of 82 studies on the registry; 25 are open to participants now.
Peter MacCallum Cancer Centre, Australia has 2 studies filed under Invasive Fungal Infections — fewer than ten, so there is no comparison to draw.
None of the studies under way reaches primary completion within a year.
Among the 10 studies in Invasive Fungal Infections with a site in Australia, from their registry updates:
Nothing recorded among them since 2026-09-25.
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This study will be a descriptive, retrospective evaluation and analysis of invasive fungal infections (IFI) conducted in patients who underwent allogeneic haematopoiectic stem cell transplant (aHSCT) in a single tertiary transplant centre, the Bone Marrow Transplant Clinical Service across Peter MacCallum Cancer Centre (PMCC) and Royal Melbourne Hospital (RMH), Victoria, Australia.
Invasive fungal infections (IFIs) remain a leading cause of mortality and morbidity in immunosuppressed patients who undergo allogenic haematopoiectic stem cell transplant (aHSCT). Both yeast and moulds cause serious IFIs in this cohort of patients, especially during the pre-engraftment neutropenic phase, and post-engraftment period when patients need to be on prolonged course of corticosteroids for severe graft-versus-host-disease (GVHD). Other risk factors for IFIs include environmental factors, genetic factors, and co-viral infections. Candida spp accounts for most of the invasive yeast infections whereas Aspergillus spp is the most common mould in aHSCT recipients. The estimated incidence of proven and probable invasive Candida infections without antifungal prophylaxis ranged from 8% to 24%; on the other hand the incidence of invasive aspergillosis was reported to be in between 3% to 14%. IFIs are often associated with mortality rate as high as 60%, and have been identified as one of the independent predictors of death in multivariate analysis. Other complications include extended hospital stay from invasive fungal infections, intensive care admissions, huge treatment cost and significant morbidity and reduced quality of life in patients.
Antifungal prophylaxis with fluconazole in aHSCT recipient has become a routine in the 1990s after several studies demonstrated fits efficacy in reducing morbidity and mortality in this group of patients. In 2007 two multi-centres, double-blinded trials, involving either aHSCT patients with GVHD or non-transplantation patients with haematologic malignancy and prolonged neutropenia, proved superiority of the mould-active agent with posaconazole to fluconazole in preventing invasive aspergillosis and death from IFI. This finding was further confirmed by a systemic review and meta-analysis in 2012 that included 20 randomised trials, comparing mould-active prophylaxis with fluconazole prophylaxis in aHSCT recipients or patients with haematologic malignancy receiving chemotherapy. Consequently, current Australian guideline proposed that all patients at high risk of IFIs (>10%) be administered mould-active antifungal prophylaxis, and these patients include aHSCT recipients with expected neutropenia of >14 days, extensive chronic GVHD, severe steroid refractory or dependent GVHD and patients with acute leukaemia or myelodysplasia who are undergoing induction or re-induction chemotherapy. Broad-spectrum triazole posaconazole is the recommended first-line therapy, with other triazoles such as voriconazole, itraconazole or echinocandin as alternative therapy.
In Australia, until 2015 posaconazole was only available in liquid form. Posaconazole suspension needs to be taken with high-fat meal or supplements to enhance its absorption. The unpredictable absorption of the suspension, especially in patients with mucositis or neutropenic colitis from chemotherapy prompted the recommendation of monitoring the trough posaconazole level. However in Victoria, this assay was not widely available and the turnaround time was often long, hence it could not be performed in real-time fashion for optimal management. A delayed-release tablet formulation of posaconazole was approved by TGA in 2013 and it was added to the Pharmaceutical Benefits Scheme (PBS) in Australia in mid-2015. At the same time an intravenous formulation was also approved by TGA. The tablet formulation has improved bioavailability as its absorption was not dependent upon high fat or supplement content like its liquid counterpart, and it is anticipated that its administration will likely result in therapeutic drug levels. As a result routine therapeutic drug monitoring is not required during prophylaxis with posaconazole tablets. The availability of the intravenous and tablet formulation may have a positive impact on the rates of IFIs, however this has not been formally reviewed in Australia. Patients on posaconazole prophylaxis with the Bone Marrow Transplant Clinical Service are currently on either tablets or the intravenous formulation (if patients have factors that impaired oral intake).
Although the introduction of mould-active antifungal prophylaxis has reduced the incidence of IFIs significantly, there have been numerous studies reporting on the changing epidemiology of these infections and concerns raised over the rates of breakthrough IFIs and emergence of azole-resistant strains, including non-albicans species of invasive candidiasis. Winston et al reported of a breakthrough IFI rate 7.5% while on posaconazole liquid formulation, and this finding was consistent with some European studies, which found incidence of 3-14% of breakthrough invasive mould disease. On the other hand, Tverdek et al reported a much improved rate of breakthrough IFI of 2% in 343 patients who received intravenous or delay-released tablet formulation of posaconazole, suggesting that these new formulations resulted in better absorption of the medication with direct implication on rates of IFI.
Most of the studies mentioned above, that reported incidence of IFIs in the era of mold-active antifungal prophylaxis, were conducted in the United States or Europe. Specifically there has not been a study done locally in Australia looking at this question, including breakthrough IFIs. The epidemiology of fungal isolates in Australia may be very different compared to that of European or American continents. For example there have been reports of higher incidence of systemic infection due to Lomentospora prolificans in Australia and Spain, involving patients with acute leukemia or with aHSCT.
The introduction of the posaconazole tablets may have improved IFI breakthrough rates in our local Bone Marrow Transplant Centre, although this has not yet been examined. Anecdotal evidence suggests that the rates of posaconazole therapeutic drug monitoring at our institution are low, but again this has not been formally documented.
It is imperative to evaluate the epidemiology of these infections in this cohort in the new era of posaconazole prophylaxis, to monitor the rates of breakthrough IFIs and if there is emergence of azole-resistance fungal isolates in the Australian context. This study aims to establish an overview of IFIs in patients receiving stem cell transplant. Not only will it provide invaluable information on local epidemiology and microbiology of invasive fungal infections, it will also enable more appropriate planning of antifungal prophylaxis strategies in these high-risk patients.
Study's hypothesis:
Aims of the study:
Patients who underwent allogeneic haematopoiectic stem cell transplant (aHSCT) in a single tertiary transplant centre, the Bone Marrow Transplant Clinical Service across Peter MacCallum Cancer Centre (PMCC) and Royal Melbourne Hospital (RMH), Victoria, Australia.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.
Allogeneic and autologous transplant
Stem cell (bone marrow) transplants. Allogeneic uses cells from a donor; autologous uses your own cells, collected earlier and given back.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
This will be our control cohort. Most of the patients would have been on posaconazole prophylaxis.
Other: No intervention
This will be the group that we will be interested in. IFI would be diagnosed based on EORTC/ MSG definitions, and most of them would have been on posaconazole prophylaxis. Underlying risk factors of acquiring IFI in this cohort of patients will be compared with that of the control cohort.
Other: No intervention
This is descriptive, retrospective study to evaluate the epidemiology of invasive fungal infections (IFI) in patients undergoing allogeneic haematopoiectic stem cell transplant in the era of antifungal prophylaxis with posaconazole delay-released tablets.
Incidence of invasive fungal infections (IFI) in patients
Incidence of IFI will be calculated as number of new episodes of IFI (index episode only) during the data collection period (1 Jan 2017 to 1 Jan 2019) over total number of patients who have undergone allogeneic stem cell transplant during the same period.
Time frame: One year
Breakthrough rates of invasive fungal infections (IFI)
Breakthrough IFI is defined as any IFI occurring during exposure to an antifungal drug, including fungi outside the spectrum of activity of an antifungal. Incidence of breakthrough rates of IFI will be calculated as number of episodes IFI over number of courses of anti fungal prophylaxis in a defined period.
Time frame: one year
Mortality
To determine all-cause mortality, non-relapse mortality and infection-related mortality in this cohort of patients.
Time frame: One year
Current practice of antifungal prophylaxis
Number of patients on different types of antifungal prophylaxis during a defined period. For patients who were on antifungal prophylaxis which required therapeutic drug monitoring (TDM)- proportion of patients who actually had TDM done and proportion of patients whose TDM was within therapeutic level.
Time frame: one year
Adverse effects from antifungal prescription
Number of participants with adverse events from antifungal as assessed by CTCAE v5.0
Time frame: One year
Plan to share: Undecided — De-identified demographics data of patients, transplant characteristic, details of invasive fungal infections
Ran from Jan 2022 to primary completion in Apr 2024, 27 months.
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This study is completed, as verified in Nov 2024. You cannot join it, but the record below documents what was studied.
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Peter MacCallum Cancer Centre, Australia