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RecruitingNCT07202078Updated Oct 7, 2025

Role of Antibiotic Therapy or Immunoglobulin On iNfections in hAematoLogy: Starting Immunoglobulin (Start Ig)

A Phase 2/3 interventional study of Trimethoprim / Sulfamethoxazole and Immune Globulin Intravenous in Myeloma, Non Hodgkin's Lymphoma and Leukemia, sponsored by Monash University. Recruiting at 3 sites in Australia. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-10-07.

Sponsored by Monash University · Phase 2/3, Interventional, and Treatment

From the registry’s dates

  • Registered 4 months after the study started (first participant enrolled May 2025, registered Sep 2025).
  • Started May 2025; still recruiting 1 year 5 months later.
Phase
Phase 2/3
Study type
Interventional
Enrollment
900
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This study is being conducted to find out how safe and effective different strategies of infection prevention are in comparison to each other, for preventing infection in patients with blood cancers. The best way to find out this information is to directly compare the effect of different treatment strategies in patients with blood cancers. We want to know how these different treatments impact on your health and your use of healthcare services.

This research project uses an Adaptive Platform Design. This design allows the researchers to compare multiple infection prevention strategies within the same trial at the same time (rather than running separate trials), to analyse results as the trial occurs and to add new research questions during the course of the trial.

The treatments that you may receive as part of the study will be determined by which domain(s) of the platform you participate in. By combining data collected within each domain as part of the platform, the researchers can investigate and compare treatment strategies and infection outcomes across a broader range of participants.

Read the detailed description

This is a domain within the RATIONAL Platform Trial to test the effectiveness and safety of prophylactic antibiotics as an alternative Ig replacement in patients who have not yet commenced Ig replacement therapy.

02

Conditions studied

  • Myeloma
  • Non Hodgkin's Lymphoma
  • Leukemia

Keywords

  • immunoglobulin
  • antibiotics
  • myeloma
  • leukaemia
  • lymphoma
  • non Hodgkins
  • infection
  • infections
  • blood
  • cancer
  • haematology
03

In context

Neoplasms, Plasma Cell

2,306 studies on the registry are indexed under Neoplasms, Plasma Cell; 246 are open to participants now.

This study's planned enrollment of 900 is above the median of 39 across 1,823 interventional studies indexed under Neoplasms, Plasma Cell.

Browse Neoplasms, Plasma Cell studies →

Lead sponsor

Monash University is the lead sponsor of 81 studies on the registry; 22 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • None.

Exclusion criteria

Exclusion Criteria:

  1. Prior or planned allogeneic haematopoietic stem cell transplantation.
  2. Already receiving systemic antibiotic prophylaxis for the purpose of preventing bacterial infection (NB: patients may receive antiviral, antifungal and PJP prophylaxis).
  3. Received immunoglobulin replacement in the preceding three months.
  4. Objection to receiving immunoglobulin products.
  5. Known history of IgA deficiency with anti-IgA.
  6. History of severe allergy to immunoglobulin products.
  7. Current active infection requiring systemic antibiotics.
  8. Allergy or intolerance of all domain antibiotic options.
  9. Pregnant or breastfeeding.
  10. Severe renal impairment (estimated or measured creatinine clearance of \< 30 mL/min).
  11. Previous splenectomy.
  12. Previous participation in this domain.
  13. Treating team deems enrolment in the domain is not in the best interest of the patient.
05

Study design

Phase
Phase 2 / Phase 3
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
900 participants (estimated)

Study arms

  • Other
    Arm A: Start prophylactic oral antibiotics

    Once daily trimethoprim-sulfamethoxazole (co-trimoxazole) 160mg/800mg. NB: Doxycycline 100mg daily as an alternative for patients with hypersensitivity to co-trimoxazole.

    Drug: Trimethoprim / Sulfamethoxazole

  • Other
    Arm B: Start immunoglobulin replacement

    IVIg every 4 weeks ± 1 week at a dose of 0.4g/kg, modified to achieve an IgG trough level of at least lower limit of age-specific serum IgG reference range; or SCIg, weekly, may be used in patients who meet local criteria for home-based self-administration in centres with established SCIg programs. Dosing is usually given at 100mg/kg/week, modified to achieve an IgG steady state level of at least the lower limit of the serum reference range. A loading IVIg dose may be given in the first month if required.

    Biological: Immune Globulin Intravenous

Interventions

  • DrugTrimethoprim / Sulfamethoxazole

    Once daily trimethoprim-sulfamethoxazole (co-trimoxazole) 160mg/800mg. NB: Doxycycline 100mg daily as an alternative for patients with hypersensitivity to co-trimoxazole.

    Also known as: Co-Trimoxazole

  • BiologicalImmune Globulin Intravenous

    IVIg every 4 weeks ± 1 week at a dose of 0.4g/kg, modified to achieve an IgG trough level of at least lower limit of age-specific serum IgG reference range; or SCIg, weekly, may be used in patients who meet local criteria for home-based self-administration in centres with established SCIg programs. Dosing is usually given at 100mg/kg/week, modified to achieve an IgG steady state level of at least the lower limit of the serum reference range. A loading IVIg dose may be given in the first month if required.

    Also known as: Immune Globulin Subcutaneous

06

What researchers measure

Primary outcomes

  1. Event-free survival (EFS).

    Defined as time from randomisation (or, in domains with a single treatment arm, time from registration) until occurrence of a Grade 3 or higher infection (as defined by CTCAE Version 5), or death from any cause.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

Secondary outcomes

  1. Occurrence of at least one Grade 3 or higher infection(s) from randomisation to 12 months.

    Occurrence of at least one Grade 3 or higher infection(s) from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  2. Occurrence of one or more clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Occurrence of one or more clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  3. Number of clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Number of clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  4. Occurrence of one or more microbiologically documented infections from randomisation to 12 months.

    Occurrence of one or more microbiologically documented infections from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  5. Number of microbiologically documented infections from randomisation to 12 months.

    Number of microbiologically documented infections from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  6. All-cause mortality at 12 months.

    All-cause mortality at 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  7. Infection-related mortality at 12 months.

    Infection-related mortality at 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  8. Time free from hospitalisation with antimicrobial administration with therapeutic intent from randomisation to 12 months.

    Time free from hospitalisation with antimicrobial administration with therapeutic intent from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  9. Occurrence of one or more treatment-related adverse events.

    Occurrence of one or more treatment-related adverse events.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  10. Number of treatment-related adverse events.

    Number of treatment-related adverse events.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  11. Isolation of fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms from randomisation to 12 months.

    Isolation of fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  12. Number of infections with fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms isolated from randomisation to 12 months.

    Number of infections with fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms isolated from randomisation to 12 months.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  13. Quality of Life (QoL) measured at randomisation then 3, 6, 9 and 12 months, using different questionnaire.

    Quality of Life (QoL) measured at randomisation then 3, 6, 9 and 12 months, using different questionnaire.

    Time frame: Randomisation, Month 3, Month 6, Month 9 and Month 12.

  14. Costs associated with allocated treatment arm and infections during study.

    Costs of infections and trial interventions will be estimated based on trial treatment and adverse event data within the hospital medical record, as well as linked data obtained from the Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS) and Australian Immunisation Register (AIR). Data from the quality of life questionnaires will be used to calculate quality adjusted life years.

    Time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

07

Study locations

3 of 3 sites recruiting
08

References and documents

Related links

Study documents

  • Study protocol · Nov 12, 2023

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No — Individual participant data will not be publicly available. Data will only be presented as a whole, no individual data will be published or presented.

09

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Oct 7, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT07202078
Lead sponsor
Monash University
Responsible party
Sponsor
First posted
Oct 1, 2025
Start date
May 7, 2025
Primary completion
Mar 31, 2027 (estimated)
Completion
Mar 31, 2027 (estimated)
Last update
Oct 7, 2025

Study contacts

Zoe McQuilten, Professor
principal investigator · Monash University

Oversight

Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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