A Strategic Study to Determine the Optimal Moment to Initiate Systemic Antifungal Therapy With Ambisome in Granulocytopenic Cancer Patients With Unexplained Fever Refractory to Empirical Antibacterials
liposomal amphotericin B
Adénopathie+144
+ Maladies génito-urinaires
+ Maladies Génitales
Soins de support
Résumé
Date de début de l'étude : 1 juin 1999
Date à laquelle le premier participant a commencé l'étude.OBJECTIVES: Compare the efficacy and side effects of amphotericin B-liposomal formulation initiated 72-84 hours vs 144-156 hours after onset of a febrile episode in cancer patients with granulocytopenia and persistent unexplained fever refractory to antibacterials. OUTLINE: This is a randomized, multicenter study. Patients are stratified according to antifungal prophylaxis (yes vs no) and type of underlying condition. Patients are randomized to 1 of 2 treatment arms. Arm I: Patients receive amphotericin B-liposomal formulation IV over 1 hour on day 3 of febrile neutropenia. Arm II: Patients receive amphotericin B-liposomal formulation IV over 1 hour on day 6 of febrile neutropenia. Treatment continues until signs and symptoms of the fungal infection appear or febrile neutropenia has resolved. Persistently neutropenic patients receive treatment for at least 10 days or until another cause of infection is determined. Patients are followed weekly for 3 weeks. PROJECTED ACCRUAL: A total of 450 patients will be accrued for this study.
Protocole
Cette section fournit des détails sur le plan de l'étude, y compris la manière dont l'étude est conçue et ce qu'elle évalue.115 participants à inclure
Nombre total de participants que l'essai clinique vise à recruter.Soins de support
Éligibilité
Les chercheurs recherchent des patients correspondant à une certaine description appelée critères d'éligibilité : état de santé général ou traitements antérieurs du patient.Tout sexe
Le sexe biologique des participants éligibles à s'inscrire.Volontaires sains non autorisés
Indique si les individus en bonne santé et ne présentant pas la condition étudiée peuvent participer.Conditions
Pathologie
Critères
DISEASE CHARACTERISTICS: Hematologic malignancy or solid tumor Must be undergoing remission induction and/or consolidation therapy for hematologic malignancy only OR Must be undergoing allogeneic or autologous bone marrow transplantation Granulocyte count less than 500/mm^3 and profound granulocytopenia expected to last for greater than 5 days Fever (greater than 38.5 degrees C) refractory for greater than 72 hours and less than 84 hours to broad spectrum antimicrobials, after exclusion of current bacterial, fungal, viral, parasitic, and mycobacterial infections Peripheral blood cultures and central venous catheter cultures negative for infections No microbiological documentation of a bacterial infection (e.g., abscess at catheter site) No invasive fungal infection No probable noninfectious cause of fever PATIENT CHARACTERISTICS: Age: Not specified Performance status: Karnofsky 40-100% OR WHO 0-2 Life expectancy: Not specified Hematopoietic: See Disease Characteristics Hepatic: Not specified Renal: Not specified Other: No prior anaphylactic reaction to amphotericin B No psychological, familial, sociological, or geographical conditions that would prevent compliance Not pregnant or nursing Normal chest X-ray or normal high resolution CT scan of the lungs PRIOR CONCURRENT THERAPY: Biologic therapy: See Disease Characteristics Chemotherapy: See Disease Characteristics Endocrine therapy: Not specified Radiotherapy: Not specified Surgery: Not specified Other: No concurrent active systemic antifungal agents or antifungal prophylaxis (e.g., azoles or polyenes) No prior IV amphotericin B during same neutropenic episode No change in antibacterial regimen within 48 hours prior to study
Centres d'étude
Ce sont les hôpitaux, cliniques ou centres de recherche où l'essai est conduit. Vous pouvez trouver le site le plus proche de vous ainsi que son statut.Cette étude comporte 24 sites
Institut Jules Bordet
Brussels, BelgiumHopital Universitaire Erasme
Brussels, BelgiumU.Z. Gasthuisberg
Leuven, Belgium