Nebulized Liposomal Amphotericin B Ambisome for Prophylaxis of Invasive Pulmonary Aspergillosis

NCT ID: NCT00391014

Last Updated: 2009-05-12

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

150 participants

Study Classification

INTERVENTIONAL

Study Start Date

2006-01-31

Study Completion Date

2009-04-30

Brief Summary

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The trial is planned as a multicentric, national, phase II, open-label trial to evaluate safety and tolerance of nebulized Liposomal Amphotericin B (Ambisome) for LMA patients during the induction therapy ,intensification, plus Allogeneic Haematopoietic Progenitor Cell transplant in due course, as well for patients diagnosed of several malignant haematologic diseases and treated with Allogeneic Haematopoietic Progenitor Cell Transplant

Detailed Description

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The invasive fungal infection (IFI) is the most common cause of mortality related to autologous stem cell transplant. Taking into account that Saprophytic Aspergillus is usually acquired by inhalation, to protect the bronchial tree just before the tissue invasion is quite attractive. In haematologic patients, as well as those ones subjected to an Allogeneic haematopoietic progenitor cell transplant, there is another group of patients at high risk of Invasive Pulmonary Aspergillosis (IPA). These are those patients with acute myeloid leucemia (AML), submitted to induction, intensification or consolidation polychemotherapy. The IPA incidence rate in these patients, whenever during their evolution, reaches 18-20%, with usual treatments. Furthermore, unlike allogeneic haematopoietic progenitor cell transplant patients, neutropenia was the only IPA risk factor. Nowadays, pharmacologic prophylaxis against IPA, in patients with allogeneic haematopoietic progenitor cell transplant and patients affected by AML in induction or intensification therapy is far from being optimal, because of problems related to tolerance and drug interactions .

The Nebulized Liposomal Amphotericin B (Ambisome) prophylaxis against IPA has shown good tolerance, safety and efficacy in lung transplant recipients.

Extrapolating the results obtained in lung transplant recipients, we get the conclusion that it would be essential to study safety and tolerance of nebulized AMBISOME in the group of patients with different peculiarities, mucositis secondary to chemotherapy, and high incidence of IPA in order to reach the goal of evaluate its efficacy as prophylaxis against IPA in this kind of patients

Conditions

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Acute Myeloid Leukemia Allogeneic Haematopoietic Progenitor Cell Transplant

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

NONE

Study Groups

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1

AML patients in induction chemotherapy treatment will received prophylaxis with nebulized liposomal amphotericin B (24 mg/week). It will be maintained during the intensification chemotherapy and in periods between cycles.

If patient required ALO-TPH, the prophylaxis should be followed.

Group Type EXPERIMENTAL

liposomal Amphotericine B

Intervention Type DRUG

AML patients in induction chemotherapy treatment will received prophylaxis with nebulized liposomal amphotericin B (24 mg/week). It will be maintained during the intensification chemotherapy and in periods between cycles.

If patient required ALO-TPH, the prophylaxis should be followed.

Interventions

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liposomal Amphotericine B

AML patients in induction chemotherapy treatment will received prophylaxis with nebulized liposomal amphotericin B (24 mg/week). It will be maintained during the intensification chemotherapy and in periods between cycles.

If patient required ALO-TPH, the prophylaxis should be followed.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Patient has decided voluntary to consent his or her participation signing the consent form before performance of any study-related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the patient at any time without prejudice to their future medical care.
* Patients with Acute myeloid Leukemia (AML), that will start induction chemotherapy or those patients submitted to an Allogeneic haematopoietic progenitor cell transplant.
* The patient is \>18 years old.

Exclusion Criteria

* Patient with prior Invasive Pulmonary Aspergillosis (IPA) history.
* History of allergy or hypersensitivity to Amphotericin B.
* Patient with intellectual deficit or patients with psychological alterations that make impossible the trial understanding.
* Pregnancy or breastfeeding.
* Patient has received other investigational drug or non traded product within 30 days before trial beginning.
* Patient is enrolled in another clinical research study or/and is receiving an investigational agent for any reason.
* Patient had major surgery within 4 weeks before enrollment.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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PETHEMA Foundation

OTHER

Sponsor Role lead

Responsible Party

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pethema

Principal Investigators

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Ruiz Isabel, Dr

Role: PRINCIPAL_INVESTIGATOR

Hospital Vall d'Hebron

Rovira Montserrat, Dr

Role: PRINCIPAL_INVESTIGATOR

Hospital Clinic of Barcelona

Locations

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Hospital de la Santa Creu i Sant Pau

Barcelona, Barcelona, Spain

Site Status

Hospital Universitario de la Princesa

Madrid, Madrid, Spain

Site Status

Hospital Universitario la Fe

Valencia, Valencia, Spain

Site Status

Hospital Universitario de Salamanca

Salamanca, , Spain

Site Status

Countries

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Spain

References

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Denning DW. Invasive aspergillosis. Clin Infect Dis. 1998 Apr;26(4):781-803; quiz 804-5. doi: 10.1086/513943. No abstract available.

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Reference Type BACKGROUND
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Reference Type BACKGROUND
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Westney GE, Kesten S, De Hoyos A, Chapparro C, Winton T, Maurer JR. Aspergillus infection in single and double lung transplant recipients. Transplantation. 1996 Mar 27;61(6):915-9. doi: 10.1097/00007890-199603270-00013.

Reference Type BACKGROUND
PMID: 8623160 (View on PubMed)

Cahill BC, Hibbs JR, Savik K, Juni BA, Dosland BM, Edin-Stibbe C, Hertz MI. Aspergillus airway colonization and invasive disease after lung transplantation. Chest. 1997 Nov 5;112(5):1160-4. doi: 10.1378/chest.112.5.1160.

Reference Type BACKGROUND
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Reference Type BACKGROUND
PMID: 9123449 (View on PubMed)

Calvo V, Borro JM, Morales P, Morcillo A, Vicente R, Tarrazona V, Paris F. Antifungal prophylaxis during the early postoperative period of lung transplantation. Valencia Lung Transplant Group. Chest. 1999 May;115(5):1301-4. doi: 10.1378/chest.115.5.1301.

Reference Type BACKGROUND
PMID: 10334143 (View on PubMed)

Dubois J, Bartter T, Gryn J, Pratter MR. The physiologic effects of inhaled amphotericin B. Chest. 1995 Sep;108(3):750-3. doi: 10.1378/chest.108.3.750.

Reference Type BACKGROUND
PMID: 7656628 (View on PubMed)

Schmitt HJ, Bernard EM, Hauser M, Armstrong D. Aerosol amphotericin B is effective for prophylaxis and therapy in a rat model of pulmonary aspergillosis. Antimicrob Agents Chemother. 1988 Nov;32(11):1676-9. doi: 10.1128/AAC.32.11.1676.

Reference Type BACKGROUND
PMID: 3252750 (View on PubMed)

Monforte V, Roman A, Gavalda J, Bravo C, Tenorio L, Ferrer A, Maestre J, Morell F. Nebulized amphotericin B prophylaxis for Aspergillus infection in lung transplantation: study of risk factors. J Heart Lung Transplant. 2001 Dec;20(12):1274-81. doi: 10.1016/s1053-2498(01)00364-3.

Reference Type BACKGROUND
PMID: 11744410 (View on PubMed)

Monforte V, Roman A, Gavalda J, Lopez R, Pou L, Simo M, Aguade S, Soriano B, Bravo C, Morell F. Nebulized amphotericin B concentration and distribution in the respiratory tract of lung-transplanted patients. Transplantation. 2003 May 15;75(9):1571-4. doi: 10.1097/01.TP.0000054233.60100.7A.

Reference Type BACKGROUND
PMID: 12792517 (View on PubMed)

Lambros MP, Bourne DW, Abbas SA, Johnson DL. Disposition of aerosolized liposomal amphotericin B. J Pharm Sci. 1997 Sep;86(9):1066-9. doi: 10.1021/js9604218.

Reference Type BACKGROUND
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Thomas DA, Myers MA, Wichert B, Schreier H, Gonzalez-Rothi RJ. Acute effects of liposome aerosol inhalation on pulmonary function in healthy human volunteers. Chest. 1991 May;99(5):1268-70. doi: 10.1378/chest.99.5.1268.

Reference Type BACKGROUND
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Kume H, Yamazaki T, Abe M, Tanuma H, Okudaira M, Okayasu I. Increase in aspergillosis and severe mycotic infection in patients with leukemia and MDS: comparison of the data from the Annual of the Pathological Autopsy Cases in Japan in 1989, 1993 and 1997. Pathol Int. 2003 Nov;53(11):744-50. doi: 10.1046/j.1440-1827.2003.01548.x.

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Nosari A, Oreste P, Cairoli R, Montillo M, Carrafiello G, Astolfi A, Muti G, Marbello L, Tedeschi A, Magliano E, Morra E. Invasive aspergillosis in haematological malignancies: clinical findings and management for intensive chemotherapy completion. Am J Hematol. 2001 Dec;68(4):231-6. doi: 10.1002/ajh.1187.

Reference Type BACKGROUND
PMID: 11754411 (View on PubMed)

Behre GF, Schwartz S, Lenz K, Ludwig WD, Wandt H, Schilling E, Heinemann V, Link H, Trittin A, Boenisch O, et al. Aerosol amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in neutropenic cancer patients. Ann Hematol. 1995 Dec;71(6):287-91. doi: 10.1007/BF01697981.

Reference Type BACKGROUND
PMID: 8534760 (View on PubMed)

Schwartz S, Behre G, Heinemann V, Wandt H, Schilling E, Arning M, Trittin A, Kern WV, Boenisch O, Bosse D, Lenz K, Ludwig WD, Hiddemann W, Siegert W, Beyer J. Aerosolized amphotericin B inhalations as prophylaxis of invasive aspergillus infections during prolonged neutropenia: results of a prospective randomized multicenter trial. Blood. 1999 Jun 1;93(11):3654-61.

Reference Type BACKGROUND
PMID: 10339471 (View on PubMed)

Conneally E, Cafferkey MT, Daly PA, Keane CT, McCann SR. Nebulized amphotericin B as prophylaxis against invasive aspergillosis in granulocytopenic patients. Bone Marrow Transplant. 1990 Jun;5(6):403-6.

Reference Type BACKGROUND
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Myers SE, Devine SM, Topper RL, Ondrey M, Chandler C, O'Toole K, Williams SF, Larson RA, Geller RB. A pilot study of prophylactic aerosolized amphotericin B in patients at risk for prolonged neutropenia. Leuk Lymphoma. 1992 Oct;8(3):229-33. doi: 10.3109/10428199209054909.

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Erjavec Z, Woolthuis GM, de Vries-Hospers HG, Sluiter WJ, Daenen SM, de Pauw B, Halie MR. Tolerance and efficacy of Amphotericin B inhalations for prevention of invasive pulmonary aspergillosis in haematological patients. Eur J Clin Microbiol Infect Dis. 1997 May;16(5):364-8. doi: 10.1007/BF01726364.

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Hertenstein B, Kern WV, Schmeiser T, Stefanic M, Bunjes D, Wiesneth M, Novotny J, Heimpel H, Arnold R. Low incidence of invasive fungal infections after bone marrow transplantation in patients receiving amphotericin B inhalations during neutropenia. Ann Hematol. 1994 Jan;68(1):21-6. doi: 10.1007/BF01695915.

Reference Type BACKGROUND
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Related Links

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http://www.aehh.org

Spanish association of Haematology

Other Identifiers

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AMBINEB

Identifier Type: -

Identifier Source: secondary_id

2005-000703-34

Identifier Type: -

Identifier Source: org_study_id

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