Caspofungin Acetate, Fluconazole, or Voriconazole in Preventing Fungal Infections in Patients Following Donor Stem Cell Transplant
Fungal Infection, Hematopoietic and Lymphoid Cell Neoplasm
About this trial
This is an interventional supportive care trial for Fungal Infection
Eligibility Criteria
Inclusion Criteria:
Age
For centers that will use fluconazole as the antifungal comparator:
- Age >= 3 months and < 21 years
For centers that will use voriconazole as the antifungal comparator:
- Age >= 2 years and < 21 years
- The patient must be undergoing allogeneic HCT from any donor (including matched related) with any stem cell source for any underlying condition
- Patients must have a performance status corresponding to Eastern Cooperative Oncology Group (ECOG) scores of 0, 1 or 2; use Karnofsky for patients > 16 years of age and Lansky for patients =< 16 years of age
Creatinine clearance or radioisotope glomerular filtration rate (GFR) >= 70 mL/min/1.73 m^2 OR a serum creatinine based on age/gender as follows:
- 0.4 mg/dL (1 month to < 6 months of age)
- 0.5 mg/dL (6 months to < 1 year of age)
- 0.6 mg/dL (1 to < 2 years of age)
- 0.8 mg/dL (2 to < 6 years of age)
- 1.0 mg/dL (6 to < 10 years of age)
- 1.2 mg/dL (10 to < 13 years of age)
- 1.5 mg/dL (male) or 1.4 mg/dL (female) (13 to < 16 years of age)
- 1.7 mg/dL (male) or 1.4 mg/dL (female) (>= 16 years of age)
- Total bilirubin < 2.5 mg/dL unless the increase in bilirubin is attributable to Gilbert's syndrome
- Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) or serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) < 5 x upper limit of normal (ULN) for age
- All patients and/or their parents or legal guardians must sign a written informed consent
- All institutional, Food and Drug Administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
Exclusion Criteria:
Within 90 days of enrollment:
- Patients with a proven or probable invasive mold infection are not eligible
- Patients with an incompletely treated invasive yeast infection are not eligible
- Patients with an elevated galactomannan level (>= 0.5 index) within 30 days prior to time of enrollment (if performed) must have a full evaluation for invasive aspergillosis (including a negative chest computed tomography [CT] scan) during that time period to be eligible for enrollment
- Patients receiving treatment for an IFI are not eligible
- Patients with a history of echinocandin or azole hypersensitivity are not eligible
- Female patients of childbearing potential are not eligible unless a negative pregnancy test result has been obtained
- Sexually active patients of reproductive potential are not eligible unless they have agreed to use an effective contraceptive method for the duration of their study participation
- Lactating females are not eligible unless they have agreed not to breastfeed their infants
Sites / Locations
- Phoenix Childrens Hospital
- Loma Linda University Medical Center
- Children's Hospital and Research Center at Oakland
- Children's Hospital of Orange County
- Lucile Packard Children's Hospital Stanford University
- Rady Children's Hospital - San Diego
- UCSF Medical Center-Parnassus
- UCSF Medical Center-Mission Bay
- Alfred I duPont Hospital for Children
- Nemours Children's Clinic-Jacksonville
- Johns Hopkins All Children's Hospital
- Children's Healthcare of Atlanta - Egleston
- University of Hawaii Cancer Center
- Kapiolani Medical Center for Women and Children
- Riley Hospital for Children
- University of Iowa/Holden Comprehensive Cancer Center
- Norton Children's Hospital
- Children's Hospital New Orleans
- Floating Hospital for Children at Tufts Medical Center
- C S Mott Children's Hospital
- Wayne State University/Karmanos Cancer Institute
- Helen DeVos Children's Hospital at Spectrum Health
- University of Minnesota/Masonic Cancer Center
- Mayo Clinic in Rochester
- University of Mississippi Medical Center
- Children's Mercy Hospitals and Clinics
- Children's Hospital and Medical Center of Omaha
- University of Nebraska Medical Center
- Hackensack University Medical Center
- Montefiore Medical Center - Moses Campus
- Roswell Park Cancer Institute
- UNC Lineberger Comprehensive Cancer Center
- Duke University Medical Center
- Children's Hospital Medical Center of Akron
- Rainbow Babies and Childrens Hospital
- Cleveland Clinic Foundation
- Nationwide Children's Hospital
- University of Oklahoma Health Sciences Center
- Children's Hospital of Philadelphia
- Children's Hospital of Pittsburgh of UPMC
- Vanderbilt University/Ingram Cancer Center
- Medical City Dallas Hospital
- UT Southwestern/Simmons Cancer Center-Dallas
- Methodist Children's Hospital of South Texas
- Primary Children's Hospital
- Children's Hospital of Wisconsin
- Alberta Children's Hospital
- CancerCare Manitoba
- Hospital for Sick Children
Arms of the Study
Arm 1
Arm 2
Experimental
Active Comparator
Arm I (caspofungin acetate)
Arm II (fluconazole or voriconazole)
Patients receive caspofungin acetate IV over 1 hour once daily (QD) beginning within 24 hours of allogeneic HSCT (day -1 or 0) and continuing until day 42 in the absence of invasive fungal infections or disease progression.
Patients receive fluconazole IV over 1-2 hours QD or PO QD; or voriconazole IV over 1-2 hours QD or PO BID beginning within 24 hours of allogeneic HSCT (day -1 or 0) and continuing until day 42 in the absence of invasive fungal infections or disease progression.