Infections

All Conditions

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Wounds and Injuries

Blood and Lymph Conditions

Skin and Connective Tissue Diseases

Rare Diseases

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Fever

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Febrile Neutropenia

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Hematologic Diseases

Leukocyte Disorders

Bacterial Infections

Bacterial Infections and Mycoses

Dermatomycoses

Skin Diseases

Skin Diseases, Infectious

Granulocytopenia

Anti-Infective Agents

All Drugs and Chemicals

Anti-Bacterial Agents

Clotrimazole

Miconazole

Antifungal Agents

Caspofungin

Enzyme Inhibitors

Anti-Infective Agents, Local

Cytochrome P-450 Enzyme Inhibitors

Hormones

Hormone Antagonists

Cytochrome P-450 CYP3A Inhibitors

Patients with persistent fever and neutropenia despite appropriate antibacterial therapy

caspofungin as preemptive antifungal therapy

The main objective of this study is to test prospectively the performance of an algorithm stratified by an index based on neutrophil counts in association with galactomannan assay and image tests to start an antifungal early therapy (empirical/preemptive) in neutropenic patients. Ths specific objectives are to determine the overall incidence of invasive fungal infections, use of antifungal agents, duration of hospitalization and mortality in this cohort, and to evaluate if this strategy is associated with a reduction in the expected use of antifungal agents if a classical empiric antifungal strategy was used, without an increase in the incidence of invasive fungal infections.

This is a prospective, non randomized, non comparative study. Patients aged ≥ 18 years are eligible if they have acute leukemia, myelodysplasia or other baseline disease submitted to chemotherapy or to allogeneic stem cell transplantation with an expected duration of neutropenia (neutrophil count \<500cells/mm³) of at least 10 days. Exclusion criteria are patients with and a past history of or invasive mold infection and those who do not want to participate. The study has no comparator arm. However, the investigators intend to determine if the algorithm based on the D-index would result in a 50% reduction in the use of antifungal agents, if all patients with persistent fever and neutropenia received empiric antifungal therapy. Based on our database of \~2,000 episodes of febrile neutropenia, 36% of patients had persistent fever between days 4 and 7 of antibiotics and would receive empiric antifungal therapy. A total of 105 patients will be needed to demonstrate a 50% reduction in antifungal use if the investigators compared this cohort with a matched control historical cohort (alpha = 5%, beta = 20%).

Neutropenia is a major risk factor for invasive fungal infections, particularly those caused by moulds, such as Aspergillus spp., Fusarium spp. and the Zygomycetes. Among neutropenic patients, these invasive mould infections (IMI) occur almost exclusively in patients with profound neutropenia (\<100 neutrophils/mm3) lasting more than 10-15 days \[1-3\]. Empiric antifungal therapy is considered standard of care in patients with persistent or recurrent fever and neutropenia. However using fever as the sole criterion for starting empiric therapy, a significant number of patients will receive antifungal therapy unnecessarily, particularly among recipients of fluconazole prophylaxis, because persistent fever in these patients is commonly due to various factors, such as uncontrolled occult bacterial infection, viral infection, drug fever and others \[4\].

An alternative to empiric antifungal therapy is the preemptive treatment. In this strategy, other markers (such as serology, radiology and clinical data) are added to persistent fever \[5,6\]. One problem of such strategy is that the biomarkers currently in use (galactomannan \[GM\], 1,3-beta-D-glucan and PCR) have high sensitivity. If one of these markers is used to trigger the start of antifungal therapy, still a considerable number of patients will use antifungal agents unnecessarily. However, a positive biomarker early in the course of neutropenia most likely represents a false-positive result. By contrast, a positive biomarker test late in the course of neutropenia is more likely to be a true positive. A problem is that no cutoff value of duration of neutropenia is validated to help clinicians to identify these 2 possibilities.

A clinical parameter that evaluated the dynamics of neutropenia, combining intensity and duration, could be a good tool to identify patients at high risk for IMI. This tool could be used to stratify patients, helping clinicians to select appropriate candidates for early antifungal therapy (empiric or preemptive) in persistently febrile neutropenic patients. We developed an index (called D-index) that uses data from white blood cell counts (WBC), and combines intensity and duration of neutropenia. This index was tested in patients with acute myeloid leukemia, and showed a good discriminatory performance in identifying patients with IMI and without IMI. A cutoff was derived, and showed good sensitivity, specificity and a very high negative predictive value (97 to 99%) \[7\]. The high negative predictive value of this index is very similar to that obtained with GM and 1,3-beta-D-glucan in febrile neutropenic patients \[8,9\]. With this regard, the D-index could be of help to assess the pre-test probability of IMI and help to interpret the results of positive serum GM and / or 1,3-beta-D-glucan: patients with low values of D-index would be best interpreted as having false-positive results of these tests. Similarly, positive biomarkers in the presence of a high D-index would be more likely to be true positives, since the combination of different tests may increase their positive predictive value.

This is a prospective cohort study. The study will be submitted to the IRB and written informed consent will be obtained from all participants.

Patients aged ≥ 18 years are eligible if they have acute leukemia, myelodysplasia or other underlying hematologic malignancy receiving chemotherapy with an expected duration of neutropenia (\<500/mm3) \>10 days. This includes allogeneic (but not autologous) hematopoietic stem cell transplantation. Patients with past history of IMI will be excluded, since for these patients secondary prophylaxis is advised.

Patients will be enrolled at initiation of chemotherapy and no later than 48h from the first day of neutropenia. The same patient will be able to be enrolled more than once, but if he develops IMI, he will be no longer eligible for a subsequent inclusion. All patients will receive antimicrobial prophylaxis with fluconazole (400mg daily). Chest imaging (X-ray or CT scan) will be performed at the enrollment. During the period of neutropenia induced by chemotherapy/ conditioning regimen, patients will be surveyed for the development of fever and will have the D-index calculated day by day. At the time of febrile neutropenia, at least 2 blood cultures will be collected. Other microbiologic exams will be obtained if clinically indicated. The patients will then receive a broad-spectrum β-lactam antibiotic (cefepime). Vancomycin will be added for patients who have clinically suspicion of catheter-related infection or a blood culture yielding Gram-positive bacteria not yet identified. Serum will be obtained 3 times a week for Aspergillus GM assay (Platelia Aspergillus; Bio-Rad) and Aspergillus sp. PCR (in-house real time qualitative and quantitative PCR). A positive GM will be defined as an index ≥ 0.5.

In case of persistent fever or a new fever, blood cultures will be collected and CT scans of the chest and the sinuses will be performed. Results of GM will be checked and the patients will be stratified according to the D-index as high, moderate or low risk for IMI. Based on this analysis, antifungal therapy (caspofungin 70 mg day 1 and 50 mg/d thereafter) will be started. In high risk patients (D index ≥ 5,800), the trigger for anti mold treatment will be the presence of any image on CT scan or any positive GM. In the moderate risk (D-index between 3,000 and 5,800), the trigger will be the presence of persistence of a positive GM in consecutive tests. In this stratum, chest CT scan will be defined as indicative of antifungal initiation only in the presence of one of the following: nodules \> 1 cm, with or without halo sign, wedge-shaped images, or cavitation. For low-risk patients (D-index \<3,000), antifungal treatment will be started only in the persistence of positive GM result in consecutive tests. In situations in which antifungal treatment is not started, reassessment of these parameters will be made at least twice a week with the evaluation of the D-index and biomarkers, and once a week with CT scans. In patients with lung infiltrates, a bronchoalveolar lavage (BAL) will be taken, provided the patient is not hypoxemic or severely thrombocytopenic and refractory to platelet transfusions. In the presence of findings in sinuses CT scans suggestive of sinusitis, nasal endoscopy will be performed. BAL and sinus aspiration samples will be processed for direct examination, culture, GM and Aspergillus PCR. Other diagnostic procedures will be performed when clinically indicated. Autopsy will be performed in all fatal cases after family authorization. Invasive fungal infection will be classified according to the Revised Definitions from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group \[10\].

To assess the performance of risk stratification based on the D-index, the overall use of antifungal treatment (al well as stratified by D-index) will be recorded, and reported by descriptive statistics. The outcome of each risk stratus (low, moderate and high) will be compared regarding: incidence of suspected and documented mold infection, use of anti mold therapy, duration of hospitalization and death rate. In addition, the proportion of patients receiving early antifungal treatment will be compared with empiric antifungal use in a historical matched-control cohort. Patients from the 2 cohorts will be compared using propensity score procedure. Propensity score analysis attempts to identify patients who are similar except for their treatment. The analysis will be performed as follows: first, the probability of any patient in the database to receive empiric antifungal therapy will be estimated using a multivariate logistic regression model that incorporates baseline characteristics, underlying diseases and co-morbidities. Next, we will match from the 2 cohorts patients with the nearest propensity score (the score generated by the multivariate equation)\[10\].

Based on our database of \~2,000 episodes of febrile neutropenia, 36% of patients had persistent fever between days 4 and 7 of antibiotics and would receive empiric antifungal therapy. A total of 105 patients would be needed to demonstrate a 50% reduction in antifungal use if we compared this cohort with a matched control historical cohort (alpha = 5%, beta = 20%).

Validation of an Index of Neutropenia (D-index) in Febrile Neutropenic Cancer Patients

Empirical Antifungal Treatment in Neutropenic Patients Stratified by Risk: Prospective Validation of an Algorithm Based on the D-index

Federal University of São Paulo

Universidade Federal do Rio de Janeiro

Associate Professor

Sepsis

Disease Attributes

using of blood biomarkers (CRP ,procalcitonin and 1, 3- β -D- glucan) in early differentiation between fungal and bacterial infections in pediatric cancer patients in comparison to blood culture.

procalcitonin ,CRP and 1, 3- β -D- glucan in early diagnosis of invasive infections

Asmaa M Soliman, demostrator

Mona A Hassan, professor

This work aims to:

1. Validate the performance of CRP, and PCT in early differentiating IFI from bacterial bloodstream infections.
2. Compare the results of CRP and PCT with the results of β-D- glucan. 3. Find the relationship between biomarkers levels \[CRP, PCT and β-D- glucan\] and the results of blood culture which is the gold standard of diagnosis.

Immunocompromised children with cancer receiving chemotherapy or undergoing hematopoietic stem cell transplant (HSCT) are at high risk of infections. Invasive fungal infection (IFI) is a significant cause of morbidity and mortality. The incidence of IFI from 5.3% to 24% and the mortality rate from 18.6% to 67.6%. Definite diagnosis of fungal infection in immunocompromised patients is particularly challenging. However, the clinical presentation of IFI is not specific, especially in pediatric patients. The culture of blood is the major method to diagnose proven IFI, but the results are mostly negative, and culture is time consuming. New nonculture-based methods, including antigen-based assays, and molecular detection of fungal DNA which may allow early diagnosis and treatment of fungal infection. Molecular techniques, including DNA sequencing and polymerase chain reaction (PCR). These techniques have become more available in many laboratories; however, it lacks methodological standardization, and the results vary widely among laboratories. More attention paid to the biomarkers. 1, 3- β -D- glucan (BDG) is a component of the fungal cell wall and therefore it considered a pan-fungal detection method. Traditional biomarkers as C-reactive protein (CRP) and procalcitonin (PCT) have also been evaluated for their abilities in distinguishing IFI and other infections. In neonates, CRP levels were significantly higher in fungemia than in bacteremia, in adult patients, there was not a significant difference between the candidemia and bacteremia groups. The PCT value was markedly lower in the fungal infection group than in the bacteremia group at the onset of fever.

Using of Biomarkers and Blood Culture in Early Detection of Systemic Infections

Blood Biomarkers Versus Blood Culture for Early Differentiation Between Fungal and Bacterial Infections in Pediatric Cancer Patients at South Egypt Cancer Institute

study will be done on 90 participants. Blood samples will be collected under sterile conditions through a venipuncture.

3-5 ml of blood will be collected on Bact alert bottles at the first 24 hours of fever early before taking antimicrobial treatment, cultured on blood agar. If positive, colonies will be cultured on McConkey, Mannitol salt agar and Sabouraud agar. Then the VITEK II method will be used to identify the colonies.

At the same time 3 ml of blood will be incubated at room temperature for 30 minutes then centrifuged at 2500 rpm for 10 minutes then serum will be used for ELISA measurement of serum procalcitonin and β-D glucan.

• Then trying to compare the results of blood culture with the biomarkers levels and find the relation between the results.

Assiut University

assistant lecturer

Neoplasms

Leukemia

Hematologic Neoplasms

Neoplasms by Histologic Type

Acute Graft Versus Host Disease

Patients with de novo or relapsed acute myeloid and lymphoid leukemia

Galina A Klyasova

Estimate the rate of occurrence of Invasive Fungal Infections (IFIs) in patients with acute leukemia for the first 6 months of chemotherapy (that usually correspond to four courses of chemotherapy), and hematopoietic stem cells transplantation.

This multi-center observational study of IFI in high risk hematological patients, the study will investigate the epidemiology of IFI, describe antifungal strategy, proportion of antifungal prophylaxis, empiric therapy, pre-emptive therapy and targeted therapy in at-risk patients.

A Russian Prospective Observational Study of Invasive Fungal Infections in Patients With Acute Leukemia and Hematopoietic Stem Cell Transplantation

Estimate the rate of IFIs in patients with acute leukemia for the first 6 months of chemotherapy (that usually correspond to four courses of chemotherapy), and hematopoietic stem cells transplantation.

National Hematological Society, Russia

The study was observational and the adverse events were not evaluated

Acute Leukemia Patients

Allo- or Auto- Transplant Recipients

Total

Age, Continuous

Age, Categorical

Sex: Female, Male

Russian Federation

Region of Enrollment

Professor Galina A Klyasova

The Rate of Invasive Fungal Infections

Overall Study

Immune System Diseases

Precursor Cell Lymphoblastic Leukemia-Lymphoma

Leukemia, Lymphoid

Lymphoma

Lymphoproliferative Disorders

Lymphatic Diseases

Immunoproliferative Disorders

Acute Lymphoblastic Leukemia

Lymphoblastic Lymphoma

Lymphosarcoma

observation of invasive fungal infections during chemotherapy

observation of invasive fungal infections

Chiara Cattaneo

Marianna Criscuolo

The study aims to evaluate incidence of invasive antifungal infections among patients with acute lymphoblastic leukemia Ph negative during the first weeks of treatment

Prospective Observational Study on Incidence of Invasive Fungal Infections Among Patients With Acute Lymphoblastic Leukemia Ph-negative

ASST Spedali Civili, Brescia

Fondazione Policlinico Universitario Agostino Gemelli IRCCS

Leukemia, Myeloid

Leukemia, Myeloid, Acute

Myeloid Leukemia

Acute Myeloid Leukemia

Acute Non Lymphoblastic Leukemia

Amphotericin B

Liposomal amphotericin B

Amebicides

Antiprotozoal Agents

Antiparasitic Agents

C. Orla Morrissey, MB, BCh, FRACP

Anthony P Schwarer, MB, BS, FRACP, MD, FRCPA

Sushrat Patil, MB, BS, FRACP, FRCPA

Anthony P. Schwarer, MB, BS, FRACP, MD, FRCPA

The purpose of this trial is to see which dose of liposomal amphotericin B is the safest when used as a preventer against invasive fungal infection in patients with acute leukaemia who are undergoing chemotherapy.

Invasive Fungal Infections (IFI)are a significant cause of death in patients with acute leukaemia who are undergoing chemotherapy. This is despite improvements in antifungal therapy for the treatment of IFI. The major reason for this is that the current standard diagnostic tests of culture and biopsy lack the ability to make a diagnosis, either early or accurately. Thus other strategies such as the use of prophylaxis are needed. Several antifungal agents have been trialled as prophylaxis but all have disadvantages that limit their effectiveness.

Liposomal amphotericin B(LAB) is a broad spectrum antifungal agent that kills fungal cells. When given in high doses intermittently it supersaturates the liver and the overspill into the bloodstream is absorbed by tissues such as lung, brain and kidneys (i.e. sites where IFI are likely to occur). This effect has been shown in a number of animal and laboratory test-tube studies to reduce fungal burden, improve survival and maintain adequate levels of the drug in between doses. However no intermittent high-dose prophylaxis study has been done in humans. Thus before we proceed to a randomised controlled clinical trial of the efficacy of intermittent high-dose LAB compared with another antifungal agent it is necessary to determine in a phase 2 study which of 2 intermittent dosing LAB regimens (i.e. 3mg/kg three times a week or 10mg/kg once a week) administered during the neutropenic phase of induction-consolidation chemotherapy for treatment of acute leukaemia is safest and best tolerated compared to the standard dosing regimen of 1mg/kg daily of LAB.

Males and females aged \>18 years who are undergoing intensive combination chemotherapy for acute leukaemia will be randomised 1:1:1 to either 1mg/kg daily; 3mg/kg 3 times a week or 10mg/kg once weekly of intravenous liposomal amphotericin B. The 3 arms will be compared for the safety of the 3 dosing regimens.

Intermittent Liposomal Amphotericin B Primary Prophylaxis

A Randomised, Stratified, Open Label, Phase II Pilot Study on the Safety of a Daily, Intermittent, or Weekly Administration of 1, 3 or 10mg/kg of AmBisome® in Antifungal Primary Prophylaxis of High-Risk Patients With Acute Myeloid Leukaemia

Gilead Sciences

Bayside Health

Posaconazole

Posaconazole 200 mg three times daily by mouth up to 6 weeks (Days 1-42)

7.5 mg/kg of ABLC intravenously infused over 4-6 hours once per week, for up to 6 weeks (from Day 1 through Day 42)

200 mg three times daily by mouth up to 6 weeks (Days 1-42)

ABLC

Issam Raad, MD/Professor

The objective of this study is to compare the safety and efficacy of ABLC versus oral Posaconazole in the prevention of invasive fungal infections in high risk patients with hematologic malignancies or hematopoietic stem cell transplant.

Primary objective is to demonstrate the low toxicity rate and low rate of invasive fungal infections associated with ABLC or Posaconazole prophylaxis.

Secondary objective will be to compare the cost effectiveness of these two prophylactic regimens.

The Study Drugs:

ABLC is an antifungal drug that is commonly used to treat and/or prevent a variety of serious invasive fungal infections (IFIs). In this study, ABLC will be used for IFI prevention.

Posaconazole is a newer antifungal drug that is commonly used to prevent serious IFIs.

Study Groups:

If you are found to be eligible to take part in this study, you will be randomly assigned (as in the toss of a coin) to receive either posaconazole or ABLC. You will have an equal chance (50/50) of being assigned to either group. You and your study doctor will know which group you are in.

Study Drug Administration:

If you are assigned to the Posaconazole Group, you will take posaconazole 3 times a day by mouth for up to 6 weeks (Days 1-42). The study doctor will advise you about taking it with fatty meals and/or nutritional supplements.

If you are assigned to the ABLC Group, you will receive ABLC once a week by vein over 4-6 hours, for up to 6 weeks (from Day 1 through Day 42). If the creatinine level increases, the dose will be divided into 2 doses per week. The drug may be given in the hospital (if you are admitted to the hospital before or during the study) or at an outpatient treatment center.

Study Visits:

Once a week from Day 1 to Day 42, you will have the following procedures performed:

* Blood (about 1 tablespoon) will be drawn for routine tests.
* You will be asked about any medications and treatments you may be receiving.
* You will be asked about any IFI symptoms that may have developed. You will also be asked about any side effects that may have occurred since your last visit. (You should contact the study doctor and/or study staff right away, if at any time you feel you have had a side effect.)

You may have certain routine diagnostic tests performed at any time in the study, if necessary to confirm you do not have an IFI. These tests may include blood collection (about 1 tablespoon), scans, skin tissue biopsy, and/or bronchoscopy.

Length of Study:

You will receive study treatment for up to 6 weeks (42 days). If you develop an IFI or any intolerable side effects, you will be taken off study early. You may also be taken off study if your neutrophil (a type of white blood cell) counts recover.

End-of-Treatment Visit:

Your End-of-Treatment visit will be on the last day you received the study drug (at most, 42 days after you started). The following procedures will be performed.

* Blood (about 1 tablespoon) will be drawn for routine tests.
* You will have a physical exam, including measurement of vital signs.
* If the study doctor and/or your primary doctor thinks you may have an IFI, routine diagnostic tests may be performed.

Follow-up Visit:

Your follow up visit will be completed 7 - 14 days after your end-of-treatment visit. The following procedures will be performed:

* You will be checked for any signs of IFI.
* If your doctor suspects you have an IFI, a scan (such as an x-ray or CT scan) and/or bronchoscopy may be performed.
* You will be asked about any medications and treatments you may be receiving, and any side effects you may have had.
* Your vital signs will be checked, and a physical exam may be performed.
* Blood (about 1 tablespoon) will be drawn for routine tests.
* An ECG may be performed.

This is an investigational study. ABLC and posaconazole are FDA approved and commercially available for the treatment and prevention of IFIs. Posaconazole is FDA approved for the way it is being used in this study. The study dose and study schedule for ABLC, however, is considered experimental. Currently, this dose and schedule for ABLC is being used in research only.

Up to 100 patients will take part in this study. All will be enrolled at M. D. Anderson.

Oral Posaconazole Three Times Per Day vs Weekly High Dose Amphotericin B Lipid Complex (ABLC)

Phase III Clinical Trial of Oral Posaconazole 3 Times/Day vs Weekly High Dose Amphotericin B Lipid Complex (ABLC) for Prevention of Invasive Fungal Infections In Patients With Hematologic Malignancies & Hematopoietic Stem Cell Transplant

Percentage of participants that developed IFI within 7 days of antifungal prophylaxis therapy (Posaconazole or ABLC).

Success: Defined as the absence of proven or probable invasive fungal infection through the end of prophylaxis and absence of Grade 1-4 toxicity related to prophylaxis requiring the discontinuation of the drug. Failure: Presence of proven or probable fungal infection or development of Grade 1-4 toxicity related to prophylaxis while on study drug and requiring discontinuation of study drug or inability to tolerate intravenous ABLC (due to infusion related toxicities) or oral Posaconazole (due to mucositis or vomiting).

Enzon Pharmaceuticals, Inc.

M.D. Anderson Cancer Center

Posaconazole 200 mg Oral

Amphotericin B Lipid Complex (ABLC) 7.5 mg/kg IV

United States

Issam Raad, MD / Chair, Infectious Diseases

Out of 46 participants, 40 were included in the analysis and 6 withdrew consent.

Incidence of Invasive Fungal Infection (IFI)

Success

Failure

Efficacy Outcome Measured as Success or Failure

Respiratory Tract (Lung and Bronchial) Diseases

Pneumonia, Pneumocystis

Pneumonia

Multiple Pulmonary Nodules

Respiratory Tract Infections

Lung Diseases

Respiratory Tract Diseases

Lung Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases, Fungal

Pneumocystis Infections

Pneumocystis Jirovecii Pneumonia

Pneumocystosis

Laurence Lachaud, MD

The intra-alveolar form of Pneumocystis jiroveci pneumonia (PjP) is a common pathology in immunocompromised patients, particularly those infected with HIV. The diagnosis is based on the detection of Pj in a LBA. Intra-tissue granulomatous form (PGP) is a rare entity observed in non-HIV immunocompromised patients. In this case, the LBA is mostly non-contributory and the diagnosis is based solely on the detection of cysts on histological examination on biopsy of a pulmonary nodule. For many years, it has been clearly demonstrated that the use of a specific PCR clearly improves the biological diagnosis of PcP. However, in case of granulomatous form this method is not implemented because the diagnostic hypothesis is not mentioned.

In 2018, two cases of PGP were diagnosed at 3-month intervals at Montpellier University Hospital Center. The diagnostic confirmation was obtained with PCR Pj. In this context the investigators will investigate the interest of implementing PCR Pj on biopsies on pulmonary nodules from hospitalized patients between 2015 and 2018. In all selected patients, histopathological aspect of the nodule was compatible with a PGP and, no other diagnosis has been confirmed (infectious, tumoral, inflammatory ...). Finally, 17 patients were selected to check retrospectively, if the presence of Pj could be at the origin of the pathology.

Granulomatous Pneumocystis Pneumonia

Biological Diagnosis of Granulomatous Pneumocystis Pneumonia

University Hospital, Montpellier

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Validation of an Index of Neutropenia (D-index) in Febrile Neutropenic Cancer Patients	NCT00982540	Invasive Fungal... Invasive Asperg... Invasive Fusari...	caspofungin as ...	18 Years -	Universidade Federal do Rio de Janeiro
Using of Biomarkers and Blood Culture in Early Detection of Systemic Infections	NCT05737537	Invasive Fungal...	procalcitonin ,...	- 18 Years	Assiut University
A Russian Prospective Observational Study of Invasive Fungal Infections in Patients With Acute Leukemia and Hematopoietic Stem Cell Transplantation	NCT01519648	Invasive Fungal...		1 Year - 95 Years	National Hematological Society, Russia
Validation of an Index of Neutropenia (D-index) in Febrile Neutropenic Cancer Patients	NCT00982540	Invasive Fungal... Invasive Asperg... Invasive Fusari...	caspofungin as ...	18 Years -	Universidade Federal do Rio de Janeiro
Prospective Observational Study on Incidence of Invasive Fungal Infections Among Patients With Acute Lymphoblastic Leukemia Ph-negative	NCT05750706	Acute Lymphobla... Invasive Fungal...	observation of ...	18 Years -	Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Prospective Observational Study on Incidence of Invasive Fungal Infections Among Patients With Acute Lymphoblastic Leukemia Ph-negative	NCT05750706	Acute Lymphobla... Invasive Fungal...	observation of ...	18 Years -	Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Intermittent Liposomal Amphotericin B Primary Prophylaxis	NCT00451711	Acute Myeloid L...	Liposomal ampho...	18 Years - 80 Years	Bayside Health
Oral Posaconazole Three Times Per Day vs Weekly High Dose Amphotericin B Lipid Complex (ABLC)	NCT00750737	Invasive Fungal... Hematologic Mal...	Posaconazole ABLC	18 Years -	M.D. Anderson Cancer Center
Granulomatous Pneumocystis Pneumonia	NCT03731156	Pulmonary Nodul... Invasive Fungal... Pneumocystis Ji...		18 Years -	University Hospital, Montpellier

Spots Global Cancer Trial Database for invasive fungal infections