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FOB in HSCT and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborator:
Blood and Marrow Transplant Group of Georgia
Information provided by (Responsible Party):
Northside Hospital, Inc.
ClinicalTrials.gov Identifier:
NCT01328873
First received: March 1, 2011
Last updated: March 16, 2017
Last verified: March 2017
March 1, 2011
March 16, 2017
March 2011
October 2015   (Final data collection date for primary outcome measure)
Number of Patients With Positive Culture or Molecular Results After Brochoscopy [ Time Frame: 30 days ]
To determine the diagnostic yield related to fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in hematopoietic stem cell transplant (HSCT) and leukemia patients with acute respiratory symptoms and pulmonary infiltrates utilizing both current standard of care microbiology testing and emerging molecular genetic laboratory assessments.
Diagnostic Yield [ Time Frame: 30 days ]
1.1 To determine the diagnostic yield related to fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) in hematopoietic stem cell transplant (HSCT) and leukemia patients with acute respiratory symptoms and pulmonary infiltrates utilizing both current standard of care microbiology testing and emerging molecular genetic laboratory assessments.
Complete list of historical versions of study NCT01328873 on ClinicalTrials.gov Archive Site
  • Number of Patients With Positive CT Result [ Time Frame: 30 days ]

    To correlate specific types of pulmonary infiltrates (focal, multifocal, or diffuse interstitial or alveolar infiltrates) with microbiological findings. Patients were evaluated by changes on the CT and categorized as follows:

    1. Air space
    2. ground glass/reticular nodular
    3. nodular/cavitary
    4. single patchy infiltrate
  • Number of Participants With Positive Bacterial Results by PCR [ Time Frame: 24-48 hours ]
    To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  • Number of Patients With Positive Fungal Results by PCR [ Time Frame: 24-48 hours ]
    To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  • Number of Participants With Positive Viral Results by PCR [ Time Frame: 24-48 hours ]
    To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  • Number of Participants With Positive Myocbacteria Results by Culture [ Time Frame: 24-48 hours ]
    To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  • Comparison of diagnostic yield to historical data [ Time Frame: 30 days ]
    To compare the diagnostic yield using the combination of standard of care microbiology testing and emerging molecular genetic microbiology PCR/assay testing to our prospectively collected historical data obtained at our institution.
  • Therapeutic changes from BAL [ Time Frame: 30 days ]
    To document therapeutic changes that occurred as a result of FOB findings
  • Correlation of infiltrates with microbiological findings [ Time Frame: 30 days ]
    To correlate specific types of pulmonary infiltrates (focal, multifocal, or diffuse interstitial or alveolar infiltrates) with microbiological findings
  • Description of microbiological findings [ Time Frame: 24-48 hours ]
    To describe the microbiological findings in HSCT and leukemia patients with fever, respiratory symptoms, and pulmonary infiltrates
  • Comparison of new testing vs SOC tests [ Time Frame: 30 days ]
    To compare the findings of the new PCR-based tests to that of current standard of care tests.
Not Provided
Not Provided
 
FOB in HSCT and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates
A Prospective Assessment of the Diagnostic Utility of Emerging Laboratory Assessments Used in Conjunction With FOB in HSCT and Leukemia Patients With Acute Respiratory Symptoms and Pulmonary Infiltrates

Pulmonary infiltrates frequently complicate the care of hematopoietic stem cell transplant (HSCT) and leukemia patients. Bronchoalveolar lavage (BAL) is frequently used to evaluate new pulmonary infiltrates in this population, however utility is limited by a historically low diagnostic yield for infection.

In an effort to improve diagnostic yields, this study will complete a Fiberoptic Bronchoscopy (FOB) within 8 hours of radiographic documentation of pulmonary infiltrates, prior to initiating new antibiotic therapy. To further improve detection of microbiological pathogens, the study will utilize PCR testing with rapid turnaround time to detect atypical pneumonia (M pneumoniae, C. Pneumonia, Legionella species, and respiratory viruses) and aspergillosis.

Proper diagnosis and prompt treatment favorably impacts survival in the post transplant setting, but is often difficult and frequently results in inappropriate or late therapy. Low yields may be linked with empiric antibody therapy begun prior to the procedure, delayed time to procedure, procedure technique, the presence of graft versus host disease (GVHD), neutropenia, and diffuse infiltrates (as opposed to localized infiltrates or focal masses and nodules). One recent study found that early FOBs (less than or equal to 4 days between detection of pulmonary infiltrates and FOB) were 2.5 times more likely to establish a diagnosis of pneumonia compared to late examinations. Delaying this procedure(greater than 5 days between detection of pulmonary infiltrates and FOB) was associated with drug resistant organisms, polymicrobial infections, and worsened patient prognosis.
Interventional
Not Provided
Intervention Model: Single Group Assignment
Masking: No masking
Primary Purpose: Treatment
Pulmonary Infiltrate New
Other: Microbiological analysis
Bronchoalveolar lavage (BAL) with subsequent testing for pathogens
Experimental: Laboratory testing
All patients will receive the lab testing on bronchoscopy specimens
Intervention: Other: Microbiological analysis

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Active, not recruiting
49
April 2017
October 2015   (Final data collection date for primary outcome measure)

Inclusion Criteria:

  • Autologous or allogeneic stem cell patients with new acute respiratory symptoms or pulmonary infiltrates
  • leukemia patients with new acute respiratory symptoms or pulmonary infiltrates thought to be unrelated to disease

Exclusion Criteria:

  • Patients unwilling to undergo FOB
  • Patients unable to undergo FOB due to clinical status
  • Patients unable to undergo FOB within 8 hours of radiographic report of pneumonia
  • Patients unable to wait until completion of FOB to implement antibiotic changes
  • Adults unable to provide informed consent
Sexes Eligible for Study: All
18 Years to 80 Years   (Adult, Senior)
No
Contact information is only displayed when the study is recruiting subjects
United States
 
 
NCT01328873
NSH 909
No
Not Provided
No
Not Provided
Northside Hospital, Inc.
Northside Hospital, Inc.
Blood and Marrow Transplant Group of Georgia
Principal Investigator: H. Kent Holland, MD Blood and Marrow Transplant Group of Georgia
Northside Hospital, Inc.
March 2017

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP