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MyelomaPhase 2/3NCT07202091

Role of Antibiotic Therapy or Immunoglobulin On iNfections in hAematoLogy Immunoglobulin Stopping or Extension (Stop Ig)

A Phase 2/3 study testing Trimethoprim Sulfamethoxazole, Amoxycillin/clavulanic acid and Immune Globulin Intravenous in people with Myeloma and Leukemia, run by Monash University at 3 sites in Australia.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

This study is being conducted to find out how safe and effective different strategies of infection prevention are in comparison to each other, for preventing infection in patients with blood cancers. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Myeloma, Leukemia, Non Hodgkin's Lymphoma
What is being tested?
Trimethoprim Sulfamethoxazole, Amoxycillin/clavulanic acid and Immune Globulin Intravenous
Type of treatment
Injection or infusion
Could I receive a placebo?
No, everyone receives an active treatment
How many people
900 participants
Where
3 sitesAustralia
Study dates
6 May 2025to 31 Mar 2027
Phase
Phase 2/3
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patients must be receiving Ig (IV or subcutaneous - SCIg) replacement for prevention of bacterial infections due to hypogammaglobulinaemia for at least 6 consecutive months.
  • Patient is eligible for trial of Ig cessation in the opinion of the treating clinician and local investigator.
  • Patient is willing and able to comply with each of the treatment arms.

Who cannot join

  • Prior or planned allogeneic haematopoietic stem cell transplantation.
  • Major infection (Grade 3 or higher) in preceding 3 months, and/or current active infection requiring systemic antimicrobial treatment.
  • Already receiving systemic antibiotic prophylaxis for the purpose of preventing bacterial infection (NB: patients may receive antiviral, antifungal and PJP prophylaxis).
  • Intolerance of all trial antibiotic options in either arm A or arm B.
  • Communication, compliance or logistical issues that are likely to limit patient's ability to take prophylactic or emergency antibiotics, or to obtain urgent medical attention for symptoms of infection.
  • Pregnant or breastfeeding.
Show all 10Show fewer
  • Severe renal impairment (estimated or measured creatinine clearance of < 30 mL/min).
  • Previous splenectomy.
  • Previous participation in this domain.
  • Treating team deems enrolment in the domain is not in the best interests of the patient.

Trial locations and contacts

3 sites in 1 country. Contact the study team or a site near you to ask about taking part.

Australia3 sites, 3 recruiting
  • Royal Adelaide Hospital

    Adelaide, South Australia, 5000

    Peter Bardy, Dr, +61 (8) 7074 5898, peter.bardy@sa.gov.au

    Chris Hoare, +61 08 7074 3290, christine.hoare@sa.gov.au

    Recruiting
  • Austin Hospital

    Melbourne, Victoria, 3004

    Andrew Lim, Dr, +61 (03) 9070 5741, andrew.lim@austin.org.au

    Selena Squillaciotti, Selena.SQUILLACIOTI@austin.org.au

    Recruiting
  • Northern Health

    Melbourne, Victoria, 3004

    Rachel Cooke, PhD, +61 (03) 8408 6000, rachel.cooke@nh.org.au

    Rhiannon Davidson, rhiannon.davidson@nh.org.au

    Recruiting

Other trials in Australia

About this study

Official title: Role of Antibiotic Therapy or Immunoglobulin On iNfections in hAematoLogy (Stop-Ig)

This study is being conducted to find out how safe and effective different strategies of infection prevention are in comparison to each other, for preventing infection in patients with blood cancers. The best way to find out this information is to directly compare the effect of different treatment strategies in patients with blood cancers. We want to know how these different treatments impact on your health and your use of healthcare services.

This research project uses an Adaptive Platform Design. This design allows the researchers to compare multiple infection prevention strategies within the same trial at the same time (rather than running separate trials), to analyse results as the trial occurs and to add new research questions during the course of the trial.

The treatments that you may receive as part of the study will be determined by which domain(s) of the platform you participate in. By combining data collected within each domain as part of the platform, the researchers can investigate and compare treatment strategies and infection outcomes across a broader range of participants.

Read the detailed description

This is a domain within the RATIONAL Platform Trial to test the effectiveness and safety of stopping Ig replacement with or without prophylactic antibiotics compare to continuing Ig replacement.

Being tested
Trimethoprim Sulfamethoxazole, Amoxycillin/clavulanic acid, Immune Globulin Intravenous
Keywords
immunoglobulin, antibiotics, myeloma, leukaemia, lymphoma, non Hodgkins, infection, infections, blood, cancer, haematology
Medical subject headings
Neoplasms, Plasma Cell, Leukemia, Lymphoma, Infections, Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Trimethoprim SulfamethoxazoleDrug

    Also called Co-Trimoxazole

    Once daily trimethoprim-sulfamethoxazole (co-trimoxazole) 160mg/800mg. NB: Doxycycline 100mg daily as an alternative for patients with hypersensitivity to co-trimoxazole.

  • Amoxycillin/clavulanic acidDrug

    Also called Ciprofloxacin

    Patients will be provided with amoxycillin/clavulanic acid 1750-2000mg/250mg and ciprofloxacin 750 mg to keep at home for initial use if symptoms of infection develop, with immediate review by their treating clinical team, or nearest emergency department or medical practitioner with phone contact to treating team if most practical.

  • Immune Globulin IntravenousBiological

    Also called Immune Globulin Subcutaneous

    Participants will continue treatment with their current Ig replacement schedule. Participants will receive monthly (every 4 weeks ± 1 week) intravenous immunoglobulin at a dose of 0.4g/kg, modified to achieve an IgG trough level of at least lower limit of age-specific serum IgG reference range. For patients who have already had their Ig dose titrated to IgG trough level, they may continue on their current monthly dose of Ig replacement. SCIg, weekly, may be used in patients who meet local criteria for home-based self-administration in centres with established SCIg programs. Dosing is usually given at 100mg/kg/week, modified to achieve an IgG steady state level of at least the lower limit of the serum reference range.

Study groups in NCT07202091
Study groupRoleWhat they receive
Arm A: Stop Ig and commence prophylactic oral antibioticsOtherOnce daily trimethoprim-sulfamethoxazole (co-trimoxazole) 160mg/800mg. NB: Doxycycline 100mg daily as an alternative for patients with hypersensitivity to co-trimoxazole.
Receives: Drug: Trimethoprim Sulfamethoxazole
Arm B: Stop IgOtherPatients will be provided with amoxycillin/clavulanic acid 1750-2000mg/250mg and ciprofloxacin 750 mg to keep at home for initial use if symptoms of infection develop, with immediate review by their treating clinical team, or nearest emergency department or medical practitioner with phone contact to treating team if most practical. NB: Clindamycin 600 mg is permitted as an alternative to amoxycillin/clavulanic acid for patients with hypersensitivity to penicillin. Ciprofloxacin is omitted for participants with hypersensitivity.
Receives: Drug: Amoxycillin/clavulanic acid
Arm C: Continue IgOtherParticipants will continue treatment with their current Ig replacement schedule. Participants will receive monthly (every 4 weeks ± 1 week) intravenous immunoglobulin at a dose of 0.4g/kg, modified to achieve an IgG trough level of at least lower limit of age-specific serum IgG reference range. For patients who have already had their Ig dose titrated to IgG trough level, they may continue on their current monthly dose of Ig replacement. SCIg, weekly, may be used in patients who meet local criteria for home-based self-administration in centres with established SCIg programs. Dosing is usually given at 100mg/kg/week, modified to achieve an IgG steady state level of at least the lower limit of the serum reference range.
Receives: Biological: Immune Globulin Intravenous

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Event-free survival (EFS).

    Defined as time from randomisation (or, in domains with a single treatment arm, time from registration) until occurrence of a Grade 3 or higher infection (as defined by CTCAE Version 5), or death from any cause.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

Secondary outcomes (14)
  1. Occurrence of at least one Grade 3 or higher infection(s) from randomisation to 12 months.

    Occurrence of at least one Grade 3 or higher infection(s) from randomisation to 12 months

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  2. Occurrence of one or more clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Occurrence of one or more clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  3. Number of clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Number of clinically documented infections (symptoms/signs of infection requiring antimicrobial treatment) from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  4. Occurrence of one or more microbiologically documented infections from randomisation to 12 months.

    Occurrence of one or more microbiologically documented infections from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  5. Number of microbiologically documented infections from randomisation to 12 months.

    Number of microbiologically documented infections from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  6. All-cause mortality at 12 months.

    All-cause mortality at 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  7. Infection-related mortality at 12 months.

    Infection-related mortality at 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  8. Time free from hospitalisation with antimicrobial administration with therapeutic intent from randomisation to 12 months.

    Time free from hospitalisation with antimicrobial administration with therapeutic intent from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  9. Occurrence of one or more treatment-related adverse events.

    Occurrence of one or more treatment-related adverse events.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  10. Number of treatment-related adverse events.

    Number of treatment-related adverse events.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration.

  11. Isolation of fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms from randomisation to 12 months.

    Isolation of fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  12. Number of infections with fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms isolated from randomisation to 12 months.

    Number of infections with fluoroquinolone resistant organisms, co-trimoxazole resistant organisms, extended spectrum beta lactamases or multidrug resistant organisms isolated from randomisation to 12 months.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

  13. Quality of Life (QoL) measured at randomisation then 3, 6, 9 and 12 months, using different questionnaire.

    Quality of Life (QoL) measured at randomisation then 3, 6, 9 and 12 months, using different questionnaire.

    Measured: Randomisation, Month 3, Month 6, Month 9 and Month 12.

  14. Costs associated with allocated treatment arm and infections during study.

    Costs of infections and trial interventions will be estimated based on trial treatment and adverse event data within the hospital medical record, as well as linked data obtained from the Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS) and Australian Immunisation Register (AIR). Data from the quality of life questionnaires will be used to calculate quality adjusted life years.

    Measured: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted1 Oct 2025
  2. Study start6 May 2025
  3. Primary completion31 Mar 2027 (estimated)
  4. Study completion31 Mar 2027 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 2/3
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Up to 900 participants will be recruited to the RATIONAL-PT, including up to 300 per domain. The aim of the platform is to determine optimal supportive care interventions for patients with haematological malignancies. The primary outcome for the platform is Event-free survival (EFS), defined as time from randomisation (or, in domains with a single treatment arm, time from registration) until occurrence of a Grade 3 or higher infection (as defined by CTCAE Version 5), or death from any cause. Data from each domain will contribute to the primary analysis.
Masking
None (open label)
Enrolment
900 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07202091
Sponsor's protocol ID
TRU-RPT-22 Stop-Ig
Status last verified
Oct 2025
First submitted
24 Sep 2025
Last updated
7 Oct 2025
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data will not be publicly available. Data will only be presented as a whole, no individual data will be published or presented.

Questions about this trial

What is this clinical trial studying?

A Phase 2/3 study testing Trimethoprim Sulfamethoxazole, Amoxycillin/clavulanic acid and Immune Globulin Intravenous in people with Myeloma and Leukemia, run by Monash University at 3 sites in Australia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 10 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 7 Oct 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in Australia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this combined phase mean?

Phase 2 studies give the treatment to a larger group to see whether it has the intended effect and to keep checking safety.

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Each site lists its own contact: choose the nearest one under Trial locations. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Event-free survival (EFS). (time frame: 12 months following randomisation (or, in domains with a single treatment arm, time from registration).). It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2025.

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