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Early Discontinuation of Antibiotics in Paediatric High-risk Febrile Neutropenia (E-STOP2)

13. mai 2026 oppdatert av: Hospital Universitari Vall d'Hebron Research Institute

Phase IV, Randomized, Open Label, Parallel Groups Clinical Trial for Evaluating the Early Stop of Antibiotic Treatment in High-risk Febrile Neutropenic Oncohaematological Paediatric Patients (e-STOP 2)

The goal of this clinical trial is to evaluate whether stopping antibiotic treatment early is safe in paediatric patients with cancer who develop high-risk febrile neutropenia but show good clinical evolution and low biomarker levels 48-72 hours after the episode.

The main questions it aims to answer are:

Is early discontinuation of antibiotics as safe as the standard strategy in terms of preventing invasive bacterial infections (such as sepsis, microbiologically documented infection, ICU admission, or death)? Does this strategy reduce the number of days on antibiotics without increasing infection-related complications?

Researchers will compare early antibiotic discontinuation with the standard care strategy to see whether the early-stop approach provides similar safety while reducing antibiotic exposure.

Participants will:

Receive standard initial antibiotic therapy for febrile neutropenia. Undergo clinical and biomarker evaluations (including CRP and PCT).

Be randomly assigned to:

Experimental group: early discontinuation of antibiotics, or Control group: continuation of the standard antibiotic strategy.

Be followed for 28 days after randomisation to monitor safety outcomes and treatment effects.

Studieoversikt

Status

Har ikke rekruttert ennå

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Children with cancer who develop febrile neutropenia (FN) routinely receive broad-spectrum intravenous antibiotics to prevent severe bacterial infections. Although this approach is essential in high-risk cases, prolonged antibiotic exposure increases the risk of adverse effects, antimicrobial resistance, drug toxicity, and longer hospital stays. Advances in risk stratification-particularly through clinical stability assessment and biomarkers such as C-reactive protein (CRP) and procalcitonin (PCT)-now allow earlier identification of patients who may no longer require intensive antibiotic coverage.

This study evaluates whether early discontinuation of antibiotic therapy is safe in paediatric patients with cancer who present high-risk FN but show a favourable clinical course 48-72 hours after onset. Eligible patients must meet predefined criteria indicating low risk of invasive bacterial infection (IBI), including clinical stability, absence of microbiologically documented infection, and decreasing biomarker levels. The trial uses a randomised, controlled, open-label design to compare an early-stop strategy with the current standard management.

The rationale for this approach is to determine whether antibiotic therapy can be safely shortened without compromising infection-related outcomes. Limiting unnecessary antibiotic exposure may reduce adverse drug events, improve patient comfort, minimise disruption of the microbiome, and support antimicrobial stewardship programmes. The study also incorporates biomarker measurements (CRP, PCT, IL-8) to explore their predictive value for IBI and to validate an IBI-risk prediction model for this population.

Participants will be monitored closely for signs of bacterial infection or clinical deterioration throughout the 28-day follow-up period. This design enables robust assessment of safety while reflecting real-world clinical decision-making and the potential benefits of personalised antibiotic duration in paediatric oncology care.

Studietype

Intervensjonell

Registrering (Antatt)

136

Fase

  • Fase 4

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiekontakt

Studiesteder

  • Spania
    • Barcelona
      • Barcelona, Barcelona, Spania, 08035
        • Hospital Universitari Vall d'Hebron
        • Ta kontakt med:
        • Hovedetterforsker:
          • Natalia A Mendoza Palomar, MD
      • Esplugues de Llobregat, Barcelona, Spania, 08950
        • Hospital Sant Joan de Déu
        • Ta kontakt med:
        • Hovedetterforsker:
          • Silvia Simó Nebot, MD, PhD
    • Madrid
      • Madrid, Madrid, Spania, 28046
        • Hospital Universitario La Paz
        • Ta kontakt med:
        • Hovedetterforsker:
          • Pilar Guerra García, MD
      • Madrid, Madrid, Spania, 28009
        • Hospital Infantil Universitario Nino Jesus
        • Ta kontakt med:
        • Hovedetterforsker:
          • Blanca Herrero Velsaco, MD

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

  • Barn
  • Voksen

Tar imot friske frivillige

Nei

Beskrivelse

Inclusion Criteria:

  1. Male and female patients ≤18 years of age expected to develop prolonged neutropenia (>7 days), with:

    • Acute myeloblastic leukaemia at any phase of chemotherapy
    • Acute lymphoblastic leukaemia in induction, consolidation, or intensification phases
    • Biphenotypic leukaemia at any phase of chemotherapy
    • Lymphoblastic lymphoma in induction and consolidation phases
    • B-cell and anaplastic lymphoma receiving high-intensity chemotherapy
    • Solid tumours receiving high-intensity chemotherapy
    • Relapsed leukaemia at any phase of treatment
  2. Episode of febrile neutropenia (FN), defined as a single axillary temperature ≥38.0°C in a patient with an absolute neutrophil count (ANC) <500 neutrophils/mm³, or expected to fall below this value within the next 48-72 hours.
  3. Antibiotic treatment initiated for the current FN episode (routine antimicrobial prophylaxis is allowed, as well as teicoplanin 3 days/week for patients with AML included in the CHIP-AML-2022 protocol and therefore in the Pro-teico study).

  4. Low risk of invasive bacterial infection (IBI) at the start of the FN episode. Patients must meet all of the following:

    • CRP <9 mg/dL
    • PCT <0.5 ng/mL
    • Absence of hypotension
  5. No microbiologically documented bacterial infection 48-72 hours after the FN episode.

  6. Good clinical evolution 48-72 hours after the FN episode, defined as:

    • Afebrile for >48 hours (axillary temperature <38°C)
    • Haemodynamically stable
    • Stable paediatric early warning score (PEWS)
  7. CRP <5 mg/dL, or CRP <9 mg/dL and PCT <0.5 ng/mL, with decreasing trend at the time of randomisation (values will be assessed on day 3 and day 5 after the FN episode).
  8. ANC <500 neutrophils/mm³ at the time of randomisation.
  9. Signed informed consent from the patient and/or parent(s)/legal representative(s).
  10. Patient and/or parent(s)/legal representative(s) must have sufficient reading and writing skills to understand and provide consent to participate in the study.
  11. Patient and/or parent(s)/legal representative(s) must be considered reliable and capable of adhering to the protocol.

Exclusion Criteria:

  1. Antibiotic treatment at the time of the FN episode different from that used prophylactically.
  2. Empirical antibiotic treatment different from that recommended in international guidelines.
  3. Patient with poor clinical evolution during the first 12 hours (hemodynamic instability, PICU admission, death).
  4. Active participation in the same study at the onset of the current FN episode.
  5. Active participation in another clinical trial that, in the investigators' opinion, may interfere with the assessment of the results.
  6. Any condition which, in the investigator's opinion, makes study participation unsuitable for the patient or could limit, prevent, or confound the assessments planned in the protocol.
  7. Female patients who are pregnant or breastfeeding

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Ingen (Open Label)

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: Early Discontinuation of Antibiotics
Participants assigned to this arm will have intravenous antibiotic therapy discontinued within 24 hours after randomization, provided they meet all clinical stability and low-risk criteria. Patients may be discharged if no other clinical reasons require hospitalization. Antibiotics may be reintroduced if fever recurs or if clinical deterioration suggests infection.
Legemiddel: Early Discontinuation of Antibiotics
Participants assigned to this intervention will stop intravenous antibiotic therapy within 24 hours after randomization, provided they meet all required clinical stability and low-risk criteria at 48-72 hours (or day 5) after the febrile neutropenia episode. Patients may be discharged once clinically appropriate. Antibiotics may be restarted if fever recurs or clinical deterioration suggests infection.
Andre navn:
  • Drug stop within 24 hours after randomization:Piperacillin-tazobactam, amikacin, meropenem, cefepime, ceftazidime, vancomycin, teicoplanin, ciprofloxacin, levofloxacine and metronidazole
Aktiv komparator: Standard Antibiotic Strategy
Participants assigned to this arm will continue antibiotic therapy for at least 7 days and/or until signs of marrow recovery are present (ANC ≥100/mm³), according to each center's standard protocol. Hospital discharge will occur once clinical criteria permit.
Legemiddel: Standard Antibiotic Continuation Strategy
Continuation of antibiotic therapy for at least 7 days and/or until marrow recovery (ANC ≥100/mm³) following standard institutional protocols. Therapy may be extended depending on clinical assessment.
Andre navn:
  • Drug continuation for at least 7d and/or until marrow recovery:Piperacillin-tazobactam,amikacin,meropenem,cefepime, ceftazidime, vancomycin, teicoplanin, ciprofloxacin, levofloxacine and metronidazole

Hva måler studien?

Primære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Composite rate of adverse outcomes attributable to invasive or clinically significant bacterial infection
Tidsramme: Day 0 (randomization) to Day 28
Composite endpoint including any of the following events: death, pediatric intensive care unit admission, sepsis or septic shock, microbiologically documented bacterial infection, or radiologically confirmed pneumonia. The proportion of participants experiencing at least one component of the composite endpoint will be compared between the early discontinuation arm and the standard continuation arm to assess non-inferiority in safety.
Day 0 (randomization) to Day 28

Sekundære resultatmål

Resultatmål
Tiltaksbeskrivelse
Tidsramme
Number of days of antibiotic therapy
Tidsramme: From Day 0 to Day 28
Total duration of systemic antimicrobial therapy will be compared between the early-stop arm and the standard-therapy arm to evaluate reduction in antibiotic exposure.
From Day 0 to Day 28
Incidence of antibiotic-related adverse events
Tidsramme: Up to Day 28
Number of participants experiencing adverse effects attributable to antimicrobial therapy, including drug toxicity or complications associated with prolonged antibiotic use.
Up to Day 28
Predictive performance of C-reactive protein (CRP) for invasive bacterial infection
Tidsramme: Measured at episode onset, at 48-72 hours, and optionally on Day 5
Retrospective evaluation of CRP levels as a predictor of invasive bacterial infection in pediatric high-risk febrile neutropenia episodes.
Measured at episode onset, at 48-72 hours, and optionally on Day 5
Predictive performance of procalcitonin (PCT) for invasive bacterial infection
Tidsramme: Measured at episode onset, at 48-72 hours, and optionally on Day 5
Retrospective evaluation of procalcitonin levels as a predictor of invasive bacterial infection in pediatric high-risk febrile neutropenia episodes.
Measured at episode onset, at 48-72 hours, and optionally on Day 5
Predictive performance of interleukin-8 (IL-8) for invasive bacterial infection
Tidsramme: Measured at episode onset and at 48-72 hours
Retrospective evaluation of IL-8 levels as a predictor of invasive bacterial infection in pediatric high-risk febrile neutropenia episodes.
Measured at episode onset and at 48-72 hours
Validation of an invasive bacterial infection (IBI) prediction model
Tidsramme: Day 0 to Day 28
Evaluation of a predictive model combining clinical variables, biomarker measurements, and risk scores to classify pediatric high-risk febrile neutropenia episodes according to risk of invasive bacterial infection.
Day 0 to Day 28

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

Hospital Universitari Vall d'Hebron Research Institute

Publikasjoner og nyttige lenker

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Generelle publikasjoner

Studierekorddatoer

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Studer hoveddatoer

Studiestart (Antatt)

1. juni 2026

Primær fullføring (Antatt)

1. juli 2028

Studiet fullført (Antatt)

1. juli 2028

Datoer for studieregistrering

Først innsendt

16. februar 2026

Først innsendt som oppfylte QC-kriteriene

13. mai 2026

Først lagt ut (Faktiske)

15. mai 2026

Oppdateringer av studieposter

Sist oppdatering lagt ut (Faktiske)

15. mai 2026

Siste oppdatering sendt inn som oppfylte QC-kriteriene

13. mai 2026

Sist bekreftet

1. mai 2026

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • EU-CT2025-524264-38-00

Legemiddel- og utstyrsinformasjon, studiedokumenter

Studerer et amerikansk FDA-regulert medikamentprodukt

Nei

Studerer et amerikansk FDA-regulert enhetsprodukt

Nei

produkt produsert i og eksportert fra USA

Nei

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