Inclusion
- Recipients of myeloablative or non-myeloablative allogeneic stem cell transplantation from HLA-matched family or unrelated donor, mismatched family or unrelated donor or cord blood donor
- Proven or probable invasive fungal disease following transplant as defined by the internationally accepted criteria of the European Organisation for Research and Treatment of Cancer and the US-based Mycoses Study Group within 1 year of allogeneic stem cell transplant
- Patients has received no more than 28 days of a therapeutic dose of an anti-fungal drug prior to fungus-specific T-cell infusion (prophylactic anti-fungal agents not included). The choice of anti-fungal agents will be unrestricted and at the discretion of the treating physician
- Adequate hepatic and renal function (< 5 x upper limit of normal for AST (SGOT), ALT (SGPT), < 3 x upper limit of normal for total bilirubin, serum creatinine)
- ECOG status 0 to 3 or Lansky score 30-100
- Patient (or legal representative) has given informed consent.
Exclusion
- Use of anti-lymphocyte globulin (ALG, ATG, Campath or other broad spectrum lymphocyte antibody) in the 4 weeks immediately prior to fungus-specific T-cell infusion or planned within 4 weeks after infusion unless anti-lymphocyte globulin levels in blood shown to be below the lympholytic threshold prior to infusion.
- Active grade II or greater graft versus host disease within 1 week prior to infusion.
- Prednisone or methylprednisolone at a dose of > 1 mg/kg daily (or equivalent in other steroid preparations) administered within 72 hours prior to cell infusion.
- Dose of prednisone or methylprednisolone (if administered) not maintained at a stable level for 72 hours prior to T cell infusion
- Active and uncontrolled relapse of malignancy
- Severe peripheral cytopenia (ANC <0.5 x 10^9/L, platelet count <20 x 10^9/L unsupported)
- Active uncontrolled non-fungal infection including bacterial sepsis requiring commencement of systemic intravenous antibiotics in the 48 hours prior to T-cell infusion, active tissue infection with opportunistic viruses or untreated or progressing post-transplant lymphoproliferative disease
- Hypotension requiring fluid or pressor support, hypoxia or neurological features such as confusion or seizures in the 48 hours prior to T-cell infusion
- Patients requiring assisted respiration (eg: CPAP/intubation)
- ECOG status 4 or Lansky score <30
- Privately insured in or outpatients in New South Wales participating centres