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RecruitingLast updated: 24 September 2025

RATIONALISE: A study investigating if oral antibiotics can be used instead of immunoglobulin for preventing infections in people with blood cancers, and how frequently the antibiotics should be takenA randomised controlled trial of continuing immunoglobulin therapy, or stopping with or without prophylactic antibiotics, on infection rate in patients with acquired hypogammaglobulinemia secondary to haematological malignancies

Trial purpose

Medical clipboardSide effect and wellbeing

Tumor type

Blood Cancers Haematological

Age

People18+

Trial acronym

RATIONALISE

Clinical summary

Summary

You may be eligible for this study if you are aged 18 years or above, have an acquired hypogammaglobulinaemia secondary to a haematological malignancy, and have received immunoglobulin (Ig) treatment for over 6 months.

Eligible participants will be randomly allocated to one of three treatment groups:

  • To stop Ig, and be given oral antibiotics to take every day
  • To stop Ig, and be given oral antibiotics to keep at home and use only if infection symptoms occur
  • To continue receiving their usual Ig treatment.

The duration of each treatment is 12 months.

Over the course of the 13 month study participation period, participants will be asked to return to the hospital for a study visit every 3 months, with monthly telephone visits to check-in on progress between each in-person visit. Participants will also be asked to complete a study diary, recording treatment compliance and signs/symptoms of infection experienced throughout the study period.

Types of assessments and data collected will include: medical history, demographics, physical examination, blood tests, stool sample, quality of life questionnaires, information about your general health, hospitalisations, medications and procedures. In order to assess and compare the cost-effectiveness of the treatment groups, the study team will also request authorisation from participants to access their Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), and Australian Immunisation Register (AIR) data.

It is hoped that this study will confirm if Ig used to prevent infections can be safely stopped, and if oral antibiotics should be given as an alternative, thus improving treatment for people with blood cancer.

Conditions

This trial is treating people with acquired hypogammaglobulinaemia secondary to a haematological malignancy, and have received immunoglobulin treatment for over 6 months.

Eligibility

Inclusion

 

1. Aged greater than or equal to 18 years of age
2. Diagnosis of chronic lymphocytic leukaemia (CLL), multiple myeloma (MM) or non-Hodgkin lymphoma (NHL).
3. Patients must be receiving Ig (IV or subcutaneous - SCIg) replacement for prevention of bacterial infections due to hypogammaglobulinaemia for longer than 6 consecutive months.
4. Patient is eligible for trial of Ig cessation in the opinion of the treating clinician and local investigator.
5. Life expectancy greater than 12 months.
6. Able to give informed consent, and willing and able to comply with each of the treatment arms.

Exclusion

 

1. Prior or planned allogeneic haematopoietic stem cell transplantation.
2. Major infection (Grade 3 or higher) in preceding 3 months, and/or current active infection requiring antimicrobial treatment.
3. Already receiving daily antibiotic prophylaxis for the purpose of preventing bacterial infection (Note: patients may receive antiviral, antifungal and PJP prophylaxis).
4. Intolerance of all trial antibiotic options in either arm A or arm B.
5. 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.
6. Pregnant or breastfeeding.
7. Severe renal impairment (estimated or measured creatinine clearance of less than 30 mL/min).
8. Previous splenectomy.
9. Previous participation in this trial.
10. Treating team deems enrolment in the study is not in the best interests of the patient.

Inclusion

  • You are able to swallow medication by mouth.
  • You have had a certain type of treatment or surgical procedure.
  • You have the type of cancer, symptoms, or health risks that this clinical trial is focused on.

Exclusion

  • You have certain types of non-cancer medical conditions.
  • You have had certain treatments, surgical procedures or drugs.
Message

Clinical trials have complex eligibility criteria, and other criteria may apply for this trial. Ask your doctor about whether this trial could be right for you.

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More information

Trial Identifiers

Information on this page is partially produced from ANZCTR *. View further details about this trial on the registry via the links below:

Trial sponsor

Monash University

Scientific Title

A randomised controlled trial of continuing immunoglobulin therapy, or stopping with or without prophylactic antibiotics, on infection rate in patients with acquired hypogammaglobulinemia secondary to haematological malignancies

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