"Diagnoses of fungal and opportunistic infections are often delayed due to limitations of culture based diagnostics. Here we will develop novel molecular and immunological diagnostic pathways to improve patient outcomes."
The objective of this stream is to introduce novel technology to optimise clinical care for patients with cancer-related infections. Our research group has pioneered, published and piloted new technologies that could dramatically improve patient care with commercialisation potential.
Early diagnosis and treatment of infections in patients with haematologic malignancies: Examining novel diagnostics including bacterial and fungal multiplex PCR and FDG-PET imaging (The PIPPIN study)
This project aims to compare the utility of PET scan vs PCR in detecting the cause of febrile neutropenia in patients with haematological malignancies.
Dr. Abby Douglas
The cause of neutropenic fever in patients with acute leukaemia and having a bone marrow transplant are frequently unclear due to deficiencies in the current diagnostics used. This leads to prolonged use of empiric antibiotics and antifungals, diagnostic uncertainty, increased costs of care, prolonged length of stay and high morbidity. Compared to the current diagnostic standards of microbiologic culture and CT scanning, we aim to prospectively examine the efficacy of bacterial and fungal multiplex PCRs on blood and PET imaging to detect the cause of the neutropenic fever and assess their impact on time to diagnosis, antimicrobial use, referral for definitive procedures, ICU admission, costs of care and mortality. We expect to find improvements in time to diagnosis and refinement in antimicrobial use, with resultant reduced length of stay and ICU admission.
Creating an atlas of the immune system to better predict infection risk in cancer patients.
This study aims to identify risk factors for infection in patients being treated for cancer
Dr Ben Teh
With recent advances in immune-based therapies, haematological malignancies such as multiple myeloma and chronic lymphocytic leukaemia have been transformed into chronic diseases maintained by multiple lines of therapy. Infections remain a leading cause of morbidity and mortality in these patients with nearly 50% of early deaths due to infection. Being able to predict which patients are at greatest risk of infection before they start treatment will significantly reduce mortality.
Therapy with immunomodulatory drugs are becoming the standard of care for patients with chronic lymphocytic leukaemia and multiple myeloma. Such therapies have effects on the immune system ranging widely from immune activation to immune suppression which has created a paradigm shift from the predictable effects seen with conventional chemotherapy. With inevitable disease progression, treatment phases are repeated to obtain and maintain disease response resulting in immeasurable cumulative immunosuppression.
Dr Teh reports that “clinical risk assessment for infections in these patients has become increasingly complex and unreliable due to the unpredictable interaction between patient, disease and treatment related risk factors. With further advances in immunotherapy, infective risk prediction will become even more challenging.”
Dr Teh and the NCIC team will now use cutting edge cyTOF and transcriptomic technology at WEHI to test their hypothesis that an imbalance in positive and negative immune mediators before initiation of immunomodulatory therapy can help predict if a patient is at risk of potentially life threatening infections. They will shortly begin testing patient blood samplesto create an atlas, or complete immune profile down to a single cell level for each patient. Biostatisticians will then be able to pinpoint the exact immune factors or biomarker of infection risk.