Feb 2023 NCIC Newsletter

Dear all,

I was extremely honoured recently to be appointed Professor of Infection in Cancer and Transplantation, University of Melbourne's Department of Infectious Diseases and the Sir Peter MacCallum Department of Oncology. This position consolidates our transition towards an all encompassing National Centre for Infections in Cancer and Transplantation. Keep an eye out on our social media for a new program of events and branding incorporating Cancer and Transplantation.

I would also like to congratulate Prof Karin Thursky, who was made a Fellow of the Australasian Institute of Digital Health (AIDH) earlier this month. AIDH is Australasia’s peak body for digital health, representing a united voice for health informatics and digital health leaders and practitioners. Thank you for your leadership Professor Thursky– a wonderful recognition of your trailblazing work in establishing the National Centre for Antimicrobial Stewardship and progressing the NCIC’s digital and connected health program of work.

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NCIC Seminar Series

Prof Graeme Forrest

AMS in TID

March 16, 12.30pm

Graeme Forrest, MBBS, is a Professor of Medicine in the Department of Medicine, Section of Infectious Diseases at Rush University Medical Center, Editor-in-Chief (EiC) of ASM’s Clinical Microbiology Reviews. Prof Forrest Forrest’s research focuses on antimicrobial stewardship and resistance in immunocompromised hosts. Graeme will be presenting on  " AMS in Transplant infectious diseases" Sign up for the live link HERE. 

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NCIC Journal Club

Monthly, Fridays 12 pm

The first of the 2023 monthly NCIC Journal Club series begins Friday March 3rd 12-1pm with Dr. Abby Douglas and Ms. Anna Khanina each presenting a paper TBA. Sign up for a live link to the NCIC Journal Club series HERE.

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Publication highlight

Detecting evidence of invasive fungal infections in cytology and histopathology reports enriched with concept-level annotations 

Vlada Rozova, Anna Khanina, Jasmine C. Teng,  Joanne S.K. Teh, Leon J. Worth, Monica A. Slavin, Karin A. Thursky, Karin Verspoor.

Invasive fungal infections (IFIs) are particularly dangerous to high-risk patients with haematological malignancies and are responsible for excessive mortality and delays in cancer therapy. Surveillance of IFI in clinical settings offers an opportunity to identify potential risk factors and evaluate new therapeutic strategies. Existing manual infection surveillance processes are time- and resource-intensive.

Supported by the NHMRC project grant MEETING THE CHALLENGES OF INVASIVE FUNGAL INFECTION: ANTIFUNGAL STEWARDSHIP AND EFFECTIVE SURVEILLANCE IN HIGH-RISK GROUPS, we aim to develop a system for automated IFI surveillance by leveraging electronic medical records and developing artificial intelligence methodologies.

This work, published in a recent edition of Journal of Biomedical Informatics, demonstrates how cytology and histopathology reports can be automatically analysed using natural language processing to detect the presence of IFI. Given its strong performance, our tool will play a key role in the broader project of automated detection of IFI to support timely and accurate infection surveillance.

This NHMRC project is led by Karin Thursky and Anna Khanina in collaboration with Karin Verspoor and Vlada Rozova at the School of Computing Technologies, RMIT University.

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Recent publications

B. Sim et al A multi-centre retrospective study of Nocardia speciation and antimicrobial susceptibility in Queensland

Chin Fen Neoh, et al Invasive Scedosporium and Lomentospora prolificans infections in Australia: a multicentre retrospective cohort study | Open Forum Infectious Diseases

V Hall and B Teh Learning how to treat coronavirus disease 2019 in hematopoietic stem cell transplant patients

B. Sim et al SARS‐CoV‐2 seropositivity in renal transplant patients administered intravenous immunoglobulin

Lindsay J, et al Invasive Fungal Infections After CLAG-M/CLAG Chemotherapy for Acute Myeloid Leukemia and High-Grade Myeloid Neoplasms.

Raad II, … Slavin M, Teh B, et al, International multicenter study comparing COVID-19 in patients with cancer to patients without cancer: impact of risk factors and treatment modalities on survivorship.

All NCIC publications can be found HERE

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Kind regards

Prof Monica Slavin, MBBS, MD, FRACP, FAAHMS
Head, Department Infectious Disease, Peter MacCallum Cancer Centre

Professor of Infection in Cancer and Transplantation, University of Melbourne Department of Infectious Diseases and the Sir Peter MacCallum Department of Oncology

Director, National Centre for Infections in Cancer

Jan 2023 NCIC Newsletter

Dear all,

It was wonderful to reconnect with everybody at the November 2022 NCIC-Synergy Investigator meeting, where we set out a road map for the next 5 years. I think we can all agree that our top priority is to expand our outreach and make the NCIC a truly National Centre. Many of the programs and pathways we have developed over the last few years at Peter Mac are now ready to be rolled out to other centres where cancer patients are managed for infections. The road map we have developed includes greater engagement with metro and regional centres across Australia, building on the networks we have worked hard to develop over the last 5 years through projects such as PROSECCO, CSMART and the CRE and continuing to develop our advanced trainees and visiting fellows.

All the details are on our new look website which is designed to be a one stop shop for all the implementation toolkits and guidelines we have developed for management of infections in kids, allergy, clinical trials and research. Also available on the website are links to the 2023 events calendar calendar. The schedule of events in 2023 include a Friday lunch Journal Club hosted by NCIC PhD students, a Symposium in November (details TBA) and monthly NCIC seminars the first of which I am pleased to announce is Prof Graeme Forrest. Get the meeting link HERE

Graeme Forrest, MBBS, is a Professor of Medicine in the Department of Medicine, Section of Infectious Diseases at Rush University Medical Center, Editor-in-Chief (EiC) of ASM’s Clinical Microbiology Reviews. Prof Forrest Forrest’s research focuses on antimicrobial stewardship and resistance in immunocompromised hosts. Graeme will be presenting on  " AMS in Transplant infectious diseases" followed by lunch and discussion with fellows interested in a career in TID (rsvp for lunch here). 

2023 will see NCIC begin the rollout of our national strategy. Beginning close to home with a series of national clinical interest group case series (request link) and a monthly journal club run by NCIC PhD students. Keep up to date with NCIC seminars here.

We are anticipating a strong NCIC presence at upcoming national and international conferences including ASID, ECCMID and the 4th Symposium on Infectious Diseases in the Immunocompromised Host, Fred Hutchinson cancer research centre, Seattle. ASID will see the inaugural meeting of the Infection in Immunocompromised Host Special Interest Group.  There will be an education day prior to ASID on Sunday April 2nd organised with The Transplant Infectious Diseases section of the Transplantation Society.  Several NCIC speakers will feature along with international speakers.  View the program and register HERE

I have been invited to deliver a keynote speech at ECCMID, Copenhagen on  Frontiers in the diagnosis and management of infections in the immunocompromised, and chair and contribute to a panel discussion of management of fungal infections at the 4th Symposium on Infectious diseases in the ICH, Fred Hutchinson. Both International conferences are offering scholarships to advanced trainees and I urge you all to consider an application.

Finally, please see the latest American Society for Transplantation and Cellular Therapy Series, for the latest in Management Management of Invasive Candidiasis in Hematopoietic Cell Transplant Recipients. All NCIC publications can be found HERE.

Wishing you all a productive year!

Kind Regards

Prof Monica Slavin, MBBS, MD, FRACP, FAAHMS
Head, Department Infectious Disease, Peter MacCallum Cancer Centre

Lead, Immunocompromised Host service, Royal Melbourne Hospital

Director, National Centre for Infections in Cancer

Archived newsletters

Please access our old newsletters HERE

Is it safe to discontinue empirical antimicrobial therapy (EAT) for febrile neutropenia in patients with haematological malignancies once there were signs of clinical recovery?

This study aimed to determine if it was safe to discontinue empirical antimicrobial therapy (EAT) for febrile neutropenia in patients with haematological malignancies once there were signs of clinical recovery.

Adults with haematological malignancies or haemopoietic stem-cell transplantation recipients, with high-risk febrile neutropenia were split into two groups; those who had EAT withdrawn once they were without fever for 72hrs or more with signs of clinical recovery and those that had EAT withdrawn once their neutrophils had recovered (0·5 × 10⁹ cells per L or higher). The study concludes that EAT can be discontinued safely after 72 h of apyrexia and clinical recovery. The benefit of this approach would be in reducing unnecessary exposure to antimicrobials.

A new model of care for Australia

Published this month in Supportive Care Cancer, we report on the implementation of a nurse led program sending patients at low risk of medical complications from neutropenic fever following chemo, home,  to be managed in an outpatient setting.

Read the full study HERE

Our results show a reduction in median length of hospital stay from 4.0 to 1.1 days and a reduction in admission cost from $8,580 to $2,360 with a net cost benefit of $71,895. Not to mention that there's "No Place Like Home".

CAR T cells and infection risk

Next gen immunotherapies, such as CAR T cells, have well and truly revolutionised cancer treatment and cure. However, in modifying the immune system (in this case- lymphodepletion with CD19- targeted CAR T cell therapy) there is a potential for altering risk of infection. In this months edition of Blood, Hill et al, retrospectively reviewed the incidence of infections following CD19 CAR T cell therapy in n=133 patients. Key findings include: a risk of infection similar to conventional chemotherapy and that modification of the treatment regimen, specifically- to reduce Cytokine Release Syndrome severity, decreased the frequency of infections. 

With the explosion of next gen immunotherapies in cancer treatment we are excited to see more studies of this nature.

IFIs and Ibrutinib

While novel immunotherapies such as Immune checkpoint inhibitors and tyrosine kinase inhibitors have revolutionised cancer therapy the effect on the immunocompromised host is unclear. This recent review investigates the link between invasive fungal infection risk and new and emerging immunotherapies.

Infection in neutropenic pts: Recommendations on how to diagnose and treat

The German Society Of Hematology And Medical Oncology Have Recently Published Treatment And Diagnosis Recommendations From The Infectious Diseases Working Group.

 A systematic review of the literature has led to publication of guidelines for optimal treatment of fever of unknown origin in adult neutropenic patients, complete with handy flow chart and tables. 

Atovaquone use in immunocompromised host

Pneumocystis jirovecii pneumonia (PCP) is a potentially life threatening infection among immunocompromised people (eg cancer patients or those living with HIV). In order to prevent infection in these people they are given prophylactic drugs that are not always well tolerated or that many can have an allergic reaction too. This study tested an alternate prophylactic drug, atovaquone, in immunocompromised people and found variable drug levels in plasma indicating some people were better able to absorb and receive benefit from the drug than others. This study suggests more careful monitoring of drug levels in immunocompromised people taking atovaquone for prevention of PCP infection.