This is a randomized 2-arm study to compare two different times of giving the drug
vancomycin. Half of the patients will begin vancomycin two days before a bone marrow
transplant. The other half will get it as soon as they have the first fever.
Streptococci are bacteria that live in one's mouth and gut. These bacteria can escape into
the blood when the lining of the mouth and gut weakens from cancer therapy. This can make
the person who is undergoing a bone marrow transplant very sick. All patients who get this
infection are treated with antibiotics. Vancomycin is one drug that is used to treat this
bloodstream infection once it is diagnosed. Studies have shown that giving vancomycin
before a bone marrow transplant seems to prevent this infection. However, giving vancomycin
too soon may increase the chance that the kidneys will be irritated. It may also increase
the chance that other bacteria will become resistant to this drug. We, the investigators at
Memorial Sloan-Kettering Cancer Center, do not know if waiting to start vancomycin until the
patient has a first fever can also prevent this infection.
The primary objective of this study is as follows:
- To compare prophylactic with empirical vancomycin administration for reducing early
viridans streptococcal bacteremia in allogeneic hematopoietic stem cell transplant
The secondary objectives of the study are:
- To examine the safety and tolerability for each vancomycin administration approach.
- To measure the incidence of vancomycin-resistant enterococcal (VRE) infections for
patients managed with each of the two vancomycin administration approaches.
- Adult patients undergoing allogeneic HSCT for hematologic malignancies or other
- Conditioning regimen that includes high-dose total body irradiation (TBI) (>1200 cGy)
- The ability to understand and the willingness to sign the Institutional Review Board
(IRB)-approved Informed Consent, including the Research Authorization component of
the Informed Consent form.
- Non-TBI conditioning regimen
- Prior history of hypersensitivity to vancomycin (excluding history of “Red Man
- Fever or infection that requires intravenous vancomycin or oral/intravenous linezolid
between day-7 and day-3 before hematopoietic stem cell transplant