Ganciclovir to Prevent Reactivation of Cytomegalovirus in Patients With Acute Respiratory Failure and Sepsis (GRAIL^3)

  • End date
    Aug 31, 2027
  • participants needed
  • sponsor
    Fred Hutchinson Cancer Center
Updated on 4 October 2022


This is a phase 3 study designed to evaluate whether the administration of ganciclovir increases ventilator-free days in immunocompetent patients with sepsis associated acute respiratory failure. Our hypothesis is that IV ganciclovir administered early in critical illness will effectively suppress CMV reactivation in CMV seropositive adults with sepsis-associated acute respiratory failure thereby leading to improved clinical outcomes

Condition Acute Respiratory Failure
Treatment IV Ganciclovir
Clinical Study IdentifierNCT04706507
SponsorFred Hutchinson Cancer Center
Last Modified on4 October 2022


Yes No Not Sure

Inclusion Criteria

Subject/next of kin informed consent
Age > 18 years
CMV IgG seropositive by lateral flow assay (LFA) or standard serologic methods
Receiving care in an ICU
Acute respiratory failure as defined in Section 4.1.1
Expected to require respiratory support for at least 2 more days after randomization
Infection confirmed or suspected by the treating clinician and felt to be the source of acute respiratory failure (Respiratory failure associated with infection confers at least 2 SOFA points above assumed baseline SOFA score of 0, thereby meeting Sepsis-3 definition)

Exclusion Criteria

Known or suspected immunosuppression, including
HIV+ (i.e. prior positive test or clinical signs of suspicion of HIV/AIDS; a negative HIV test is not required for enrollment)
stem cell transplantation
within 6 months after autologous transplantation or
within 1 years after allogeneic transplantation (regardless of immunosuppression)
greater than 1 year of allogeneic transplantation if still taking systemic immunosuppression or prophylactic antibiotics (e.g. for chronic graft versus host disease) Note: if details of stem cell transplantation are unknown, patients who do not take systemic immunosuppression and do not take anti-infective prophylaxis are acceptable for enrollment and randomization
solid organ transplantation with receipt of systemic immunosuppression (any time)
cytotoxic anti-cancer chemotherapy within the past three months (Note: next-of-kin estimate is acceptable)
congenital immunodeficiency requiring antimicrobial prophylaxis (e.g. TMP-SMX, dapsone, antifungal drugs, intravenous immunoglobulin)
receipt of one or more of the following in the indicated time period (see Appendix C)
within 6 months: alemtuzumab, antithymocyte/antilymphocyte antibodies, or other immunosuppressive drugs associated with CMV reactivation Note: if no information on these agents is available in the history and no direct or indirect evidence exists from the history that any condition exists that requires treatment with these agents (based on the investigator's assessment), the subject may be enrolled. For all drug information, next-of-kin estimates are acceptable. See Appendix C for commonly prescribed immunosuppressive agents. Information on the use of biologics with moderate immunosuppressive effect but no known effect on CMV are permitted and will be recorded in the CRFs
Expected to survive < 72 hours (in the opinion of the investigator)
Has been hospitalized for > 120 hours (subjects who are transferred from a chronic care ward, such as a rehabilitation unit, with an acute event are acceptable)
Pregnant or breastfeeding (either currently or expected within one month). Note: for women of childbearing age (18-60 years, unless documentation of surgical sterilization [hysterectomy, tubal ligation, oophorectomy]), if a pregnancy test has not been done as part of initial ICU admission work-up, it will be ordered stat and documented to be negative before randomization. Both urine and blood tests are acceptable
Absolute neutrophil count < 1,000/mm3 (if no ANC value is available, the WBC must be > 2500/mm3)
Use of anti-CMV drugs (cidofovir, letermovir, foscarnet, valganciclovir, ganciclovir) within seven (7) days of patient randomization
Currently enrolled in an interventional trial of an investigational therapeutic agent known or suspected to have anti-CMV activity or to be associated with significant known hematologic toxicity (prior approval required)
At baseline patients who have both a tracheostomy, and have been on continuous 24-hour chronic mechanical ventilation
Patients with Child Class C Cirrhosis
Patients with severe (requiring home oxygen) pre-existing interstitial lung disease
Allergy to ganciclovir
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