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    Clinical Trial Results:
    Adoptive Immunotherapy with CD25/71 allodepleted donor T cells to improve immunity after unrelated donor stem cell transplant (ICAT)

    Summary
    EudraCT number
    2013-000872-14
    Trial protocol
    GB  
    Global end of trial date
    30 Jan 2020

    Results information
    Results version number
    v1(current)
    This version publication date
    02 Nov 2022
    First version publication date
    02 Nov 2022
    Other versions

    Trial information

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    Trial identification
    Sponsor protocol code
    UCL/11/0519
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT01827579
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Cancer Research UK and UCL Cancer Trials Centre
    Sponsor organisation address
    90 Tottenham Court Road , London, United Kingdom, W1T 4TJ
    Public contact
    ATIMP trials group, Cancer Research UK and UCL Cancer Trials Centre, 44 2076799797, ctc.icat@ucl.ac.uk
    Scientific contact
    ATIMP trials group, Cancer Research UK and UCL Cancer Trials Centre, 44 2076799797, ctc.icat@ucl.ac.uk
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    18 Dec 2020
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    30 Jan 2020
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    The primary objective of the study is to determine whether adoptive immunotherapy with CD25/71 allodepleted donor T-cells can be safely used to improve T-cell reconstitution after unrelated donor SCT.
    Protection of trial subjects
    Patient safety was monitored through eligibility criteria and regular patient assessments during treatment and follow up as well as regular review of safety data by Independent Data Monitoring Committee (IDMC) and Trial Management Group (TMG). All adverse events that occurred between Day 30 to Day 120 post-transplant (or after this date if the site investigator felt the event was related to the trial treatment) were recorded in the patient notes and the trial CRFs. Those meeting the definition of a Serious Adverse Event (SAE) were also be reported to UCL CTC.
    Background therapy
    All patients underwent 9/10 or 10/10 HLA matched unrelated donor peripheral blood stem cell transplantation with an Alemtuzumab based conditioning regimen as per standard local institutional protocols. Conditioning regimens were either myeloablative or reduced intensity.
    Evidence for comparator
    The control group in the ICAT trial received standard of care therapy as well as identical supportive care to the ATIMP arm. The rationale for the use of comparators is as follows: - The primary end-point is the circulating CD3 count at 4 months post-SCT and this has been compared between the treatment and control cohorts. - The following secondary efficacy end-points have been compared between the treatment and control cohorts: 1. Time to recovery of normal T-cell (> 700/mkl) and CD4 (> 300/mkl) counts and normal TCR diversity as assessed by V spectratyping post-SCT 2. In vitro anti-viral responses of circulating PBMC 3. TRM and DFS at 1 year post-SCT - The safety secondary end–point is the incidence of significant (grade II-IV) acute and moderate/severe chronic GVHD. This has been compared between the 2 cohorts.
    Actual start date of recruitment
    01 Aug 2014
    Long term follow-up planned
    No
    Independent data monitoring committee (IDMC) involvement?
    Yes
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United Kingdom: 37
    Worldwide total number of subjects
    37
    EEA total number of subjects
    37
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    0
    Adults (18-64 years)
    32
    From 65 to 84 years
    5
    85 years and over
    0

    Subject disposition

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    Recruitment
    Recruitment details
    Between Aug2014-Feb2019, 37 patients were enrolled, 21 patients were treated and included in analysis (control 8, ATIMP 13) 15 were withdrawn before treatment(donor refusal(7), patient unwell(3), developed GVHD(3), ATIMP not manufactured (1)), and 2 patients were replaced as 1withdrew consent and 1 died before reaching primary end point.

    Pre-assignment
    Screening details
    History and physical examination including weight Histological or bone marrow confirmation of haematological malignancy and disease status pre-transplant Serological testing for HIV, HTLV, Hepatitis B and C, syphilis, EBV and CMV Pregnancy test, if appropriate

    Period 1
    Period 1 title
    Overall trial (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Randomised - controlled
    Blinding used
    Not blinded
    Blinding implementation details
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Active intervention (ATIMP)
    Arm description
    Adoptive immunotherapy with allodepleted donor T-cells (ATIMP)
    Arm type
    Experimental

    Investigational medicinal product name
    CD25/71 allodepleted donor T-cells
    Investigational medicinal product code
    Other name
    Pharmaceutical forms
    Suspension for injection
    Routes of administration
    Intravenous use
    Dosage and administration details
    Intravenous injections of allodepleted donor T-cells at increasing doses (105/kg at day 30 post-SCT [+/- 10 days*], 3 x 105/kg at day 60 [+/- 10 days*] and 106/kg at day 90 [+/- 10 days*]) at monthly intervals post-SCT until either their circulating CD3 count is normal (> 700/L) or they develop acute GVHD >Grade I.

    Arm title
    Control
    Arm description
    Patients in the control arm received standard of care treatment.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Active intervention (ATIMP) Control
    Started
    27
    10
    Completed
    13
    8
    Not completed
    14
    2
         Developed grade II GVHD
    3
    -
         Adverse event, serious fatal
    -
    1
         Consent withdrawn by subject
    -
    1
         Patient declined due to feeling too unwell
    1
    -
         Patient required supplemental oxygen
    1
    -
         Problem with ATIMP manufacture
    1
    -
         Donor refused participation
    7
    -
         Patient too cytopenic
    1
    -

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Active intervention (ATIMP)
    Reporting group description
    Adoptive immunotherapy with allodepleted donor T-cells (ATIMP)

    Reporting group title
    Control
    Reporting group description
    Patients in the control arm received standard of care treatment.

    Reporting group values
    Active intervention (ATIMP) Control Total
    Number of subjects
    27 10 37
    Age categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    0 0 0
        Adults (18-64 years)
    23 9 32
        From 65-84 years
    4 1 5
        85 years and over
    0 0 0
    Gender categorical
    Units: Subjects
        Female
    10 5 15
        Male
    17 5 22
    Disease type
    Type of haematologcal malignancy patient had when registered into the trial
    Units: Subjects
        ALL
    2 0 2
        AML
    16 2 18
        CLL
    2 0 2
        CML
    0 2 2
        NHL
    4 4 8
        HL
    0 1 1
        Myelodisplasia
    3 1 4
    Disease status
    Patient disease status at time of registration into the study
    Units: Subjects
        Complete remission
    20 4 24
        Partial remission
    6 2 8
        Stable disease
    0 2 2
        Progressive disease
    0 2 2
        Not recorded
    1 0 1

    End points

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    End points reporting groups
    Reporting group title
    Active intervention (ATIMP)
    Reporting group description
    Adoptive immunotherapy with allodepleted donor T-cells (ATIMP)

    Reporting group title
    Control
    Reporting group description
    Patients in the control arm received standard of care treatment.

    Primary: Circulating CD3+ve T cell count at 4 months post-SCT

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    End point title
    Circulating CD3+ve T cell count at 4 months post-SCT
    End point description
    The primary end-point is the circulating CD3 count at 4 months post-SCT and this will be compared between the treatment and control cohorts. A standardized difference (or difference between two medians) will be estimated, with 95% confidence interval and p-value (compared against the 15% level from the sample size calculation). The results for the primary endpoint of the study (T-cell reconstitution at month 4 post-transplant) are shown in the uploaded ppt 'ICAT_EudraCT_ Results_upload' Figure 2A. The mean circulating CD3+ T-cell at month 4 were higher in the ADT cohort (730/µL, range 10-4080) than in the control cohort (212.5/µL, range 10-500). However, data were not normally distributed and non-parametric tests did not show a significant difference in the median T-cell count between both cohorts: 230/µL (range 10-4080) in treatment cohort and 145/µL (range 10-500) in controls (one-sided p=0.18)
    End point type
    Primary
    End point timeframe
    The primary end-point is the circulating CD3 count at 4 months post-SCT
    End point values
    Active intervention (ATIMP) Control
    Number of subjects analysed
    13
    8
    Units: cells/microlitre
        median (full range (min-max))
    230 (10 to 4080)
    145 (10 to 500)
    Attachments
    ICAT_EdraCT_Results_Upload_2021_February
    Statistical analysis title
    Data analysis
    Statistical analysis description
    With an 80% power and one-sided test of statistical significance of 15%, this 2:1 randomised trial required 16 patients in the experimental treatment and 8 in the control to detect a standardized difference of ≥0.85 in the circulating CD3 count at 4 months post-SCT. Statistical analysis in this study was mostly descriptive. Wilcoxon signed-rank test was used to compare median values for lymphocyte recovery at 4 months, as data was not normally distributed.
    Comparison groups
    Active intervention (ATIMP) v Control
    Number of subjects included in analysis
    21
    Analysis specification
    Pre-specified
    Analysis type
    other [1]
    P-value
    ≤ 0.15 [2]
    Method
    Wilcoxon (Mann-Whitney)
    Parameter type
    Wilcoxon signed-rank test
    Confidence interval
    Notes
    [1] - Statistical analysis was mostly descriptive. 37 patients were recruited, 16 were withdrawn due to donor refusal (7), GVHD (3), death, consent withdrawal, manufacture problem & clinical decision. Out of the 21 patients, 13 were treated on the ATIMP arm and 8 on the control arm. All 21 patients were evaluable for the primary endpoint (T cell recovery at 4 months postSCT); 18 patients completed the 12 month follow up (3 patients died before 12month: relapse(2) in ATIMP arm; TRM(1) in control arm.
    [2] - one-sided p

    Secondary: Time to recovery of normal T-cell

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    End point title
    Time to recovery of normal T-cell
    End point description
    Survival analysis and Kaplan-Meier plot was used to display the time to patients achieve CD3 counts greater than 700. We observed a trend towards T cell recovery (>700/µL) in the ADT cohort (uploaded ppt 'ICAT_Figures_for_EudraCT_results_upload', Figure 2D), though this was not statistically significant: HR= 1.83 (95%CI: 0.52 to 6.41), p=0.35.
    End point type
    Secondary
    End point timeframe
    Time to recovery of normal CD3 counts at 4, 6 and 12 months post-SCT
    End point values
    Active intervention (ATIMP) Control
    Number of subjects analysed
    13
    8
    Units: percent
        Month 0
    0
    0
        Month 4
    23
    0
        Month 6
    39
    0
        Month 9
    48
    13
        Month 12
    48
    27
    No statistical analyses for this end point

    Secondary: DFS at 1 year post-SCT

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    End point title
    DFS at 1 year post-SCT
    End point description
    DFS will be analysed using Kaplan-Meier curves and Cox regression. 1-year disease-free survival rate was 67.7% in ADT vs 62.5% in controls.
    End point type
    Secondary
    End point timeframe
    At 1 year
    End point values
    Active intervention (ATIMP) Control
    Number of subjects analysed
    13
    8
    Units: percent
        number (not applicable)
    67.7
    62.5
    No statistical analyses for this end point

    Secondary: TRM at 1 year postSCT

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    End point title
    TRM at 1 year postSCT
    End point description
    Mortality will be analysed using Kaplan-Meier curves and Cox regression. The one-year overall survival rate for patients treated with allodepleted T cells was 92% compared to 88% in the controls. A total of 4 deaths were reported in the ADT group and 1 death in the control group. Three patients died during the 12-month follow-up: 2/13 in the ADT group due to disease progression/relapse and 1/8 controls due to TRM (viral infection). Two further patients died after 12-month follow-up, both in the ADT arm: one due to relapse at 21 months post-transplant and one due to pneumonia at 14 months post-transplant.
    End point type
    Secondary
    End point timeframe
    At 1 year postSCT
    End point values
    Active intervention (ATIMP) Control
    Number of subjects analysed
    13
    8
    Units: percent
        number (not applicable)
    92
    88
    No statistical analyses for this end point

    Secondary: Incidence of grade II-IV acute and chronic GVHD

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    End point title
    Incidence of grade II-IV acute and chronic GVHD
    End point description
    GVHD and toxicity will be reported in terms of frequencies and percentages by treatment group. (Excel named 'ICAT_AE_Dat_18_12_2020 listing all adverse events reported for the study (max grade / number of patients) has been also uploaded with the ICAT results for completeness)
    End point type
    Secondary
    End point timeframe
    Up to 12months postSCT
    End point values
    Active intervention (ATIMP) Control
    Number of subjects analysed
    13
    8
    Units: number of patients
        Acute GVHD grade II or higher
    7
    4
        Acute GVHD grade III
    3
    2
        Acute GVHD grade IV
    0
    0
        Chronic GVHD - mild
    1
    3
        Chronic GVHD - moderate
    1
    0
        Chronic GVHD - severe
    1
    0
    Attachments
    ICAT_AE_Data_18_12_2020
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    GVHD between 1 and 12 months post-transplant. All other AEs between 1 and 4months post-transplant
    Adverse event reporting additional description
    GVHD and toxicity are reported in terms of frequencies and percentages by treatment group. The most common AEs (experienced by 5 or more patients) have been entered into the EudraCT database. A complete list of all AEs with frequencies and percentages by treatment group is provided in the upload excel 'ICAT_AE_data_18_12_2020'.
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    CTCAE
    Dictionary version
    4.03
    Reporting groups
    Reporting group title
    Active intervention (ATIMP)
    Reporting group description
    Adoptive immunotherapy with allodepleted donor T-cells (ATIMP)

    Reporting group title
    Control
    Reporting group description
    Patients in the control arm received standard of care treatment.

    Serious adverse events
    Active intervention (ATIMP) Control
    Total subjects affected by serious adverse events
         subjects affected / exposed
    6 / 13 (46.15%)
    2 / 8 (25.00%)
         number of deaths (all causes)
    4
    1
         number of deaths resulting from adverse events
    0
    0
    Investigations
    Ejection fraction decreased
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 8 (12.50%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Vascular disorders
    Haemorrhage into temporal AVM
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 8 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Cardiac disorders
    Heart failure
         subjects affected / exposed
    0 / 13 (0.00%)
    1 / 8 (12.50%)
         occurrences causally related to treatment / all
    0 / 0
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    General disorders and administration site conditions
    Fever
         subjects affected / exposed
    1 / 13 (7.69%)
    2 / 8 (25.00%)
         occurrences causally related to treatment / all
    0 / 2
    0 / 4
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Immune system disorders
    GVHD
         subjects affected / exposed
    5 / 13 (38.46%)
    1 / 8 (12.50%)
         occurrences causally related to treatment / all
    6 / 6
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Eye disorders
    Dry eye
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 8 (0.00%)
         occurrences causally related to treatment / all
    1 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Gastrointestinal disorders
    Vomiting
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 8 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Infections and infestations
    Device related infection
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 8 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Chest
         subjects affected / exposed
    1 / 13 (7.69%)
    0 / 8 (0.00%)
         occurrences causally related to treatment / all
    0 / 1
    0 / 0
         deaths causally related to treatment / all
    0 / 0
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Active intervention (ATIMP) Control
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    13 / 13 (100.00%)
    8 / 8 (100.00%)
    Investigations
    Lymphocyte count decreased
         subjects affected / exposed
    7 / 13 (53.85%)
    1 / 8 (12.50%)
         occurrences all number
    7
    1
    Neutrophil count decreased
         subjects affected / exposed
    6 / 13 (46.15%)
    2 / 8 (25.00%)
         occurrences all number
    6
    2
    White blood cell count decreased
         subjects affected / exposed
    6 / 13 (46.15%)
    1 / 8 (12.50%)
         occurrences all number
    6
    1
    Platelet count decreased
         subjects affected / exposed
    4 / 13 (30.77%)
    2 / 8 (25.00%)
         occurrences all number
    4
    2
    Vascular disorders
    Hypertension
         subjects affected / exposed
    3 / 13 (23.08%)
    3 / 8 (37.50%)
         occurrences all number
    3
    3
    General disorders and administration site conditions
    Fever
         subjects affected / exposed
    4 / 13 (30.77%)
    2 / 8 (25.00%)
         occurrences all number
    4
    2
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    3 / 13 (23.08%)
    2 / 8 (25.00%)
         occurrences all number
    3
    2
    Gastrointestinal disorders
    Diarrhoea
         subjects affected / exposed
    8 / 13 (61.54%)
    2 / 8 (25.00%)
         occurrences all number
    8
    2
    Nausea
         subjects affected / exposed
    3 / 13 (23.08%)
    2 / 8 (25.00%)
         occurrences all number
    3
    2
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    4 / 13 (30.77%)
    1 / 8 (12.50%)
         occurrences all number
    4
    1
    Infections and infestations
    Infection
         subjects affected / exposed
    8 / 13 (61.54%)
    4 / 8 (50.00%)
         occurrences all number
    8
    4
    Metabolism and nutrition disorders
    Anorexia
         subjects affected / exposed
    4 / 13 (30.77%)
    1 / 8 (12.50%)
         occurrences all number
    4
    1

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    20 Dec 2013
    Protocol v2.0 19/12/2013 Summary of changes: • Sec on 2.2 ‐ Clarification on how the CD25/71 ADTs will be produced from the starting material. Addition of‐ +2/ day flexibility for when infusing the ATIMP in case d30, 60 or 90 fell on a weekend. Change made throughout protocol. • Sec on 4 ‐ Clarification that only donors for patients randomised to receive the ATIMP will be approached for consent to the trial and confirmation that donors can withdraw up to the point where ADTs are infused into the patient. • Sec on 5.2 ‐ Clarification that starting material will only be obtained by donors if the patient is randomised to receive the ATIMP. • Sec on 7.2.2 ‐ Clarification that if the products do not meet the release criteria, the case will be discussed with the CI, CTC, and manufacturer as it may be in the best interest of the patient to infuse the cells. • Sec on 7.4 ‐ Addition of circulating T cell count >700/μl as an inclusion criteria for consistency reasons. • Sec on 10.2.2 ‐ Clarification that sites must have procedures in place to notify donor collect on centres for a SAR which could be linked to the quality and safety of the donor blood/leucapheresis. Furthermore that the blood collection centre must have systems in place to notify the site of an SAE in a donor which could affect the safety of the patient. This is in line with HTA guidance. • Other typographical changes throughout the protocol, addition of CTA number to the title page, removal of full contact details for the statistician, amending figures to state that the star ng donor material may be donor leucapheresis/blood, minor changes throughout to ensure the protocol is consistent with the new CTC protocol template.
    08 Dec 2014
    Protocol v3.0 25/11/2014 Summary of changes: • Inclusion Criteria changed from patients with ‘underlying acute myeloid or acute lymphoblastic leukaemia’ to patients with ‘underlying haematological malignancy’ • EBV and CMV serology added to the screening assessments for patients • ‘+/2 working days’ changed to ‘+/7 days’ when referring to the infusion schedules (D30, D60 and D90 posttransplant) • Clarification that any delays to ATIMP infusion for clinical reasons need to be agreed in advance with the trials office. • Addition that surplus ATIMP (CD25/71 ADTs) may be stored at the manufacturing site for use in future ethically approved research related solely to ICAT, following obtaining patient and donor consent. • Removal of the list of ‘expected adverse events’ following allodepleted donor T cell infusion, as they are no longer exempt from SAE reporting.
    17 Dec 2015
    Protocol 4.0 17/12/2015 NOTE: this amendment was approved by both REC and MHRA but MRC in their role as funder did not approve, therefore this amendment was not implemented at sites and the latest document versions in use before the submission of the amendment remained in use.
    04 May 2016
    Protocol v5.0 04/05/2016 Summary of changes: • ‘+/- 7 days’ changed to ‘+/- 10 days’ when referring to the infusion schedules (D30, D60 and D90 posttransplant). • "A minimum of 25 days should be given between consecutive doses to ensure no GVHD has developed" has been added throughout for clarification in light of the above change
    12 Dec 2016
    Protocol v6.0 12/12/2016 The trial protocol was amended to clarify that it is not always possible for the laboratory to manufacture enough allodepleted donor T cells for the patient to be able to receive 3 doses of the ATIMP. In such cases, after discussion with the patient, only 1 or 2 doses may be administered (depending on the number of cells manufactured). The last substantial amendment approved by the ethics committee on 04/10/2016 amended the patient information sheet to account for this but it was omitted from the trial protocol in error. The randomisation section was amended to outline that patients on both the ATIMP arm and control arm of the trial should receive a patient contact card to ensure the trial adheres to good clinical practice guidelines for advanced therapies. The statistics section was amended so that the predicted dropout rate has been changed from 35% to 50% and the potential target recruitment total amended from 32 to 50 patients to account for this. This has been done as the dropout rate was greatly underestimated and the current recruitment total is 26 patients. The target treatment total remains at 24 patients but recruitment is expected to run until July 2017 and so it is likely that the trial will meet the target recruitment total before meeting the target treatment total. Therefore, this has been amended to allow for the original target treatment total to be met even if the original estimated target recruitment total is surpassed.
    12 Jul 2017
    Protocol v7.0 12/07/2017 Summary of changes: 1. Twelve month extension to recruitment from 3 to 4 years (section 1.1’Summary of Trial Design’) 2. Section 15.1 ‘Sample size calculation’ now clarifies that once the required 8 patients in the control arm reach 4 months (primary end point assessment), any remaining patients will be registered into the ATIMP arm until the target of 16 treated ATIMP patients is achieved and the trial will close to recruitment. In addition the following clarifications regarding the serology tests required to be performed at screening have been added to sections 5.1 ‘Pre-randomisation evaluation’ and 5.3.2 ‘Exclusion Criteria’ (no new tests have been added): • results from HBV, HCV, syphilis and HIV tests are required prior to randomisation of patient into the study to assess eligibility, while EBV, CMV and HTLV results are needed for information • patients with ‘active’ HBV, HCV and HIV infection are excluded from the trial and PCR should be used to rule out ‘active infection’ if serology result is positive.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported (?)
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