Clinical Trial Results:
Adoptive Immunotherapy with CD25/71 allodepleted donor T cells to improve immunity after unrelated donor stem cell transplant (ICAT)
Summary
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EudraCT number |
2013-000872-14 |
Trial protocol |
GB |
Global end of trial date |
30 Jan 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
02 Nov 2022
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First version publication date |
02 Nov 2022
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Other versions |
Trial Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
Subject Disposition
Baseline Characteristics
End Points
Adverse Events
More Information
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Trial identification
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Sponsor protocol code |
UCL/11/0519
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT01827579 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Cancer Research UK and UCL Cancer Trials Centre
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Sponsor organisation address |
90 Tottenham Court Road , London, United Kingdom, W1T 4TJ
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Public contact |
ATIMP trials group, Cancer Research UK and UCL Cancer Trials Centre, 44 2076799797, ctc.icat@ucl.ac.uk
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Scientific contact |
ATIMP trials group, Cancer Research UK and UCL Cancer Trials Centre, 44 2076799797, ctc.icat@ucl.ac.uk
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Paediatric regulatory details
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Is trial part of an agreed paediatric investigation plan (PIP) |
No
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Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial? |
No
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Results analysis stage
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Analysis stage |
Final
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Date of interim/final analysis |
18 Dec 2020
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Is this the analysis of the primary completion data? |
No
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Global end of trial reached? |
Yes
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Global end of trial date |
30 Jan 2020
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Was the trial ended prematurely? |
No
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General information about the trial
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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.
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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.
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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
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Long term follow-up planned |
No
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Independent data monitoring committee (IDMC) involvement? |
Yes
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Population of trial subjects
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Number of subjects enrolled per country |
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Country: Number of subjects enrolled |
United Kingdom: 37
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Worldwide total number of subjects |
37
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EEA total number of subjects |
37
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Number of subjects enrolled per age group |
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In utero |
0
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Preterm newborn - gestational age < 37 wk |
0
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Newborns (0-27 days) |
0
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Infants and toddlers (28 days-23 months) |
0
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Children (2-11 years) |
0
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Adolescents (12-17 years) |
0
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Adults (18-64 years) |
32
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From 65 to 84 years |
5
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85 years and over |
0
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Recruitment
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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
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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
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Period 1 title |
Overall trial (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||||||||||||||||
Allocation method |
Randomised - controlled
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Blinding used |
Not blinded | ||||||||||||||||||||||||||||||||||||
Blinding implementation details |
Not blinded
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Arms
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Are arms mutually exclusive |
Yes
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Arm title
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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
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Suspension for injection
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Routes of administration |
Intravenous use
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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.
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Arm title
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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
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Baseline characteristics reporting groups
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Reporting group title |
Active intervention (ATIMP)
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Reporting group description |
Adoptive immunotherapy with allodepleted donor T-cells (ATIMP) | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Control
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Reporting group description |
Patients in the control arm received standard of care treatment. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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End points reporting groups
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Reporting group title |
Active intervention (ATIMP)
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Reporting group description |
Adoptive immunotherapy with allodepleted donor T-cells (ATIMP) | ||
Reporting group title |
Control
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Reporting group description |
Patients in the control arm received standard of care treatment. |
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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)
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End point type |
Primary
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End point timeframe |
The primary end-point is the circulating CD3 count at 4 months post-SCT
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Attachments |
ICAT_EdraCT_Results_Upload_2021_February |
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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.
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Comparison groups |
Active intervention (ATIMP) v Control
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Number of subjects included in analysis |
21
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Analysis specification |
Pre-specified
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Analysis type |
other [1] | ||||||||||||
P-value |
≤ 0.15 [2] | ||||||||||||
Method |
Wilcoxon (Mann-Whitney) | ||||||||||||
Parameter type |
Wilcoxon signed-rank test | ||||||||||||
Confidence interval |
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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 |
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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.
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End point type |
Secondary
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End point timeframe |
Time to recovery of normal CD3 counts at 4, 6 and 12 months post-SCT
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No statistical analyses for this end point |
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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.
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End point type |
Secondary
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End point timeframe |
At 1 year
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No statistical analyses for this end point |
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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.
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End point type |
Secondary
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End point timeframe |
At 1 year postSCT
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No statistical analyses for this end point |
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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)
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End point type |
Secondary
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End point timeframe |
Up to 12months postSCT
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Attachments |
ICAT_AE_Data_18_12_2020 |
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No statistical analyses for this end point |
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Adverse events information
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Timeframe for reporting adverse events |
GVHD between 1 and 12 months post-transplant.
All other AEs between 1 and 4months post-transplant
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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'.
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Assessment type |
Systematic | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
CTCAE | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
4.03
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Reporting groups
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Reporting group title |
Active intervention (ATIMP)
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Reporting group description |
Adoptive immunotherapy with allodepleted donor T-cells (ATIMP) | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Reporting group title |
Control
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Reporting group description |
Patients in the control arm received standard of care treatment. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Frequency threshold for reporting non-serious adverse events: 5% | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Substantial protocol amendments (globally) |
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Were there any global substantial amendments to the protocol? Yes | |||
Date |
Amendment |
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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.
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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.
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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.
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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
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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.
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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.
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Interruptions (globally) |
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Were there any global interruptions to the trial? No | |||
Limitations and caveats |
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Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data. | |||
None reported (?) |