Clinical Trial Results:
A Single-Arm, Open-Label, Multi-Centre, Phase I/II Study Evaluating the Safety and Clinical Activity Of AUTO3, a CAR T Cell Treatment Targeting CD19 And CD22 in Paediatric And Young Adult Patients With Relapsed or Refractory B Cell Acute Lymphoblastic Leukaemia
Summary
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EudraCT number |
2016-004680-39 |
Trial protocol |
GB |
Global end of trial date |
18 May 2020
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Results information
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Results version number |
v1(current) |
This version publication date |
04 Dec 2020
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First version publication date |
04 Dec 2020
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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 |
AUTO3-PA1
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Additional study identifiers
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ISRCTN number |
- | ||
US NCT number |
NCT03289455 | ||
WHO universal trial number (UTN) |
- | ||
Sponsors
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Sponsor organisation name |
Autolus Ltd
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Sponsor organisation address |
58 Wood Lane, White City, London, United Kingdom, W12 7RZ
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Public contact |
Clinical Project Manager, Autolus Ltd, +44 1483 920748, clinicaltrials@autolus.com
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Scientific contact |
Clinical Project Manager, Autolus Ltd, +44 1483 920748, clinicaltrials@autolus.com
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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 May 2020
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Is this the analysis of the primary completion data? |
Yes
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Primary completion date |
18 May 2020
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Global end of trial reached? |
Yes
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Global end of trial date |
18 May 2020
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Was the trial ended prematurely? |
Yes
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General information about the trial
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Main objective of the trial |
The main objectives of Phase 1 of this trial were to assess the overall safety and tolerability of AUTO3 administration and to confirm and evaluate the recommended Phase II dose (RP2D) and dosing schedule, and confirm maximum tolerated dose (MTD), if an MTD exists, of AUTO3 in both paediatric and adult patients. The main objective of Phase 2 of this trial was to evaluate the anti-leukaemic effect of AUTO3 in paediatric and young adult patients (aged 1-24 years).
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Protection of trial subjects |
This study was conducted in accordance with standards of Good Clinical Practice (as defined by the International Council on Harmonisation), ethical principles that have their origin in the Declaration of Helsinki and all applicable national and local regulations.
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Background therapy |
- | ||
Evidence for comparator |
- | ||
Actual start date of recruitment |
28 Jul 2017
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Long term follow-up planned |
Yes
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Long term follow-up rationale |
Safety, Efficacy | ||
Long term follow-up duration |
24 Months | ||
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: 23
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Worldwide total number of subjects |
23
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EEA total number of subjects |
23
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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) |
17
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Adolescents (12-17 years) |
6
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Adults (18-64 years) |
0
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From 65 to 84 years |
0
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85 years and over |
0
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Recruitment
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Recruitment details |
Subjects were recruited at three study centres in the United Kingdom. | ||||||||||||||||||||||
Pre-assignment
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Screening details |
Screening procedures were performed up to 12 weeks before study drug was administered. After screening subjects went through the sequential stages of leukapheresis, and pre conditioning before subjects were treated with actual doses of 0.3 to 5.0 x 10^6 /kg CD19/CD22 CAR-positive T cells. | ||||||||||||||||||||||
Period 1
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Period 1 title |
Overall Study (overall period)
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Is this the baseline period? |
Yes | ||||||||||||||||||||||
Allocation method |
Not applicable
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Blinding used |
Not blinded | ||||||||||||||||||||||
Arms
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Arm title
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AUTO3 | ||||||||||||||||||||||
Arm description |
Paediatric subjects with relapse or refractory B-cell acute lymphoblastic leukaemia (ALL). | ||||||||||||||||||||||
Arm type |
Experimental | ||||||||||||||||||||||
Investigational medicinal product name |
AUTO3 (CD19/22 CAR T cells)
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Investigational medicinal product code |
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Other name |
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Pharmaceutical forms |
Solution for infusion
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Routes of administration |
Intravenous use
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Dosage and administration details |
Following preconditioning with chemotherapy (cyclophosphamide and fludarabine) subjects were treated with actual doses of 0.3 to 5.0 x 10^6 /kg CD19/CD22 Chimeric Antigen Receptor (CAR) positive T cells
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Baseline characteristics reporting groups
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Reporting group title |
Overall Study
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Reporting group description |
- | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Subject analysis sets
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Subject analysis set title |
Received Study Treatment
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Subject analysis set type |
Intention-to-treat | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Subject analysis set description |
Patients who received at least 1 (complete or partial) dose of AUTO3 (infused set)
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End points reporting groups
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Reporting group title |
AUTO3
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Reporting group description |
Paediatric subjects with relapse or refractory B-cell acute lymphoblastic leukaemia (ALL). | ||
Subject analysis set title |
Received Study Treatment
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Subject analysis set type |
Intention-to-treat | ||
Subject analysis set description |
Patients who received at least 1 (complete or partial) dose of AUTO3 (infused set)
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End point title |
Incidence of Grade 3-5 Toxicities Occurring Within the Dose Limiting Toxicity (DLT) Period of AUTO3 Infusion [1] | ||||||
End point description |
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End point type |
Primary
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End point timeframe |
Within 30 days (+/- 3 days) after the last dose of AUTO3
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Notes [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Only summary statistics were planned for this endpoint. |
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No statistical analyses for this end point |
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End point title |
Frequency of Dose Limiting Toxicity (DLT) of AUTO3 [2] | ||||||
End point description |
DLT was defined as i) any new non-hematological AE of Grade 3 or higher toxicity using the NCI CTCAE (version 5.0), which is probably or definitely related to AUTO3 therapy, which occurs within the DLT evaluation period, and which fails to resolve to Grade 2 or better within 14 days, despite appropriate supportive measures; ii) Grade 4 CRS or neurotoxicity, cerebral edema, or Grade 3 neurotoxicity (including cerebral edema) that lasts >72 hours; iii) Grade >3 disseminated intravascular coagulation; iv) Grade >2 infusion reaction; v) Any other fatal event (Grade 5) or life-threatening event (Grade 4) that cannot be managed with conventional supportive measures or which in the opinion of the SEC necessitates dose reduction or other modification to trial treatment to avoid a similar hazard in future subjects.
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End point type |
Primary
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End point timeframe |
Within 30 days (+/- 3 days) after the last dose of AUTO3
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Notes [2] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Only summary statistics were planned for this endpoint. |
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No statistical analyses for this end point |
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End point title |
Proportion of Patients Achieving Morphological Remission (Complete Response(CR) or Complete Response With Incomplete Count Recovery (CRi) and Minimal Residual Disease (MRD)-Negative Response in the Bone Marrow (PCR)). [3] | ||||||
End point description |
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End point type |
Primary
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End point timeframe |
Within 30 days (+/- 3 days) post AUTO3 infusion
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Notes [3] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point. Justification: Only summary statistics were planned for this endpoint. |
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No statistical analyses for this end point |
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End point title |
Feasibility of Generating AUTO3: Number of Subjects' Cells Successfully Manufactured as a Proportion of the Number of Subjects Undergoing Leukapheresis | ||||||
End point description |
Feasibility of product generation was examined by assessing the number of AUTO3 successfully manufactured as a fraction of the number of subjects undergoing leukapheresis (all subjects screened).
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End point type |
Secondary
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End point timeframe |
Up to 8 weeks post leukapheresis
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Notes [4] - This endpoint includes all patients who were screened and underwent leukapheresis. |
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No statistical analyses for this end point |
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End point title |
Event-Free Survival (EFS) by Morphological Analysis | ||||||||
End point description |
Time from date of first AUTO3 infusion until the earliest of treatment failure (defined as not achieving CR/CRi post AUTO3 infusion / no response), morphological relapse, or death due to any cause, whichever occurred first.
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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No statistical analyses for this end point |
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End point title |
Incidence of CD19- and/or CD22-negative Relapse | ||||||
End point description |
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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No statistical analyses for this end point |
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End point title |
Relapse-Free Survival (RFS) by Morphological Anlaysis | ||||||||
End point description |
Time from first achievement of morphological CR/CRi post AUTO3 treatment until the earliest of morphological relapse, or death due to any cause, whichever occurred first.
99999 is used as the upper limit of the confidence interval was not reached.
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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No statistical analyses for this end point |
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End point title |
Overall Survival (OS) | ||||||||
End point description |
Calculated from the date of AUTO3 treatment to the date of death anytime post AUTO3 infusion. Patients who had not died were censored at the date of last contact.
99999 is used where the upper limit of the confidence interval had not been reached.
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End point type |
Secondary
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End point timeframe |
Up to last patient last visit
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No statistical analyses for this end point |
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End point title |
Expansion of AUTO3 Following Adoptive Transfer | ||||||||
End point description |
Expansion of AUTO3 was measured as the median peak (Cmax) of transgene levels in the peripheral blood after AUTO3 infusion.
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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No statistical analyses for this end point |
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End point title |
Persistence of AUTO3 Following Adoptive Transfer | ||||||||
End point description |
Persistence of AUTO3 was measured by qualitative polymerase chain reaction (PCR) and/or flow cytometry at a range of time points in the peripheral blood and the bone marrow.
Persistence was defined as the timepoint in days of last detectable CAR T cell by qPCR or last assessment if zero copies per μg DNA (whichever occurred later) before morphological relapse (Tlast).
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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No statistical analyses for this end point |
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End point title |
Duration of B Cell Aplasia | ||||||||
End point description |
Depletion of circulating B cells assessed by flow cytometry at a range of time points in the peripheral blood.
99999 is entered as B cell aplasia from the database was inconclusive because the total lymphocytes from the peripheral blood analyzed by flow cytometry were not collected systematically.
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End point type |
Secondary
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End point timeframe |
Up to 2 years
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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 |
From AUTO3 infusion (Day 0) to until the end of study or withdrawal, whichever occurred first.
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Assessment type |
Non-systematic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary used for adverse event reporting
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Dictionary name |
MedDRA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Dictionary version |
23.0
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Reporting groups
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Reporting group title |
AUTO3
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Reporting group description |
Paediatric subjects with relapse or refractory B-cell acute lymphoblastic leukaemia (ALL). | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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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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01 Jun 2017 |
Protocol version 2 - Summary of Changes:
- Typographical and administrative changes
- Changed dose escalation to dose evaluation/escalation
- Expanded inclusion criterion 1c with broader definitions extreme hyperdiploidy or hypodiploidy
- Added further clarity for high-risk CNS relapse subjects in inclusion criterion 1i and exclusion criterion 1
- Clarified screening window i.e. Day -84 to Day -35
- Clarified the inpatient period in the case of a split dose i.e. 30 (-3/+5) days post-AUTO3 infusion and up to 14 days after the second split dose
- Added text to clarify when the second split dose can be administered i.e. only at ≤ Grade 1 CRS and no ongoing CRS or neurotoxicity at Day 7
- Clarified the procedure for re-starting the trial following a halt as per the safety stopping criteria
- Clarified DLT period of 30 days (±3 days) after last dose or until start of a new ALL therapy
- Added hypoxia risks and mitigation strategy, respiratory toxicity guidelines
- Added GVHD risks and mitigation strategy as per the Investigator’s Brochure
- Clarified early use of tocilizumab for CRS safety management
- Added text to note patients will be monitored for CMV weekly during admission or as necessary
- Updated frequency of IDMC meetings to every 6 months in Phase II. Added text regarding the information received and the decision(s) that can be taken by the IDMC, particularly with regards to opening Phase II
- Updated the withdrawal of consent for patient samples stored for research |
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24 Oct 2017 |
Protocol version 3 - Summary of Changes:
- Typographical and administrative changes
- Updated and added new exclusion criteria
- Clarified Rolling 6 Dose Evaluation Decision Rules
- Added details on which blast count will be used to choose the cohort for a subject
- Added that subjects must have a full neurological assessment prior to pre-conditioning (Day -7)
- Amended central laboratory for MRD analysis from Great Ormond Street to Bristol Genetics Laboratory
- Updated Management of CRS text
- Updated concomitant medications and therapies |
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02 Feb 2018 |
Protocol version 4 - Summary of Changes:
- Typographical and administrative changes
- Updated schedule of events
- Added up to 3 dose levels for Phase 1 and clarified that each dose level will have 2 cohorts
- Added interim analysis on safety and preliminary efficacy
- Updated study product wording for AUTO3
- Changed dose evaluation to dose escalation
- Increased the number of patients needed for Phase I from 12-18 to 18-30. And increased the total number of patients needed for the whole study from 50 to 62
- Modified pre-conditioning regimen
- Timing of 2nd split dose reduced from 14 days (+/- 7d) to 5-10 days
- Updates to inclusion and exclusion criteria
- Addition of available clinical data in the first 3 patients treated with CD19/CD22 CAR-positive T cells
- Clarification of use of data from re-treated patients
- SEC recommended to declared the Cohort 1 dose as safe and escalate dose for subsequent patients to 3x10^6 CD19/CD22-positive CAR-T cells/kg and further if needed to establish a RP2D
- Modified text based on recently published data indicating that patients at risk of severe CRS or neurotoxicity develop signs and symptoms very early and early dosing of the second fraction between day 5-10 is likely to maximise the potential effect of pre-conditioning induced cytokines on AUTO3 without increasing the risk of severe toxicity
- Updated DLT criteria
- Clarified text regarding patients with ≥25% blasts can be treated with single doses if both single and split doses are determined to be safe
- Revised Safety Stopping Criteria
- Dosing caveat added to increase patient safety
- Updated text regarding re-treatment of patients
- Updated the CRS management guidelines
- Update the tocilizumab dosing guidelines to match the current label
- Revised concomitant medications text
- Updated dietary and lifestyle restrictions
- Clarified interim analysis text
- Clarified study discontinuation text
- Clarified monitoring text |
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11 May 2018 |
Protocol version 5 - Summary of Changes:
- Clarified exclusion criteria
- Updated schedule of events |
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10 Oct 2018 |
Protocol version 6 - Summary of Changes:
(US only; not implemented)
- Typographical changes
- Revised text regarding single or split doses based on disease burden, but clarified they will be analysed as one group
- Updated DLT definition based on FDA recommendation
- Made corrections to the risks and mitigations section |
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29 Mar 2019 |
Protocol version 7 - Summary of Changes:
(implemented in v. 8)
- ‘Young adult’ has been replaced by ‘adult’
- Inclusion of a potential 4th dose level, that increases the total number of paediatric/young adult patients required for Phase I to 24-36
- Inclusion of an adult cohort (≥25 years), which adds 12-24 patients into Phase I
- Update to Infectious Disease Screening
- Reduction of blood volume required for RCR testing and insertional mutagenesis from 10ml to 5
- Update to paediatric/young adult exclusion criteria
- Update of window for DLT period at Day 30 to ±3 days
- The recommended in-patient stay after AUTO3 dosing in Phase I has been reduced from 30 (-3/+5) days to 14 days, or longer if necessary. In Phase II the duration of admission to hospital will be based on emerging data and the patient’s condition. Patient may be discharged before 14 days or treated as out patients
- MRD will now be analysed at all time points by both PCR and flow
- Bone marrow and cerebrospinal fluid tests at Day 0 removed
- Frequency of blood tests for cytokines and CAR T cells reduced
- Immunological profiling will be done in Phase I only
- Schedule of assessments updated
- Update to the clinical data in AUTO3-PA1 to new data
- Update to secondary objectives and endpoints
- The SEC has agreed that Cohort 2b (3x10^6/kg split dose) should be closed after 1 patient as it is deemed sub-therapeutic
- A minimum of 6 patients need to be treated in a cohort before it can be declared as the phase 2 dose
- Updated DLT definition
- Updated text in risks and mitigation section
- Clarification of patients going on hold before dosing
- Update to information on the administration of AUTO3
- New text added to Monitoring During and After Drug Administration section
- Definitions of relapse disease have been clarified
- New text added for HRQOL measures and bridging therapy
- New CRS/MAS treatment option
- Updated Lee et al, 2018 guidance
- CTCAE version updated to v5. |
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10 May 2019 |
Protocol version 8 - Summary of Changes:
- The recommended in-patient stay after AUTO3 dosing has been returned from 14 days to 30 days (±3), or longer if necessary for monitoring and management, per MHRA request
- The following text was deleted: AEs such as severe cytopenias that require re-hospitalization within 30 (±3) days of AUTO3 because the patient was discharged early should not be automatically reported as SAEs unless clinically indicated ex febrile neutropenia
- Reporting of prolonged Grade 4 cytopenia lasting more than 60 days: text moved and clarification added
- BMA immunophenotyping and flow MRD tests at screening |
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Interruptions (globally) |
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Were there any global interruptions to the trial? Yes | |||||||
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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. | |||||||
Early completion of the study leading to small numbers of patients analyzed from the Phase I part of the study. |