Trial Outcomes & Findings for TLR9 Agonist SD-101, Ibrutinib, and Radiation Therapy in Treating Patients With Relapsed or Refractory Grade 1-3A Follicular Lymphoma (NCT NCT02927964)

NCT ID: NCT02927964

Last Updated: 2024-10-16

Results Overview

Dose-limiting toxicity was continuously throughout the trial. Adverse event information was collected at each visit. Safety labs were collected on week 2, 4, 6, 12 and every 12 weeks thereafter until the final study visit.

Recruitment status

COMPLETED

Study phase

PHASE1/PHASE2

Target enrollment

21 participants

Primary outcome timeframe

Up to 24 months

Results posted on

2024-10-16

Participant Flow

Participant milestones

Participant milestones
Measure
Phase I -SD-101 3mg
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Phase II -SD-101 3mg
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Overall Study
STARTED
11
10
Overall Study
COMPLETED
11
9
Overall Study
NOT COMPLETED
0
1

Reasons for withdrawal

Withdrawal data not reported

Baseline Characteristics

TLR9 Agonist SD-101, Ibrutinib, and Radiation Therapy in Treating Patients With Relapsed or Refractory Grade 1-3A Follicular Lymphoma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Phase 1b -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=11 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Phase II -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=10 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Total
n=21 Participants
Total of all reporting groups
Age, Categorical
<=18 years
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Age, Categorical
Between 18 and 65 years
6 Participants
n=5 Participants
7 Participants
n=7 Participants
13 Participants
n=5 Participants
Age, Categorical
>=65 years
5 Participants
n=5 Participants
3 Participants
n=7 Participants
8 Participants
n=5 Participants
Sex: Female, Male
Female
4 Participants
n=5 Participants
5 Participants
n=7 Participants
9 Participants
n=5 Participants
Sex: Female, Male
Male
7 Participants
n=5 Participants
5 Participants
n=7 Participants
12 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
11 Participants
n=5 Participants
10 Participants
n=7 Participants
21 Participants
n=5 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Asian
2 Participants
n=5 Participants
1 Participants
n=7 Participants
3 Participants
n=5 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Black or African American
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
White
9 Participants
n=5 Participants
9 Participants
n=7 Participants
18 Participants
n=5 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=5 Participants
0 Participants
n=7 Participants
0 Participants
n=5 Participants
Region of Enrollment
United States
11 participants
n=5 Participants
10 participants
n=7 Participants
21 participants
n=5 Participants

PRIMARY outcome

Timeframe: Up to 24 months

Population: Participants who received treatment are included in the analysis

Dose-limiting toxicity was continuously throughout the trial. Adverse event information was collected at each visit. Safety labs were collected on week 2, 4, 6, 12 and every 12 weeks thereafter until the final study visit.

Outcome measures

Outcome measures
Measure
Phase 1b -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=6 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Phase II -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Number of Dose-limiting Toxicity Assessed Using Common Terminology Criteria for Adverse Events Version 4.0 (Phase Ib)
1 Participants
0 Participants

PRIMARY outcome

Timeframe: Up to 24 months

Population: Participants who received treatment are included in the analysis

Tumor response rate of intratumoral SD 101 in combination with ibrutinib and radiation in subjects will be assessed. Tumor response rates (complete response, partial response) will be calculated based on the Lugano classification for low-grade B-cell lymphomas.

Outcome measures

Outcome measures
Measure
Phase 1b -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=11 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Phase II -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=9 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Tumor Response Rates (Phase II)
Partial Response
4 Participants
5 Participants
Tumor Response Rates (Phase II)
Complete Response
0 Participants
1 Participants

SECONDARY outcome

Timeframe: Up to 24 months

Population: Participants who received treatment are included in the analysis

Progression free Survival is defined as the time elapsed between treatment initiation (Day 1) and tumor progression or death from any cause. Progression will be defined using the Lugano Classification. This outcome will be measured on any individual who has received at least one intratumoral injection of SD 101 at the recommended phase 2 dose level.

Outcome measures

Outcome measures
Measure
Phase 1b -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=11 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Phase II -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=9 Participants
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Progression-free Survival (Phase II)
11 Months
Interval 7.0 to 21.9
11 Months
Interval 7.0 to 21.9

Adverse Events

Phase 1b/phase2 -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)

Serious events: 8 serious events
Other events: 20 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Phase 1b/phase2 -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=20 participants at risk
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Blood and lymphatic system disorders
Bacteremia
5.0%
1/20 • Number of events 1 • up to 24 months
Renal and urinary disorders
Urinary tract infection
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Diarrhea
5.0%
1/20 • Number of events 1 • up to 24 months
Skin and subcutaneous tissue disorders
maculopapular rash
10.0%
2/20 • Number of events 2 • up to 24 months
Cardiac disorders
Atrial fibrillation
5.0%
1/20 • Number of events 1 • up to 24 months
Skin and subcutaneous tissue disorders
Cellulitis
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Soft tissue infection
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Infection other
5.0%
1/20 • Number of events 1 • up to 24 months

Other adverse events

Other adverse events
Measure
Phase 1b/phase2 -SD-101 3mg: Treatment (Radiation Therapy, TLR9 Agonist SD-101, Ibrutinib)
n=20 participants at risk
Patients underwent radiation therapy on days 1 and 2. Within 12 hours of the completion of radiation therapy, patients received TLR9 agonist SD-101 IT on day 2 and on days 9, 16, 23, 30 and 37. Patients also received ibrutinib PO daily beginning on day 9 for 96 weeks or in the absence of disease progression or unexpected toxicity.
Blood and lymphatic system disorders
Anemia
35.0%
7/20 • Number of events 7 • up to 24 months
Cardiac disorders
Palpitations
30.0%
6/20 • Number of events 7 • up to 24 months
Cardiac disorders
Atrial fibrillation
15.0%
3/20 • Number of events 3 • up to 24 months
Cardiac disorders
Tachycardia
10.0%
2/20 • Number of events 2 • up to 24 months
Cardiac disorders
Heart failure
5.0%
1/20 • Number of events 1 • up to 24 months
Eye disorders
Blurred vision
10.0%
2/20 • Number of events 2 • up to 24 months
Eye disorders
Conjunctivitis
15.0%
3/20 • Number of events 3 • up to 24 months
Eye disorders
Eye Pain
15.0%
3/20 • Number of events 3 • up to 24 months
Eye disorders
Dry Eyes
5.0%
1/20 • Number of events 1 • up to 24 months
Eye disorders
Eye Infection
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Diarrhea
80.0%
16/20 • Number of events 34 • up to 24 months
Gastrointestinal disorders
Nausea
55.0%
11/20 • Number of events 28 • up to 24 months
Gastrointestinal disorders
Abdominal Pain
45.0%
9/20 • Number of events 14 • up to 24 months
Gastrointestinal disorders
Oral mucositis
35.0%
7/20 • Number of events 14 • up to 24 months
Gastrointestinal disorders
Dyspepsia
40.0%
8/20 • Number of events 10 • up to 24 months
Gastrointestinal disorders
Sore Throat
20.0%
4/20 • Number of events 13 • up to 24 months
Gastrointestinal disorders
Dry mouth
20.0%
4/20 • Number of events 5 • up to 24 months
Gastrointestinal disorders
Bloating
15.0%
3/20 • Number of events 4 • up to 24 months
Gastrointestinal disorders
Vomiting
15.0%
3/20 • Number of events 4 • up to 24 months
Gastrointestinal disorders
Dysgeusia
15.0%
3/20 • Number of events 3 • up to 24 months
Gastrointestinal disorders
Oral hemorrhage
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Bleeding gum
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Constipation
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Dark stool
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Early satiety
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Epigastric pain
5.0%
1/20 • Number of events 1 • up to 24 months
Gastrointestinal disorders
Swollen lip
5.0%
1/20 • Number of events 2 • up to 24 months
General disorders
Fatigue
95.0%
19/20 • Number of events 49 • up to 24 months
General disorders
Injection site reaction
75.0%
15/20 • Number of events 40 • up to 24 months
General disorders
Chills
75.0%
15/20 • Number of events 37 • up to 24 months
General disorders
Fever
55.0%
11/20 • Number of events 22 • up to 24 months
General disorders
Edema limbs
10.0%
2/20 • Number of events 5 • up to 24 months
General disorders
Malaise
15.0%
3/20 • Number of events 3 • up to 24 months
General disorders
Chest pain
20.0%
4/20 • Number of events 8 • up to 24 months
General disorders
Ear pain
5.0%
1/20 • Number of events 1 • up to 24 months
General disorders
General pain
10.0%
2/20 • Number of events 2 • up to 24 months
General disorders
Naval pain
5.0%
1/20 • Number of events 1 • up to 24 months
General disorders
Neck pain
5.0%
1/20 • Number of events 2 • up to 24 months
Infections and infestations
Upper respiratory infection
30.0%
6/20 • Number of events 8 • up to 24 months
Infections and infestations
Skin infection
15.0%
3/20 • Number of events 6 • up to 24 months
Infections and infestations
Bronchial infection
15.0%
3/20 • Number of events 3 • up to 24 months
Infections and infestations
Bursitis
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Shingles
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Skin wound
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Soft tissue infection
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Urinary tract infection
5.0%
1/20 • Number of events 1 • up to 24 months
Infections and infestations
Paronychia
5.0%
1/20 • Number of events 1 • up to 24 months
Injury, poisoning and procedural complications
Bruising
60.0%
12/20 • Number of events 15 • up to 24 months
Injury, poisoning and procedural complications
Fall
10.0%
2/20 • Number of events 2 • up to 24 months
Injury, poisoning and procedural complications
Procedural complication
5.0%
1/20 • Number of events 2 • up to 24 months
Injury, poisoning and procedural complications
Shoulder injury
5.0%
1/20 • Number of events 1 • up to 24 months
Injury, poisoning and procedural complications
Arm injury
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Lymphocyte count decreased
45.0%
9/20 • Number of events 18 • up to 24 months
Investigations
White blood cell count decreased
45.0%
9/20 • Number of events 12 • up to 24 months
Investigations
Neutrophil count decreased
30.0%
6/20 • Number of events 11 • up to 24 months
Investigations
Creatinine increased
15.0%
3/20 • Number of events 4 • up to 24 months
Investigations
Increased LDH
15.0%
3/20 • Number of events 3 • up to 24 months
Investigations
Blood bilirubin increased
10.0%
2/20 • Number of events 2 • up to 24 months
Investigations
Alanine aminotransferase increased
10.0%
2/20 • Number of events 2 • up to 24 months
Investigations
Alkaline phosphatase decreased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Monocyte increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Neutrophil count increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Alkaline phosphatase increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Lipase increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Lymphocyte count increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Blood bicarbonate decreased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Chloride increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low Chloride
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Aspartate aminotransferase increased
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
High ketones
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low magnesium
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low Phosphorus
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low Ferritin
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low serum globulin concentration
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low transferrin saturation
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
Low Albumin
5.0%
1/20 • Number of events 1 • up to 24 months
Investigations
High PTT
5.0%
1/20 • Number of events 1 • up to 24 months
Metabolism and nutrition disorders
Platelet count decreased
55.0%
11/20 • Number of events 20 • up to 24 months
Metabolism and nutrition disorders
Hypocalcemia
25.0%
5/20 • Number of events 7 • up to 24 months
Metabolism and nutrition disorders
Loss of appetite (anorexia)
20.0%
4/20 • Number of events 7 • up to 24 months
Metabolism and nutrition disorders
Hyponatremia
15.0%
3/20 • Number of events 5 • up to 24 months
Metabolism and nutrition disorders
Hypoalbuminemia
15.0%
3/20 • Number of events 4 • up to 24 months
Metabolism and nutrition disorders
Hypokalemia
15.0%
3/20 • Number of events 3 • up to 24 months
Metabolism and nutrition disorders
Hypoglycemia
10.0%
2/20 • Number of events 2 • up to 24 months
Metabolism and nutrition disorders
Hypernatremia
5.0%
1/20 • Number of events 1 • up to 24 months
Musculoskeletal and connective tissue disorders
Myalgia
85.0%
17/20 • Number of events 37 • up to 24 months
Musculoskeletal and connective tissue disorders
Arthralgia
50.0%
10/20 • Number of events 20 • up to 24 months
Musculoskeletal and connective tissue disorders
Back and shoulder pain
35.0%
7/20 • Number of events 17 • up to 24 months
Musculoskeletal and connective tissue disorders
Muscle Cramping
25.0%
5/20 • Number of events 9 • up to 24 months
Musculoskeletal and connective tissue disorders
Arthritis
10.0%
2/20 • Number of events 2 • up to 24 months
Musculoskeletal and connective tissue disorders
Weakness
5.0%
1/20 • Number of events 1 • up to 24 months
Musculoskeletal and connective tissue disorders
Fracture
5.0%
1/20 • Number of events 1 • up to 24 months
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Neoplasms benign
5.0%
1/20 • Number of events 1 • up to 24 months
Nervous system disorders
Headache
75.0%
15/20 • Number of events 58 • up to 24 months
Nervous system disorders
Dizziness
20.0%
4/20 • Number of events 7 • up to 24 months
Nervous system disorders
Paresthesia
15.0%
3/20 • Number of events 3 • up to 24 months
Nervous system disorders
Peripheral sensory neuropathy
5.0%
1/20 • Number of events 3 • up to 24 months
Nervous system disorders
Lightheadedness
5.0%
1/20 • Number of events 1 • up to 24 months
Psychiatric disorders
Insomnia
15.0%
3/20 • Number of events 4 • up to 24 months
Psychiatric disorders
Confusion
10.0%
2/20 • Number of events 2 • up to 24 months
Psychiatric disorders
Anxiety
5.0%
1/20 • Number of events 2 • up to 24 months
Psychiatric disorders
Decreased libido
5.0%
1/20 • Number of events 1 • up to 24 months
Reproductive system and breast disorders
Menorrhagia
5.0%
1/20 • Number of events 1 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Epistaxis
30.0%
6/20 • Number of events 12 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Cough
30.0%
6/20 • Number of events 6 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Nasal Congestion
10.0%
2/20 • Number of events 3 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Dyspnea
10.0%
2/20 • Number of events 2 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Pleural effusion
5.0%
1/20 • Number of events 1 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Wheezing
5.0%
1/20 • Number of events 1 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Hoarseness
5.0%
1/20 • Number of events 1 • up to 24 months
Respiratory, thoracic and mediastinal disorders
Pleural Hemorrhage
5.0%
1/20 • Number of events 1 • up to 24 months
Skin and subcutaneous tissue disorders
Skin rash
55.0%
11/20 • Number of events 29 • up to 24 months
Skin and subcutaneous tissue disorders
Dry skin
25.0%
5/20 • Number of events 7 • up to 24 months
Skin and subcutaneous tissue disorders
Itchiness
20.0%
4/20 • Number of events 6 • up to 24 months
Skin and subcutaneous tissue disorders
Night Sweats
15.0%
3/20 • Number of events 4 • up to 24 months
Skin and subcutaneous tissue disorders
Alopecia
15.0%
3/20 • Number of events 3 • up to 24 months
Skin and subcutaneous tissue disorders
Dry brittle finger nails
15.0%
3/20 • Number of events 3 • up to 24 months
Skin and subcutaneous tissue disorders
Blisters
15.0%
3/20 • Number of events 3 • up to 24 months
Skin and subcutaneous tissue disorders
Skin discoloration
5.0%
1/20 • Number of events 1 • up to 24 months
Skin and subcutaneous tissue disorders
Bleeding
5.0%
1/20 • Number of events 1 • up to 24 months
Vascular disorders
Hypertension
15.0%
3/20 • Number of events 7 • up to 24 months
Vascular disorders
Flushing
5.0%
1/20 • Number of events 1 • up to 24 months
Vascular disorders
Cold hands and feet
5.0%
1/20 • Number of events 1 • up to 24 months

Additional Information

Dr. Ronald Levy

Stanford University

Phone: (650) 725-6452

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place