Phase I Study of Cell Therapies for the Treatment of Patients With Relapsed or Refractory AML or High-risk MDS

Inclusion Criteria:

18 years or older

Acute myeloid leukemia (AML) Subjects: WHO-confirmed AML (WHO AML Criteria 2016), other than APL, with no standard treatment options available Relapsed or refractory disease after 1 or 2 lines of therapy

Relapsed: Bone marrow blasts ≥ 5% following achievement of complete remission (CR)/Complete remission with incomplete blood count recovery (CRi)/morphological leukemia-free state (MLFS)
Refractory: Failure to achieve CR/CRi/MLFS with evidence of persistence leukemia by blood and/or bone marrow after any of the following:

i. At least 2 cycles of 7+3 based therapy ii. At least 1 cycle of high or intermediate dose cytarabine containing induction regimen iii. at least 2 cycles of venetoclax (VEN)-based lower intensity therapy, e.g., with hypomethylating agents (HMA), or low-dose Cytarabine (LDAC) or cladribine+LDAC iv. at least 4 cycles of HMA-based therapy with venetoclax

Myelodysplastic syndrome (MDS) Subjects: Diagnosis of MDS and ≥ 10% bone marrow blasts with indication of high-risk disease defined as those having resistant or refractory disease to at least one course of therapy including HMA given at conventional regimen, with or without venetoclax or other agents. Failure is defined as failure to attain a response, or relapse after prior response to HMA therapy per the modified IWG criteria. Patents relapsing after allogeneic hematopoietic stem cell transplant (HSCT) >6 months prior are eligible if they have recovered from all transplant-related toxicities and are off all immunosuppression for at least 6 weeks
Eastern Cooperative Oncology Group (ECOG) Performance Status 0-1

Adequate organ function, including renal and hepatic function based on last clinical assessment performed within the screening period

Creatinine clearance ≥50 ml/min (Cockcroft-Gault or 24-hour urine collection in cases in which Cockroft-Gault is unreliable or if preferred by physician) and not on dialysis
Alanine aminotransferase <3 x upper limit of normal (ULN)
Aspartate aminotransferase <3 x the upper limit of normal (ULN)
Total bilirubin <2 x upper limit of normal (ULN) (except for patients with known or suspected history of Gilbert's Syndrome where up to 3x ULN is allowed)
Left Ventricular Ejection Fraction (LVEF) ≥45% by echocardiography (ECHO) or multigated acquisition (MUGA) scan
Pulse oxygenation ≥92% on room air
Prothrombin time test (PTT), prothrombin time (PT)/international normalized ratio (INR) <1.5 x ULN, unless on a stable dose of anti-coagulant for thromboembolic event (patients with any history of thromboembolic stroke; or history or Grade 2 (G2) or greater hemorrhage within 60 days are excluded)
Resolution of adverse events (AEs) from any prior systemic anticancer therapy, radiotherapy, or surgery to Grade 1 or baseline (except G2 alopecia and G2 sensory neuropathy)
Prior allogeneic stem cell transplant is allowed, provided the subject has recovered from all AEs, there is no ongoing graft-versus-host-disease (GvHD) and subject is not on taking any immunosuppressive medications to prevent GvHD
Male and females of childbearing potential must agree to use highly effective methods of birth control through 6 months after the dose of study treatment
Patients must have an identified potential donor and transplant strategy/plan prior to initiation of the lymphodepletion regimen to ensure availability of hematopoeitic stem cells (HSCs) for potential urgent allogeneic HSC transplant (HSCT) if needed for persistent bone marrow aplasia without evidence of residual leukemia. Transplant decision making would be a discussion between subject and investigator due to potential for treatment-related mortality and is not required
Willing to comply with and able to tolerate study procedures, including Long-Term Safety Follow-up lasting up to 15 years
Subject's apheresis product from non-mobilized cells is received and accepted for cell processing by manufacturing site. NOTE: apheresis will be accepted only after all other eligibility criteria have been met

Exclusion Criteria:

Patients with acute promyelocytic leukemia (APL)
Patients with active CNS involvement. Subjects may be cleared of CNS involvement if there has been no evidence of CNS involvement for at least 3 months prior to enrollment
Hyperleukocytosis (≥25,000 blasts/μL) or rapidly progressive disease that in the estimation of the investigator and sponsor would compromise ability to complete study therapy. (Note: Subjects may be receiving or may receive hydroxyurea to maintain or control hyperleukocytosis)
Previous treatment with an investigational gene or chimeric antigen receptor therapy (Note: May be permitted after discussion with Medical Monitor)
Previous treatment with a directed therapy (T-cell engager or ADC) against the target for the specific sparX protein in the specific arm for enrollment
Use of any anti-AML/MDS directed chemotherapy or targeted therapy, except hydroxyurea therapy, within 14 days or 5 half-lives (whichever is shorter) prior to the date of leukapheresis and use of any anti-AML/MDS directed monoclonal antibody within 28 days prior to date of leukapheresis
Known infection with Human Immunodeficiency Virus or Human T-Cell leukemia/lymphoma virus type 1 (HTLV-1)
A known hypersensitivity or severe allergy to study drug components including dimethyl sulphoxide (DMSO) and human serum albumin
Contraindication to cyclophosphamide or fludarabine
Subject has systemic fungal, bacterial, viral or other infection that is exhibiting ongoing signs/symptoms related to the infection without improvement despite appropriate treatment

Severe uncontrolled intercurrent illness including:

Cardiovascular disease
Symptomatic congestive heart failure
Unstable angina, arrythmia, or myocardial infarction (MI) within 6 months prior to screening
Significant pulmonary dysfunction
Uncontrolled thromboembolic events or recent severe hemorrhage
Any history of pulmonary embolism (PE) ever or deep vein thrombosis (DVT) within 3 months of screening. Therapeutic dosing of anticoagulants (e.g., warfarin, low molecular weight heparin, Factor Xa inhibitors) is allowed for history of DVT if greater than 3 months from time of screening) Note: Central line thrombosis not requiring anticoagulation will not be excluded and will not require a 3-month screening window
Autoimmune disease

Seropositive for and with evidence of active hepatitis B or C infection at time of Screening

Subjects with a history of hepatitis B but have received antiviral therapy and have non-detectable viral DNA for 6 months are eligible
Subjects seropositive because of hepatitis B virus vaccine with no signs or active infection are eligible
Subjects who had hepatitis C but have received antiviral therapy and show no detectable hepatitis C virus (HCV) viral RNA for 6 months are eligible
Any sign of active CNS pathology within 6 months of screening including history of epilepsy, seizure requiring anti-seizure medications, paresis, aphasia, stroke, severe brain injury, dementia, cerebellar disease, Parkinson's disease, organic brain syndrome or psychosis. Subarachnoid hemorrhage or central nervous system (CNS) bleed within 3 months of screening
Subject has active malignant tumors other than AML/MDS that requires active antineoplastic or radiation therapy at the time of screening. Maintenance therapy or hormonal therapy for well-controlled malignancy is allowed
Females who are pregnant or breastfeeding
Subjects with any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in study (or full access to medical records) as written including follow up, the interpretation of data or place the subject at unacceptable risk are excluded