Phase I Study of Cell Therapies for the Treatment of Patients With Relapsed or Refractory AML or High-risk MDS
Primary Purpose
Acute Myeloid Leukemia, Myelodysplastic Syndromes
Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
SPRX002
ARC-T Cells
Sponsored by
About this trial
This is an interventional treatment trial for Acute Myeloid Leukemia focused on measuring Arcellx, ARC-T cells, SparX, SPRX002, ACLX-002
Eligibility Criteria
Inclusion Criteria:
- 18 years or older
- For AML subjects: WHO-confirmed AML (2016 criteria) with no standard treatment options
- Relapsed or refractory disease after 1 or 2 lines of therapy
- relapsed: bone marrow blasts ≥ 5% following achievement of CR/CRi/MLFS
- refractory: failure to achieve CR/CRi/MLFS with evidence of persistence leukemia by blood or bone marrow after: 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 VEN-based lower intensity therapy iv. at least 4 cycles of HMA-based therapy with ventoclax
- For MDS subjects: diagnosis of MDS and ≥ 10% bone marrow blasts with indication of high risk disease defined as resistant or refractory disease to at least one course of therapy including hypomethelating agents with or without ventoclax
- Must have an identified potential donor and transplant strategy/plan prior to initiation of lymphodepletion regimen.
Exclusion Criteria:
- Patients with APL (acute promyelocytic leukemia)
- Patients with active CNS involvement
- hyperleukocytosis or rapidly progressing disease
- previous treatment with an investigational gene or chimeric antigen receptor therapy
- previous treatment with an anti-CD123 directed therapy
Sites / Locations
- City of HopeRecruiting
- The Sidney Kimmel Comprehensive Cancer Center at Johns HopkinsRecruiting
- Dana Farber Cancer Institute
- Montefiore Einstein Cancer CenterRecruiting
- MD Anderson Cancer CenterRecruiting
Arms of the Study
Arm 1
Arm Type
Experimental
Arm Label
CD123-Specific Adapter (SPRX002) and Universal CAR-Modified T Cell (ARC-T Cells)
Arm Description
Arm 1: Phase 1 Study of monovalent CD123-Specific Adapter (SPRX002) and Universal CAR-Modified T cell (ARC-T Cells) for the Treatment of Patients with Relapsed or Refractory Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndromes
Outcomes
Primary Outcome Measures
Incidence of treatment-emergent adverse events (TEAEs), including dose-limiting toxicities (DLTs) and establish recommended Phase II dose (RP2D)
The RP2D will be determined based on the totality of data, including the maximum tolerated dose (MTD); if applicable, and other endpoints such as observed efficacy, pharmacokinetics (PK), pharmacodynamics (PD), and other safety endpoints (adverse events (AEs), laboratory assessment, vital signs, and physical examinations)
Secondary Outcome Measures
Anti-Tumor Activity
Serial blood and bone marrow sampling to determine response to treatment by modified International Working Group (IWG) Response Criteria in AML and MDS, or other appropriate response criteria for the malignancy under study, such as overall response rate, composite complete remission rate, and rate of negative minimum residual disease (MRD)
Pharmacokinetics (PK)
Quantification of ARC-T cells and SPRX002 using vector copy number (VCN) on peripheral blood mononuclear cells
Full Information
1. Study Identification
Unique Protocol Identification Number
NCT05457010
Brief Title
Phase I Study of Cell Therapies for the Treatment of Patients With Relapsed or Refractory AML or High-risk MDS
Official Title
Master Protocol for the Phase 1 Study of Cell Therapies for the Treatment of Patients With Relapsed or Refractory Acute Myeloid Leukemia or High-risk Myelodysplastic Syndrome, Including Long-term Safety Follow-up
Study Type
Interventional
2. Study Status
Record Verification Date
June 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 28, 2022 (Actual)
Primary Completion Date
September 30, 2025 (Anticipated)
Study Completion Date
November 17, 2025 (Anticipated)
3. Sponsor/Collaborators
Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Arcellx, Inc.
4. Oversight
Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No
5. Study Description
Brief Summary
The purpose of this study is to evaluate the safety and preliminary activity of ARC-T cells and SPRX002 in participants with relapsed or refractory acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS)
Detailed Description
This is a Phase I open-label, safety, and dose-escalation study of ARC-T cells and SPRX002 in participants with relapsed or refractory AML or high-risk MDS. The study will have the following sequential phases: screening, enrollment, pretreatment with lymphodepletion (LD) chemotherapy, treatment with SPRX002 and ARCT cells, treatment extension with SPRX002, follow up, and long-term safety follow-up.
Following a single infusion of SPRX002 and ARC T (Day 0) and followed by regular administration of SPRX002 at the assigned dose level, both safety and efficacy data will be assessed. Dose limiting toxicities (DLTs) will be assessed through Day 28 and safety data will be collected throughout the study. Long-term safety data will be collected for up to 15 years per health authority guidelines. Efficacy will be assessed monthly for the first 6 months, then quarterly up to 2 years, or upon subject relapse.
ARC-T cells are a genetically modified autologous T-cell product. The T cell has been transduced using a third-generation lentiviral vector encoding a binding domain (referred to as AF101) chimeric antigen receptor (CAR), followed by CD8 spacer and transmembrane region that is fused to the intracellular signaling domains 4-1BB and CD3ζ. AF101 specifically binds to the "TAG" protein (referred to as Q26) of the soluble protein antigen-receptor x-linker (sparX; specifically, SPRX002).
6. Conditions and Keywords
Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Acute Myeloid Leukemia, Myelodysplastic Syndromes
Keywords
Arcellx, ARC-T cells, SparX, SPRX002, ACLX-002
7. Study Design
Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Sequential Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
24 (Anticipated)
8. Arms, Groups, and Interventions
Arm Title
CD123-Specific Adapter (SPRX002) and Universal CAR-Modified T Cell (ARC-T Cells)
Arm Type
Experimental
Arm Description
Arm 1: Phase 1 Study of monovalent CD123-Specific Adapter (SPRX002) and Universal CAR-Modified T cell (ARC-T Cells) for the Treatment of Patients with Relapsed or Refractory Acute Myeloid Leukemia or High-Risk Myelodysplastic Syndromes
Intervention Type
Biological
Intervention Name(s)
SPRX002
Intervention Description
SPRX002 is a soluble protein with a "TAG" region to which ARC-T cells bind and a binding region targeting CD123
Intervention Type
Biological
Intervention Name(s)
ARC-T Cells
Intervention Description
ARC-T Cells is a genetically modified autologous T-cell product. The T cell has a binding domain chimeric antigen receptor (CAR), which specifically binds to the "TAG" protein of the soluble protein antigen-receptor x-linker (sparX; specifically, SPRX002). When ARC-T cells bind to a "TAG" and the SPRX protein is bound to its target (in this case CD123), ARC-T cells are capable of activation, expansion, and killing (based on preclinical experiments).
Primary Outcome Measure Information:
Title
Incidence of treatment-emergent adverse events (TEAEs), including dose-limiting toxicities (DLTs) and establish recommended Phase II dose (RP2D)
Description
The RP2D will be determined based on the totality of data, including the maximum tolerated dose (MTD); if applicable, and other endpoints such as observed efficacy, pharmacokinetics (PK), pharmacodynamics (PD), and other safety endpoints (adverse events (AEs), laboratory assessment, vital signs, and physical examinations)
Time Frame
24 months
Secondary Outcome Measure Information:
Title
Anti-Tumor Activity
Description
Serial blood and bone marrow sampling to determine response to treatment by modified International Working Group (IWG) Response Criteria in AML and MDS, or other appropriate response criteria for the malignancy under study, such as overall response rate, composite complete remission rate, and rate of negative minimum residual disease (MRD)
Time Frame
24 months
Title
Pharmacokinetics (PK)
Description
Quantification of ARC-T cells and SPRX002 using vector copy number (VCN) on peripheral blood mononuclear cells
Time Frame
24 months
10. Eligibility
Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
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
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Clinical Information
Phone
240-327-0379
Email
clinical@arcellx.com
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Tim Welliver, MD, PhD
Organizational Affiliation
Arcellx, Inc.
Official's Role
Study Chair
Facility Information:
Facility Name
City of Hope
City
Duarte
State/Province
California
ZIP/Postal Code
91010
Country
United States
Individual Site Status
Recruiting
Facility Name
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
City
Baltimore
State/Province
Maryland
ZIP/Postal Code
21205
Country
United States
Individual Site Status
Recruiting
Facility Name
Dana Farber Cancer Institute
City
Boston
State/Province
Massachusetts
ZIP/Postal Code
02215
Country
United States
Individual Site Status
Not yet recruiting
Facility Name
Montefiore Einstein Cancer Center
City
New Rochelle
State/Province
New York
ZIP/Postal Code
10801
Country
United States
Individual Site Status
Recruiting
Facility Name
MD Anderson Cancer Center
City
Houston
State/Province
Texas
ZIP/Postal Code
77030
Country
United States
Individual Site Status
Recruiting
12. IPD Sharing Statement
Plan to Share IPD
No
Learn more about this trial
Phase I Study of Cell Therapies for the Treatment of Patients With Relapsed or Refractory AML or High-risk MDS
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