Acute Myeloid LeukemiaPhase 1NCT05038644
XmAb18968 (CD3-CD38) in Relapsed or Refractory Acute Leukemia and T Cell Lymphoblastic Leukemia
A Phase 1 study testing XmAb18968 - Dose level -1, XmAb18968 - Dose level 0 (starting dose) and XmAb18968 - Dose level 1 in people with Acute Myeloid Leukemia and T Cell Acute Lymphoblastic Leukemia, run by Ehab L Atallah at 6 sites in United States.
Trial summary
This is a phase 1, dose-escalation study (using 3 + 3 dose-limiting toxicity (DLT) criteria) evaluating the safety and tolerability of XmAb18968, as well as establishing a recommended phase II dose (RP2D) in subjects with T cell acute lymphoblastic leukemia (T-ALL) and T cell lymphoblastic (lymphoma) T-LBL (Group A)… Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Acute Myeloid Leukemia, T Cell Acute Lymphoblastic Leukemia, T Cell Lymphoblastic Lymphoma
- What is being tested?
- XmAb18968 - Dose level -1, XmAb18968 - Dose level 0 (starting dose) and XmAb18968 - Dose level 1
- Type of treatment
- Injection or infusion
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 22 participants
- Where
- 6 sitesUnited States
- Study dates
- 2 Feb 2022to 18 Nov 2024
- Phase
- Phase 1
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Voluntary written consent must be given before performance of any study-related procedure not part of standard medical care.
- Male or female subjects 18 years or older.
- Morphologically documented T-ALL, AML (including undifferentiated leukemia and bi-phenotypic leukemia, or T-LBL in relapsed/refractory status (at least one line of prior therapy). Subjects with measurable residual disease by flow cytometry, molecular testing or cytogenetics will be eligible for the trial.
- CD38 expression ≥ 20% by flow cytometry or immunohistochemistry at time of relapse.
- Adequate organ system function as outlined below:
- Total bilirubin ≤ 1.5 × upper limit of normal (ULN), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 3 × ULN. If total bilirubin > 1.5 × ULN then check direct bilirubin. Subject will be eligible if direct bilirubin is < 1.5 × ULN.
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- Calculated creatinine clearance ≥ 40 mL/min (calculated by Cockcroft-Gault formula) for subjects with creatinine levels above institutional normal.
- Ejection > 40% by echocardiogram or multiple-gated acquisition (MUGA) scan.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2.
- Female subjects who:
- Are postmenopausal for at least one year before the screening visit, OR
- Are surgically sterile, OR
- If they are of childbearing potential:
- Agree to practice one highly effective method and one additional effective (barrier) method of contraception, at the same time, from the time of signing the informed consent through four months after the last dose of study drug (female and male condoms should not be used together), OR ii. Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods] withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception).
- Male subjects, even if surgically sterilized (i.e., status postvasectomy), who:
- Agree to practice effective barrier contraception during the entire study drug treatment period from the time of signing the informed consent through four months after the last dose of study drug (female and male condoms should not be used together), OR
- Agree to practice true abstinence, when this is in line with the preferred and usual lifestyle of the subject. (Periodic abstinence [e.g., calendar, ovulation, symptothermal, post-ovulation methods for the female partner] withdrawal, spermicides only, and lactational amenorrhea are not acceptable methods of contraception.)
Who cannot join
- Acute promyelocytic leukemia.
- Treatment with systemic antineoplastic therapy within 5 half-lives from the last dose before cycle one day one of therapy. Radiation within 7 days before C1D1 of therapy. The use of hydroxyurea, steroids, or vincristine for leukoreduction is permitted.
- Prior treatment with an anti-CD38 antibody in last 6 months.
- Hematopoietic stem cell transplantation within 6 months of enrollment, or evidence of veno-occlusive disease at any time post-transplant, or active graft-versus-host disease requiring immunosuppressive therapy.
- Any serious medical or psychiatric illness that could, in the Investigator's opinion, potentially interfere with the completion of study procedures.
- Active, significant, uncontrolled infection. Subjects with infections that are controlled by antibiotics, antiviral or antifungal therapy can be enrolled in the study.
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- Presence of another active malignancy (requiring treatment) treated within 12 months with the exception of:
- Adequately treated non-melanoma skin cancer,
- Adequately treated melanoma Grade 2 or less,
- Cervical intraepithelial neoplasia,
- Adequately treated in situ carcinoma of the cervix uteri or carcinoma in situ of breast,
- Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin,
- Adequately treated prostate cancer.
- Life-threatening illness with life expectancy < 6 months unrelated to cancer.
- Subjects with active central nervous system (CNS) disease. Subjects with adequately treated CNS disease may enroll on the study.
- Known hepatitis B surface antigen seropositive or known or suspected active hepatitis C infection. Note: Subjects who have isolated positive hepatitis B core antibody (i.e., in the setting of negative hepatitis B surface antigen and negative hepatitis B surface antibody) must have an undetectable hepatitis B viral load. Subjects who have positive hepatitis C antibody may be included if they have an undetectable hepatitis C viral load.
- Known cardiopulmonary disease defined as:
- Unstable angina,
- Congestive heart failure (New York Heart Association [NYHA] Class III or IV;
- Myocardial infarction (MI) within six months prior to enrollment (subjects who had ischemic heart disease such as acute coronary syndrome, MI, and/or revascularization > 6 months before Screening and who are without cardiac symptoms may enroll),
- Clinically significant pulmonary hypertension requiring pharmacologic therapy,
- Clinically significant arrhythmia:
- History of polymorphic ventricular fibrillation or torsade de pointes, ii. Uncontrolled permanent atrial fibrillation (A-Fib), defined as continuous A-Fib for ≥ 6 months and not well controlled with adequate A-Fib therapy, iii. Uncontrolled persistent A-Fib, defined as sustained A-Fib lasting > 7 days and/or requiring cardioversion in the four weeks before Screening and not well controlled with A-Fib therapy, iv. Grade 3 A-Fib defined as symptomatic and incompletely controlled medically, or controlled with device (e.g., pacemaker), or ablation, and v. Subjects with paroxysmal A-Fib or < Grade 3 A-Fib for a period of at least 6 months are permitted to enroll provided that their rate is controlled on a stable regimen.
- Subject has chronic respiratory disease that requires continuous oxygen, or significant history of renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, cardiovascular disease, gastrointestinal or any other medical condition that in the opinion of the Investigator would adversely affect his/her participating in this study.
- Uncontrolled high blood pressure as determined by the treating physician (i.e., systolic blood pressure > 180 mm Hg, diastolic blood pressure > 100 mm Hg).
- Subjects with uncontrolled coagulopathy or bleeding disorder.
- Known moderate-to-severe chronic obstructive pulmonary disease, interstitial lung disease, and pulmonary fibrosis.
- Major surgery within 14 days before the enrollment or a prescheduled major surgery during study period.
- Female subjects who are both lactating and breastfeeding or of childbearing potential who have a positive serum or urine test during Screening.
- Female subjects who intend to donate eggs (ova) during the course of this study or four months after receiving their last dose of study drug(s).
- Male subjects who intend to donate sperm during the course of this study or four months after receiving their last dose of study drug(s).
Trial locations and contacts
6 sites in 1 country.
6 sites in 1 country
United States6 sites
University of Chicago Medicine
Chicago, Illinois, 60637
Mayo Clinic
Jacksonville, Florida, 32224
Froedtert Hospital & the Medical College of Wisconsin
Milwaukee, Wisconsin, 53226
Mayo Clinic
Phoenix, Arizona, 85054
Oregon Health & Science University
Portland, Oregon, 97239
Moffitt Cancer Center
Tampa, Florida, 33612
About this study
Official title: MCW-XEN21: A Phase 1 Study of XmAb18968 (CD3-CD38) for the Treatment of Patients With Relapsed/Refractory CD38 Positive Acute Leukemia and T Cell Lymphoblastic Lymphoma
This is a phase 1, dose-escalation study (using 3 + 3 dose-limiting toxicity (DLT) criteria) evaluating the safety and tolerability of XmAb18968, as well as establishing a recommended phase II dose (RP2D) in subjects with T cell acute lymphoblastic leukemia (T-ALL) and T cell lymphoblastic (lymphoma) T-LBL (Group A) and acute myeloid leukemia (AML) (Group B).
Read the detailed description
The primary objective of this portion of the study is to determine a recommended phase II dose (RP2D) for XmAb18968. The trial will use a variation of the 3 + 3 design where both escalation and de-escalation are possible. There will be separate cohorts; Group A (T cell acute lymphoblastic leukemia, T cell lymphoblastic lymphoma) and Group B (acute myeloid leukemia). A minimum of 24 and a maximum of 60 subjects will be needed for the study.
The first dose on Cycle 1 Day 1 (C1D1) will be split into two doses to ensure the safety of subjects and to closely monitor for CRS. The dose will be split into C1D1 and Cycle 1 Day 2 (C1D2) with approximately 25% of the dose given on C1D1 and 75% of the dose given on C1D2. Thereafter, subjects will receive the full dose planned for that cohort.
Prior to enrolling subjects at the next applicable dose level, the Data Safety Monitoring Committee (DSMC) will review the results.
Although AEs may occur at any point during treatment, only AEs occurring during Cycle 1 of treatment will necessarily influence decisions regarding dose escalation, expansion of a dose level, or evaluation of intermediate dose levels. Subjects will be monitored through all cycles of therapy for treatment-related toxicities.
Toxicity will be evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. If multiple AEs are seen, the presence of a DLT will be based on the most severe AE experienced. The DLT will be based on the tolerability observed during the first 28 days (or up to 42 days for hematological DLTs) of treatment/observation.
DLT will be defined as any of the following events:
- Any grade 4 or higher non-hematological adverse reaction.
- Cytokine release syndrome (CRS) is a possible side effect that can occur as a result of administration of XmAb18968. For this protocol, any grade 3 or higher CRS adverse event (AE) (per revised CRS grading system will be considered a DLT except grade 3 CRS AE that resolves to grade 1 within seven days).
- Any subject meeting the criteria for Hy's Law case (i.e., severe drug-induced liver injury (DILI)). A Hy's Law case is defined as: aspartate aminotransferase (AST) or alanine transaminase (ALT) values ≥ 3 × upper limit of normal (ULN) AND with serum total bilirubin (TBIL) level > 2 × ULN or international normalized ratio (INR) > 1.5 without signs of cholestasis.
- Any non-Hy's Law grade 3 liver abnormality lasting more than 72 hours will be considered a DLT.
- Grade 3 electrolyte abnormalities - sodium (Na), potassium (K), chloride (Cl), carbon dioxide (CO2), calcium (Ca), magnesium (Mg), phosphate - that do not return to grade 1 or lower within 72 hours.
- Any grade 4 neurotoxicity will be considered a DLT. Grade 3 neurotoxicity that lasts more than 72 hours will be considered a DLT.
- Any grade 3 nausea, vomiting, or diarrhea that requires hospitalization, tube feeding or total parenteral nutrition.
- Any adverse reaction that leads to dose reduction or withdrawal.
- Grade 3 transaminitis (AST/ALT) elevation that does not return to grade 1 or lower within 72 hours.
- Any grade 3 infection lasting more than seven days in the absence of active leukemia.
- Any grade 3 bleeding with thrombocytopenia in the absence of active leukemia.
- Any grade 4 or higher neutropenia lasting past cycle day 42 in the absence of active leukemia.
- Conditions
- Acute Myeloid Leukemia, T Cell Acute Lymphoblastic Leukemia, T Cell Lymphoblastic Lymphoma
- Being tested
- XmAb18968 - Dose level -1, XmAb18968 - Dose level 0 (starting dose), XmAb18968 - Dose level 1, XmAb18968 - Dose level 2, XmAb18968 - Dose level 3
- Keywords
- XmAb18968
- Medical subject headings
- Leukemia, Myeloid, Acute, Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
XmAb18968 - Dose level -1Drug
0.1 mg IV C1D1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle.
XmAb18968 - Dose level 0 (starting dose)Drug
0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle.
XmAb18968 - Dose level 1Drug
0.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle.
XmAb18968 - Dose level 2Drug
0.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle.
XmAb18968 - Dose level 3Drug
0.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle.
| Study group | Role | What they receive |
|---|---|---|
| Arm Z: Dose Level -1 for Group A (T-ALL, T-LBL) | Experimental | 0.1 mg intravenous (IV) Cycle (C) 1 Day (D) 1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level -1 |
| Arm A: Dose Level 0 (Starting Dose) for Group A (T-ALL, T-LBL) | Experimental | 0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 0 (starting dose) |
| Arm B: Dose Level 1 for Group A (T-ALL, T-LBL) | Experimental | 0.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 1 |
| Arm C: Dose Level 2 Group A (T-ALL, T-LBL) | Experimental | 0.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 2 |
| Arm D: Dose Level 3 Group A (T-ALL, T-LBL) | Experimental | 0.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 3 |
| Arm Z: Dose Level -1 Group B (AML) | Experimental | 0.1 mg IV C1D1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level -1 |
| Arm A: Dose Level 0 (Starting Dose) Group B (AML) | Experimental | 0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 0 (starting dose) |
| Arm B: Dose Level 1 Group B (AML) | Experimental | 0.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 1 |
| Arm C: Dose Level 2 Group B (AML) | Experimental | 0.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 2 |
| Arm D: Dose Level 3 Group B (AML) | Experimental | 0.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle. Receives: Drug: XmAb18968 - Dose level 3 |
What is being measured
The primary outcome is the main question the study is designed to answer.
The number of dose-limiting toxicities for group A level -1
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group A level 0
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group A level 1
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group A level 2
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group A level 3
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group B level -1
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group B level 0
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group B level 1
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group B level 2
See DLT definitions in the detailed study description.
Measured: 4 Years
The number of dose-limiting toxicities for group B level 3
See DLT definitions in the detailed study description.
Measured: 4 Years
Recommended Phase 2 Dose for Group A
This dose will be dependent on the number of dose-limiting toxicities reported in primary outcomes 1-5.
Measured: 4 Years
Recommended Phase 2 Dose for Group B
This dose will be dependent on the number of dose-limiting toxicities reported in primary outcomes 6-10.
Measured: 4 Years
Secondary outcomes (23)
The number of subjects with complete response in group A level -1.
This is defined as no circulating lymphoblasts or extramedullary disease (no lymphadenopathy, splenomegaly). Testicular mass, skin/gum infiltration, CNS involvement; trilineage hematopoiesis with < 5% blasts; ANC > 1.0 × 10^9/L (1,000/μL); Platelet count > 100 × 10^9/L (100,000/μL); No recurrence for four weeks.
Measured: 4 Years
The number of subjects with complete response in group B level -1.
This is defined as bone marrow blasts < 5%; absence of blasts with Auer rods; absence of extramedullary disease; ANC > 1.0 × 10^9/L (1,000/μL); platelet count > 100 × 10^9/L (100,000/μL); independence of red cell transfusions.
Measured: 4 Years
The number of subjects with complete response in group A level 0.
This is defined as no circulating lymphoblasts or extramedullary disease (no lymphadenopathy, splenomegaly). Testicular mass, skin/gum infiltration, CNS involvement; trilineage hematopoiesis with < 5% blasts; ANC > 1.0 × 10^9/L (1,000/μL); Platelet count > 100 × 10^9/L (100,000/μL); No recurrence for four weeks.
Measured: 4 Years
The number of subjects with complete response in group B level 0.
This is defined as bone marrow blasts < 5%; absence of blasts with Auer rods; absence of extramedullary disease; ANC > 1.0 × 10^9/L (1,000/μL); platelet count > 100 × 10^9/L (100,000/μL); independence of red cell transfusions.
Measured: 4 Years
The number of subjects with complete response in group A level 1.
This is defined as no circulating lymphoblasts or extramedullary disease (no lymphadenopathy, splenomegaly). Testicular mass, skin/gum infiltration, CNS involvement; trilineage hematopoiesis with < 5% blasts; ANC > 1.0 × 10^9/L (1,000/μL); Platelet count > 100 × 10^9/L (100,000/μL); No recurrence for four weeks.
Measured: 4 Years
The number of subjects with complete response in group B level 1.
This is defined as bone marrow blasts < 5%; absence of blasts with Auer rods; absence of extramedullary disease; ANC > 1.0 × 10^9/L (1,000/μL); platelet count > 100 × 10^9/L (100,000/μL); independence of red cell transfusions.
Measured: 4 Years
The number of subjects with complete response in group A level 2.
This is defined as no circulating lymphoblasts or extramedullary disease (no lymphadenopathy, splenomegaly). Testicular mass, skin/gum infiltration, CNS involvement; trilineage hematopoiesis with < 5% blasts; ANC > 1.0 × 10^9/L (1,000/μL); Platelet count > 100 × 10^9/L (100,000/μL); No recurrence for four weeks.
Measured: 4 Years
The number of subjects with complete response in group B level 2.
This is defined as bone marrow blasts < 5%; absence of blasts with Auer rods; absence of extramedullary disease; ANC > 1.0 × 10^9/L (1,000/μL); platelet count > 100 × 10^9/L (100,000/μL); independence of red cell transfusions.
Measured: 4 Years
The number of subjects with complete response in group A level 3.
This is defined as no circulating lymphoblasts or extramedullary disease (no lymphadenopathy, splenomegaly). Testicular mass, skin/gum infiltration, CNS involvement; trilineage hematopoiesis with < 5% blasts; ANC > 1.0 × 10^9/L (1,000/μL); Platelet count > 100 × 10^9/L (100,000/μL); No recurrence for four weeks.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level -1.
Meets all criteria for CR except absolute neutrophil count (ANC) or platelet count.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level -1.
All complete response (CR criteria) except for residual neutropenia (< 1.0 × 10^9/L [1,000/μL]) or thrombocytopenia (< 100 × 10^9/L [100,000/μL]).
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 0 (starting dose).
Meets all criteria for CR except absolute neutrophil count (ANC) or platelet count.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 0 (starting dose).
All complete response (CR criteria) except for residual neutropenia (< 1.0 × 109/L [1,000/μL]) or thrombocytopenia (< 100 × 109/L [100,000/μL]).
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 1.
Meets all criteria for CR except absolute neutrophil count (ANC) or platelet count.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 1.
All complete response (CR criteria) except for residual neutropenia (< 1.0 × 109/L [1,000/μL]) or thrombocytopenia (< 100 × 109/L [100,000/μL]).
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 2.
Meets all criteria for CR except absolute neutrophil count (ANC) or platelet count.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 2.
All CR criteria except for residual neutropenia (< 1.0 × 109/L [1,000/μL]) or thrombocytopenia (< 100 × 109/L [100,000/μL]).
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 3.
Meets all criteria for CR except ANC or platelet count.
Measured: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 3.
All complete response (CR criteria) except for residual neutropenia (< 1.0 × 109/L [1,000/μL]) or thrombocytopenia (< 100 × 109/L [100,000/μL]).
Measured: 4 Years
Event-free survival (EFS) in group A
EFS will be defined from the time of achievement of CR/CRi to the time of next relapse/progression/death as measured by the National Comprehensive Cancer Network (NCCN) Response Criteria for Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma.
Measured: 4 Years
Event-free survival (EFS) in group B
EFS will be will be defined from the time of achievement of CR/CRi to the time of next relapse/progression/death as measured by the Response Evaluation Criteria: Acute Myeloid Leukemia.
Measured: 4 Years
Overall survival in group A
The length of time from when a subject begins treatment until death due to any cause.
Measured: 4 Years
Overall survival in group B.
The length of time from when a subject begins treatment until death due to any cause.
Measured: 4 Years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted9 Sep 2021
- Study start2 Feb 2022
- Primary completion24 Apr 2024
- Study completion18 Nov 2024
Why it stopped: Drug expired May 31, 2024.
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Acute Myeloid LeukemiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 1
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Enrolment
- 22 participants (actual)
Sponsor and investigators
- Lead sponsor
- Ehab L Atallah
- Sponsor type
- University, hospital or other
- Responsible party
- Sponsor-investigator, Ehab L Atallah, Medical College of Wisconsin
- Investigators
- Ehab Atallah, MD, Principal investigator, Medical College of Wisconsin
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05038644
- Sponsor's protocol ID
- PRO00041908
- Status last verified
- May 2025
- First submitted
- 3 Sep 2021
- Last updated
- 8 May 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Guru Murthy GS, Shah B, Badar T, Leonard J, DuVall A, Arana Yi C, Szabo A, Baim A, Harrington A, Runaas L, Carlson K, Michaelis L, Abedin S, Kearl T, Atallah E. Targeting CD38 with bispecific antibody XmAb 18968 in patients with relapsed/refractory acute myeloid leukemia and T-cell acute lymphoblastic leukemia. Leukemia. 2026 Sep 14. doi: 10.1038/s41375-026-03130-x. Online ahead of print.
PubMed 42736326
Study at a glance
From the registry record, last updated by the sponsor on 8 May 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- MCW-XEN21: A Phase 1 Study of XmAb18968 (CD3-CD38) for the Treatment of Patients With Relapsed/Refractory CD38 Positive Acute Leukemia and T Cell Lymphoblastic Lymphoma
- ClinicalTrials.gov ID
- NCT05038644
- Acronym / sponsor ID
- PRO00041908
- Conditions
- Acute Myeloid Leukemia, T Cell Acute Lymphoblastic Leukemia, T Cell Lymphoblastic Lymphoma
- Keywords
- XmAb18968
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- TerminatedReason stopped: Drug expired May 31, 2024.
- Enrolment
- 22 participants (actual)
- Lead sponsor
- Ehab L AtallahUniversity, hospital or other
- Study start
- 2 Feb 2022 (actual)
- Primary completion
- 24 Apr 2024 (actual)
- Study completion
- 18 Nov 2024 (actual)
- First posted
- 9 Sep 2021 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This is a phase 1, dose-escalation study (using 3 + 3 dose-limiting toxicity (DLT) criteria) evaluating the safety and tolerability of XmAb18968, as well as establishing a recommended phase II dose (RP2D) in subjects with T cell acute lymphoblastic leukemia (T-ALL) and T cell lymphoblastic (lymphoma) T-LBL (Group A) and acute myeloid leukemia (AML) (Group B).
Detailed description
The primary objective of this portion of the study is to determine a recommended phase II dose (RP2D) for XmAb18968. The trial will use a variation of the 3 + 3 design where both escalation and de-escalation are possible. There will be separate cohorts; Group A (T cell acute lymphoblastic leukemia, T cell lymphoblastic lymphoma) and Group B (acute myeloid leukemia). A minimum of 24 and a maximum of 60 subjects will be needed for the study.
The first dose on Cycle 1 Day 1 (C1D1) will be split into two doses to ensure the safety of subjects and to closely monitor for CRS. The dose will be split into C1D1 and Cycle 1 Day 2 (C1D2) with approximately 25% of the dose given on C1D1 and 75% of the dose given on C1D2. Thereafter, subjects will receive the full dose planned for that cohort.
Prior to enrolling subjects at the next applicable dose level, the Data Safety Monitoring Committee (DSMC) will review the results.
Although AEs may occur at any point during treatment, only AEs occurring during Cycle 1 of treatment will necessarily influence decisions regarding dose escalation, expansion of a dose level, or evaluation of intermediate dose levels. Subjects will be monitored through all cycles of therapy for treatment-related toxicities.
Toxicity will be evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. If multiple AEs are seen, the presence of a DLT will be based on the most severe AE experienced. The DLT will be based on the tolerability observed during the first 28 days (or up to 42 days for hematological DLTs) of treatment/observation.
DLT will be defined as any of the following events:
- Any grade 4 or higher non-hematological adverse reaction.
- Cytokine release syndrome (CRS) is a possible side effect that can occur as a result of administration of XmAb18968. For this protocol, any grade 3 or higher CRS adverse event (AE) (per revised CRS grading system will be considered a DLT except grade 3 CRS AE that resolves to grade 1 within seven days).
- Any subject meeting the criteria for Hy's Law case (i.e., severe drug-induced liver injury (DILI)). A Hy's Law case is defined as: aspartate aminotransferase (AST) or alanine transaminase (ALT) values ≥ 3 × upper limit of normal (ULN) AND with serum total bilirubin (TBIL) level > 2 × ULN or international normalized ratio (INR) > 1.5 without signs of cholestasis.
- Any non-Hy's Law grade 3 liver abnormality lasting more than 72 hours will be considered a DLT.
- Grade 3 electrolyte abnormalities - sodium (Na), potassium (K), chloride (Cl), carbon dioxide (CO2), calcium (Ca), magnesium (Mg), phosphate - that do not return to grade 1 or lower within 72 hours.
- Any grade 4 neurotoxicity will be considered a DLT. Grade 3 neurotoxicity that lasts more than 72 hours will be considered a DLT.
- Any grade 3 nausea, vomiting, or diarrhea that requires hospitalization, tube feeding or total parenteral nutrition.
- Any adverse reaction that leads to dose reduction or withdrawal.
- Grade 3 transaminitis (AST/ALT) elevation that does not return to grade 1 or lower within 72 hours.
- Any grade 3 infection lasting more than seven days in the absence of active leukemia.
- Any grade 3 bleeding with thrombocytopenia in the absence of active leukemia.
- Any grade 4 or higher neutropenia lasting past cycle day 42 in the absence of active leukemia.
Study design
- Primary purpose
- Treatment
- Allocation
- Non-randomised
- Intervention model
- Sequential
- Masking
- None (open label)
- Number of arms
- 10
| Arm | Type | Receives |
|---|---|---|
| Arm Z: Dose Level -1 for Group A (T-ALL, T-LBL) | Experimental | Drug: XmAb18968 - Dose level -10.1 mg intravenous (IV) Cycle (C) 1 Day (D) 1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm A: Dose Level 0 (Starting Dose) for Group A (T-ALL, T-LBL) | Experimental | Drug: XmAb18968 - Dose level 0 (starting dose)0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm B: Dose Level 1 for Group A (T-ALL, T-LBL) | Experimental | Drug: XmAb18968 - Dose level 10.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm C: Dose Level 2 Group A (T-ALL, T-LBL) | Experimental | Drug: XmAb18968 - Dose level 20.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm D: Dose Level 3 Group A (T-ALL, T-LBL) | Experimental | Drug: XmAb18968 - Dose level 30.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm Z: Dose Level -1 Group B (AML) | Experimental | Drug: XmAb18968 - Dose level -10.1 mg IV C1D1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm A: Dose Level 0 (Starting Dose) Group B (AML) | Experimental | Drug: XmAb18968 - Dose level 0 (starting dose)0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm B: Dose Level 1 Group B (AML) | Experimental | Drug: XmAb18968 - Dose level 10.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm C: Dose Level 2 Group B (AML) | Experimental | Drug: XmAb18968 - Dose level 20.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle. |
| Arm D: Dose Level 3 Group B (AML) | Experimental | Drug: XmAb18968 - Dose level 30.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (17 listed)
- Voluntary written consent must be given before performance of any study-related procedure not part of standard medical care.
- Male or female subjects 18 years or older.
- Morphologically documented T-ALL, AML (including undifferentiated leukemia and bi-phenotypic leukemia, or T-LBL in relapsed/refractory status (at least one line of prior therapy). Subjects with measurable residual disease by flow cytometry, molecular testing or cytogenetics will be eligible for the trial.
- CD38 expression ≥ 20% by flow cytometry or immunohistochemistry at time of relapse.
- Adequate organ system function as outlined below:
Key exclusion criteria (31 listed)
- Acute promyelocytic leukemia.
- Treatment with systemic antineoplastic therapy within 5 half-lives from the last dose before cycle one day one of therapy. Radiation within 7 days before C1D1 of therapy. The use of hydroxyurea, steroids, or vincristine for leukoreduction is permitted.
- Prior treatment with an anti-CD38 antibody in last 6 months.
- Hematopoietic stem cell transplantation within 6 months of enrollment, or evidence of veno-occlusive disease at any time post-transplant, or active graft-versus-host disease requiring immunosuppressive therapy.
- Any serious medical or psychiatric illness that could, in the Investigator's opinion, potentially interfere with the completion of study procedures.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| XmAb18968 - Dose level -10.1 mg IV C1D1, 0.3 mg IV C1D2, then 0.4 mg IV on D8, D15, and D22 in a 28-day cycle. | Drug | Arm Z: Dose Level -1 Group B (AML), Arm Z: Dose Level -1 for Group A (T-ALL, T-LBL) |
| XmAb18968 - Dose level 0 (starting dose)0.2 mg IV C1D1, 0.6 mg IV C1D2, then 0.8 mg IV on D8, D15, and D22 in a 28-day cycle. | Drug | Arm A: Dose Level 0 (Starting Dose) Group B (AML), Arm A: Dose Level 0 (Starting Dose) for Group A (T-ALL, T-LBL) |
| XmAb18968 - Dose level 10.25 mg IV C1D1, 0.75 mg IV C1D2, then 1.0 mg IV on D8, D15, and D22 in a 28-day cycle. | Drug | Arm B: Dose Level 1 Group B (AML), Arm B: Dose Level 1 for Group A (T-ALL, T-LBL) |
| XmAb18968 - Dose level 20.4 mg IV C1D1, 0.9 mg IV C1D2, then 1.3 mg IV on D8, D15, and D22 in a 28-day cycle. | Drug | Arm C: Dose Level 2 Group A (T-ALL, T-LBL), Arm C: Dose Level 2 Group B (AML) |
| XmAb18968 - Dose level 30.5 mg IV C1D1, 1.0 mg IV C1D2, then 1.5 mg IV on D8, D15, and D22 in a 28-day cycle. | Drug | Arm D: Dose Level 3 Group A (T-ALL, T-LBL), Arm D: Dose Level 3 Group B (AML) |
Primary outcome
The number of dose-limiting toxicities for group A level -1
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group A level 0
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group A level 1
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group A level 2
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group A level 3
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group B level -1
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group B level 0
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group B level 1
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group B level 2
Time frame: 4 Years
See DLT definitions in the detailed study description.
The number of dose-limiting toxicities for group B level 3
Time frame: 4 Years
See DLT definitions in the detailed study description.
Recommended Phase 2 Dose for Group A
Time frame: 4 Years
This dose will be dependent on the number of dose-limiting toxicities reported in primary outcomes 1-5.
Recommended Phase 2 Dose for Group B
Time frame: 4 Years
This dose will be dependent on the number of dose-limiting toxicities reported in primary outcomes 6-10.
23 secondary outcomes
The number of subjects with complete response in group A level -1.
Time frame: 4 Years
The number of subjects with complete response in group B level -1.
Time frame: 4 Years
The number of subjects with complete response in group A level 0.
Time frame: 4 Years
The number of subjects with complete response in group B level 0.
Time frame: 4 Years
The number of subjects with complete response in group A level 1.
Time frame: 4 Years
The number of subjects with complete response in group B level 1.
Time frame: 4 Years
The number of subjects with complete response in group A level 2.
Time frame: 4 Years
The number of subjects with complete response in group B level 2.
Time frame: 4 Years
The number of subjects with complete response in group A level 3.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level -1.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level -1.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 0 (starting dose).
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 0 (starting dose).
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 1.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 1.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 2.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 2.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group A level 3.
Time frame: 4 Years
The number of subjects with complete response with incomplete hematological recovery in group B level 3.
Time frame: 4 Years
Event-free survival (EFS) in group A
Time frame: 4 Years
Event-free survival (EFS) in group B
Time frame: 4 Years
Overall survival in group A
Time frame: 4 Years
Overall survival in group B.
Time frame: 4 Years
Results and safety
The study was stopped early (reason given: Drug expired May 31, 2024.). Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 8 May 2025.
- Derived from this study: PubMed 42736326Guru Murthy GS, Shah B, Badar T, Leonard J, DuVall A, Arana Yi C, Szabo A, Baim A, Harrington A, Runaas L, Carlson K, Michaelis L, Abedin S, Kearl T, Atallah E. Targeting CD38 with bispecific antibody XmAb 18968 in patients with relapsed/refractory acute myeloid leukemia and T-cell acute lymphoblastic leukemia. Leukemia. 2026 Sep 14. doi: 10.1038/s41375-026-03130-x. Online ahead of print.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Ehab Atallah, MD principal investigator
Medical College of Wisconsin
6 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing XmAb18968 - Dose level -1, XmAb18968 - Dose level 0 (starting dose) and XmAb18968 - Dose level 1 in people with Acute Myeloid Leukemia and T Cell Acute Lymphoblastic Leukemia, run by Ehab L Atallah at 6 sites in United States.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 17 inclusion and 31 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: stopped early, as of the sponsor's last update on 8 May 2025. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 6 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 1 studies test a treatment in a small group of people for the first time or in a new way, mainly to check safety and find the right dose.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study was stopped early (reason given: Drug expired May 31, 2024.). Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
The number of dose-limiting toxicities for group A level -1 (time frame: 4 Years). The study lists 12 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05038644, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 May 2025.