Recurrent Acute Myeloid LeukemiaPhase 1NCT06572631
Multi-antigen Specific CD8+ T Cells With Decitabine and Lymphodepleting Chemotherapy for the Treatment of Patients With Relapsed or Refractory AML or MDS Following an Allogeneic Hematopoietic Cell Transplantation From a Matched Donor
A Phase 1 study testing Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001, Biospecimen Collection and Bone Marrow Aspiration in people with Recurrent Acute Myeloid Leukemia and Recurrent Myelodysplastic Syndrome, run by City of Hope Medical Center.
Trial summary
This phase I trial tests the safety, side effects and best dose of NEXI-001 when given with decitabine and lymphodepleting chemotherapy in treating patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) that has come back after a period of improvement (relapsed) or that has not responded to… Read more about this study
- Who is it for?
- Ages 18 years and olderHealthy volunteers can take part
- Conditions the study is for
- Recurrent Acute Myeloid Leukemia, Recurrent Myelodysplastic Syndrome, Refractory Acute Myeloid Leukemia
- What is being tested?
- Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001, Biospecimen Collection and Bone Marrow Aspiration
- Type of treatment
- Injection or infusion, Surgery or procedure
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 0 participants
- Where
- No sites listed yet
- Study dates
- 7 Jun 2025to 12 Dec 2026
- 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
- Healthy volunteers accepted
- Adult, Older adult
Who may be able to join
- PARTICIPANT: Documented informed consent of the participant and/or legally authorized representative and documented informed consent of the donor
- PARTICIPANT: Agreement to allow the use of archival tissue from diagnostic tumor biopsies (if unavailable, exceptions may be granted with study principal investigator [PI] approval)
- PARTICIPANT: Age: ≥ 18 years
- PARTICIPANT: Eastern Cooperative Oncology Group (ECOG) ≤ 1 or Karnofsky performance score (KPS) ≥ 70
- PARTICIPANT: Confirmed diagnosis of AML/MDS that has relapsed after or is refractory to an allogeneic hematopoietic cell transplantation (HCT) from a matched donor.
- Refractory - failure to achieve a complete response minimal residual disease (CRMRD) (-) by multicolor flow cytometry (MFC) or reverse transcription polymerase chain reaction (RT qPCR)
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- Relapse - detection of clonal abnormal myeloid blasts by morphology (morphologic relapse) or by MFC, or RT-qPCR analysis (MRD[+] relapse) after achieving a CRMRD(-) induced by an allogeneic HCT or maintained by allogeneic HCT administered as consolidation therapy.
- Note: Patients who meet the protocol definition of relapse/refractory (r/r) AML/MDS at screening and subsequently achieve a CRMRD(-) response status following protocol-specified bridging therapy will remain eligible to continue participation in this study
- PARTICIPANT: At least 100 days post allogeneic HCT
- PARTICIPANT: Donor match at 8 out of 8 loci for human leucocyte antigen (HLA) -A, -B, -C, and -DRB1 (each typed at high resolution by deoxyribonucleic acid [DNA]-based methods)
- PARTICIPANT: Expression of HLA-A*0201 as determined by high resolution sequence-based typing methods
- PARTICIPANT: Total bilirubin ≤ 1.5 X upper limit of normal (ULN) (unless has Gilbert's disease) (to be performed within 28 days of consenting)
- PARTICIPANT: Aspartate aminotransferase (AST) ≤ 2.5 x ULN (to be performed within 28 days of consenting)
- PARTICIPANT: Alanine aminotransferase (ALT) ≤ 2.5 x ULN (to be performed within 28 days of consenting)
- PARTICIPANT: Serum creatinine < 1.5 mg/dL or creatinine clearance of ≥ 60 mL/min per 24 hour urine test or the Cockcroft-Gault formula (to be performed within 28 days of consenting)
- PARTICIPANT: Left ventricular ejection fraction (LVEF) ≥ 50% Note: To be performed before the first dose of lymphodepletion chemotherapy
- PARTICIPANT: If able to perform pulmonary function tests: Forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and diffuse lung capacity for carbon monoxide (DLCO) (diffusion capacity) ≥ 50% of predicted (corrected for hemoglobin) (to be performed within 28 days of consenting)
- PARTICIPANT: If unable to perform pulmonary function tests: Oxygen (O2) saturation > 92% on room air (to be performed within 28 days of consenting)
- PARTICIPANT: Seronegative for HIV antigen/antibody (Ag/Ab) combo, hepatitis C virus (HCV), active hepatitis B virus (HBV) (surface antigen negative), and syphilis (rapid plasma reagin [RPR]) (to be performed within 28 days of consenting)
- If positive, hepatitis C ribonucleic acid (RNA) quantitation must be performed. OR
- If seropositive for HIV, HCV or HBV, nucleic acid quantitation must be performed. Viral load must be undetectable
- PARTICIPANT: Women of childbearing potential (WOCBP): Negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required (to be performed within 28 days of consenting)
- PARTICIPANT: Agreement by females and males of childbearing potential to use an effective method of birth control or abstain from heterosexual activity for the course of the study through at least 3 months after the completion of the last cycle of protocol therapy.
- Childbearing potential defined as not being surgically sterilized (men and women) or have not been free from menses for > 1 year (women only)
- DONOR: The identified donor must be the donor whose stem cells were used for the research participant's allo HCT
- DONOR: The donor's hematocrit value is ≥ 35%
- DONOR: The donor's platelet count is > 100,000 per microliter
- CRITERIA TO PROCEED TO START OF CYCLE 1: NEXI-001 product is released from manufacturing with a certificate of analysis (COA)
- CRITERIA TO PROCEED TO START OF CYCLE 1: Bone marrow aspirate and bone marrow biopsy within one week prior to treatment for baseline disease status (all disease statuses are eligible to proceed) and correlative studies
- CRITERIA TO PROCEED TO START OF CYCLE 1: T-cell chimerism ≥ 50% to donor by polymerase chain reaction (PCR) analysis
- CRITERIA TO PROCEED TO START OF CYCLE 1: Fully recovered to ≤ grade 1 from non-hematologic acute toxic effects (except alopecia) from prior anti-cancer therapy
- CRITERIA TO PROCEED TO START OF CYCLE 1: Total bilirubin ≤ 1.5 X ULN (unless has Gilbert's disease) (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: AST =< 2.5 x ULN (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: ALT =< 2.5 x ULN (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: Serum creatinine < 1.5 mg/dL or creatinine clearance of ≥ 60 mL/min per 24 hour urine test or the Cockcroft-Gault formula (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: If not receiving anticoagulants: International normalized ratio (INR) OR prothrombin (PT) ≤ 1.5 x ULN. If on anticoagulant therapy: PT must be within therapeutic range of intended use of anticoagulants (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: If not receiving anticoagulants: Activated partial thromboplastin Time (aPTT) ≤ 1.5 x ULN. If on anticoagulant therapy: aPTT must be within therapeutic range of intended use of anticoagulants (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: Left ventricular ejection fraction (LVEF) ≥ 50% (to be performed within 2 days prior to start of cycle therapy)
- Note: To be performed before the first dose of LD chemotherapy
- CRITERIA TO PROCEED TO START OF CYCLE 1: Corrected QT (QTc) ≤ 480 ms (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: O2 saturation > 92% on room air (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: Women of childbearing potential (WOCBP): Negative urine or serum pregnancy test. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required (to be performed within 2 days prior to start of cycle therapy)
- CRITERIA TO PROCEED TO START OF CYCLE 1: Investigational drugs or devices within 30 days prior to start of cycle 1 therapy
- NEXI-001 INCLUSION CRITERIA: Total bilirubin ≤ 2.5 X ULN (unless has Gilbert's disease) (to be performed within 1 days prior to NEXI-001 infusion)
- NEXI-001 INCLUSION CRITERIA: AST =< 3 x ULN (to be performed within 1 days prior to NEXI-001 infusion)
- NEXI-001 INCLUSION CRITERIA: Serum creatinine < 2 mg/dL (to be performed within 1 days prior to NEXI-001 infusion)
- NEXI-001 INCLUSION CRITERIA: O2 saturation > 92% on room air (to be performed within 1 days prior to NEXI-001 infusion)
- CRITERIA TO PROCEED TO CYCLE 2: Patient has achieved a response of at least stable disease
- CRITERIA TO PROCEED TO CYCLE 2: ANC must be at least 1,000/uL and platelets at least 50,000/uL to begin decitabine
- CRITERIA TO PROCEED TO CYCLE 2: Patient has not experienced a ≥ grade 3 NEXI-001-related nonhematological AE that did not resolve to ≤ grade 2 within 72 hours
Who cannot join
- PARTICIPANT: Patients who have had 2 prior allogeneic (allo) HCTs
- PARTICIPANT: Patients who have received more than 3 anti-leukemic treatments regimens since their allo HCT
- PARTICIPANT: Vaccination with a live virus within six months prior to study treatment.
- Inactivated influenza vaccination is allowed
- PARTICIPANT: Active acute or chronic GVHD
- PARTICIPANT: Known hypersensitivity to any component of the NEXI-001 T-cell product or fludarabine, cyclophosphamide, decitabine, or tocilizumab
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- PARTICIPANT: Clinically significant uncontrolled illness
- PARTICIPANT: A second primary malignancy that has not been in remission for > 2 years. Exceptions include the following resected lesions:
- Non-melanoma skin cancer.
- Carcinoma in situ.
- Squamous intraepithelial lesions on Pap smear.
- Localized prostate cancer (Gleason score < 6).
- Melanoma in situ
- PARTICIPANT: Females only: Pregnant or breastfeeding
- PARTICIPANT: Clinically significant cardiovascular disease:
- Myocardial infarction or unstable angina within 6 months prior to the start of lymphodepleting (LD) chemotherapy.
- Cerebral vascular accident or a transient ischemic attack within 6 months prior to the start of LD chemotherapy.
- Clinically significant cardiac arrhythmia
- Uncontrolled hypertension
- Congestive heart failure (New York Heart Association Class III or IV)
- Pericarditis or clinically significant pericardial effusion
- Myocarditis
- PARTICIPANT: History of autoimmune disease resulting in end organ injury or requiring systemic immunosuppression or systemic disease modifying therapy within 2 years prior to enrollment.
- Patients with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone remain eligible.
- Patients with controlled type 1 diabetes mellitus on a stable insulin regimen remain eligible
- PARTICIPANT: Major trauma or major surgery within 4 weeks of enrollment
- PARTICIPANT: Dementia or altered mental status that precludes understanding the informed consent form
- PARTICIPANT: History of seizures or other chronic clinically significant neurologic disorders.
- Patients with well-controlled seizures on anti-seizure medication without a seizure episode for ≥ 6 months remain eligible
- PARTICIPANT: Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- PARTICIPANT: Prospective participants who, in the opinion of the investigator, may not be able to comply with all study procedures (including compliance issues related to feasibility/logistics)
- DONOR: The donor is pregnant or breastfeeding at the time of requested donation
- DONOR: The donor had granulocyte colony stimulating factor (G-CSF) administered within one month, prior to leukapheresis
- DONOR: The donor has an active bacterial or fungal infection, which is currently not responding to antimicrobial treatment
- CRITERIA TO PROCEED TO START OF CYCLE 1: Other anti-leukemic (bridging) therapies within 14 days of start of cycle 1 therapy
- CRITERIA TO PROCEED TO START OF CYCLE 1: Patients receiving systemic corticosteroid (> 20 mg/day prednisone equivalent) or any other immunosuppressant agents at the time of initiation of LD chemotherapy. Intermittent topical, inhaled, or intranasal corticosteroids are allowed
- CRITERIA TO PROCEED TO START OF CYCLE 1: Active acute or chronic GVHD (Note: must have resolved by the time of initiation of cycle 1 of therapy
- CRITERIA TO PROCEED TO START OF CYCLE 1: Active or uncontrolled infection requiring antibiotics by the time LD chemotherapy is scheduled. Prophylactic and ongoing therapy for prior controlled infection is allowed
- CRITERIA TO PROCEED TO START OF CYCLE 1: Females only: Pregnant or breastfeeding
- CRITERIA TO PROCEED TO START OF CYCLE 1: Clinically significant cardiovascular disease:
- Myocardial infarction or unstable angina within 6 months prior to the start of LD chemotherapy
- Cerebral vascular accident or a transient ischemic attack within 6 months prior to the start of LD chemotherapy
- Clinically significant cardiac arrhythmia
- Uncontrolled hypertension
- Congestive heart failure (New York Heart Association Class III or IV)
- Pericarditis or clinically significant pericardial effusion
- Myocarditis
- History of seizures or other chronic clinically significant neurologic disorders. Patients with well-controlled seizures on anti-seizure medication without a seizure episode for ≥ 6 months remain eligible
- CRITERIA TO PROCEED TO START OF CYCLE 1: Any other condition that would, in the Investigator's judgment, contraindicate the patient's participation in the clinical study due to safety concerns with clinical study procedures
- NEXI-001 EXCLUSION CRITERIA: Patient has no evidence of NEXI-001-related nonhematological adverse events (AEs), e.g. cytokine release syndrome (CRS), immune effector cell-associated neurotoxicity syndrome (ICANS), hemophagocytic lymphohistiocytosis (HLH)/macrophage activation syndrome (MAS)
- NEXI-001 EXCLUSION CRITERIA: Patient has not developed any of the exclusion criteria for treatment
- CRITERIA TO PROCEED TO CYCLE 2: Patient has not developed any of the exclusion criteria for treatment
About this study
Official title: Phase 1b Expansion Study of Multi-Antigen Specific CD8+ T Cells After Decitabine-enhanced Lymphodepletion: An Adoptive Cellular Therapy for Patients With Relapsed or Refractory AML or MDS Following an Allogeneic Hematopoietic Cell Transplantation From Matched HLA Donors
This phase I trial tests the safety, side effects and best dose of NEXI-001 when given with decitabine and lymphodepleting chemotherapy in treating patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory) following an allogeneic hematopoietic cell transplantation from a matched donor. NEXI-001 is a type of chimeric antigen receptor T cell therapy in which a patient's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells. T cells are taken from a patient's blood. Then the gene for a special receptor that binds to a certain protein on the patient's cancer cells is added to the T cells in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion for treatment of certain cancers. Decitabine is in a class of medications called hypomethylation agents. It works by helping the bone marrow produce normal blood cells and by killing abnormal cells in the bone marrow. Lymphodepleting chemotherapy, with fludarabine and cyclophosphamide, helps kill cancer cells in the body and helps prepare the body for the new CAR-T cells. Giving NEXI-001 with decitabine and lymphodepleting chemotherapy may be safe and tolerable in treating patients with relapsed or refractory AML or MDS following an allogeneic hematopoietic cell transplantation from a matched donor.
Read the detailed description
PRIMARY OBJECTIVES:
- Characterize the safety of allogeneic CD8+ leukemia-associated antigens specific T cells NEXI-001 (NEXI-001) combined with decitabine.
II. Determine the recommended phase 2 dose (RP2D) for NEXI-001 T cells combined with decitabine.
SECONDARY OBJECTIVES:
- Investigate the preliminary anti-leukemic activity of NEXI-001 T cells combined with decitabine based on:
Ia. Complete response (CR) rate; Ib. Overall response rate (ORR); Ic. Median duration of response; Id. 1-year overall survival (OS); Ie. 1-year progression-free survival (PFS). II. Cumulative incidence of acute graft-versus-host disease (aGVHD) of grades 2-4 and 3-4 at day 100 post first infusion of NEXI-001.
III. Cumulative incidence of chronic graft-versus-host disease (cGVHD) of all grades at 1 year post first infusion of NEXI-001.
IV. Characterize the T cells in the NEXI-001 product by immunophenotype and tumor antigen specificity.
- Characterize NEXI-001 T cells in peripheral blood (PB) and bone marrow (BM) by immunophenotype and tumor antigen specificity.
VI. Expansion and persistence of NEXI-001 T cells in PB and BM.
EXPLORATORY OBJECTIVES:
- Evaluate the effect of the following factors on the safety and efficacy of NEXI-001 T cells combined with decitabine:
Ia. NEXI-001 T-cell immunophenotype; Ib. Persistence of NEXI-001 T cells in PB and BM; Ic. Blood levels of the antigen-specific NEXI-001 T cells; Id. Biomarkers of activation, proliferation, and exhaustion of T cells; Ie. The expression of tumor associated antigen (TAAs) and checkpoint molecules on AML blasts.
OUTLINE: This is a dose-escalation study of decitabine in combination with NEXI-001, fludarabine and cyclophosphamide.
DONOR: Donors undergo leukapheresis on study.
PATIENTS: Patients may receive bridging therapy per standard of care ≥ 14 days prior to the start of cycle 1. Patients receive decitabine intravenously (IV) over 1 hour once per day (QD) on day -3, -5 or -10 to day -1, lymphodepletion chemotherapy with fludarabine IV over 30 minutes QD and cyclophosphamide IV over 60 minutes QD on day -5 to -3 and then receive NEXI-001 IV over 30 minutes QD on days 1, 8 and 15 of cycle 1. Cycles repeat every 33 or 38 days in the absence of disease progression or unacceptable toxicity. If NEXI-001 cells remain and treatment criteria are met, patients may receive and additional cycle of decitabine IV over 1 hour QD on day -5 to -1 and NEXI-001 IV QD on days 1, 8 and 15 in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO) during screening, bone marrow aspirate and/or bone marrow biopsy, positron emission tomography (PET)/computed tomography (CT) scan or magnetic resonance imaging (MRI) and blood sample collection throughout the study.
After completion of study treatment, patients are followed up within 30 days and every 3 months for up to 1 year.
- Conditions
- Recurrent Acute Myeloid Leukemia, Recurrent Myelodysplastic Syndrome, Refractory Acute Myeloid Leukemia, Refractory Myelodysplastic Syndrome
- Being tested
- Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001, Biospecimen Collection, Bone Marrow Aspiration, Bone Marrow Biopsy, Computed Tomography
- Medical subject headings
- Leukemia, Myeloid, Acute, Myelodysplastic Syndromes
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001Biological
Also called NEXI 001, NEXI-001, NEXI001
Given IV
Biospecimen CollectionProcedure or surgery
Also called Biological Sample Collection, Biospecimen Collected, Specimen Collection
Undergo blood sample collection
Bone Marrow AspirationProcedure or surgery
Undergo bone marrow aspiration
Bone Marrow BiopsyProcedure or surgery
Also called Biopsy of Bone Marrow, Biopsy, Bone Marrow
Undergo bone marrow biopsy
Computed TomographyProcedure or surgery
Also called CAT, CAT Scan, Computed Axial Tomography, Computerized Axial Tomography
Undergo PET/CT
CyclophosphamideDrug
Also called (-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Asta B 518, B 518
Given IV
DecitabineDrug
Also called 5-Aza-2'-deoxycytidine, Dacogen, Decitabine for Injection, Deoxyazacytidine
Given IV
EchocardiographyProcedure or surgery
Also called EC
Undergo ECHO
FludarabineDrug
Also called Fluradosa
Given IV
LeukapheresisProcedure or surgery
Also called Leukocytopheresis, Therapeutic Leukopheresis
Undergo leukapheresis
Magnetic Resonance ImagingProcedure or surgery
Also called Magnetic Resonance, Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (procedure), Magnetic Resonance Imaging Scan
Undergo MRI
Positron Emission TomographyProcedure or surgery
Also called Medical Imaging, Positron Emission Tomography, PET, PET Scan, Positron emission tomography (procedure)
Undergo PET/CT
| Study group | Role | What they receive |
|---|---|---|
| Treatment (NEXI-001, decitabine, chemotherapy) | Experimental | DONOR: Donors undergo leukapheresis on study.
PATIENTS: Patients may receive bridging therapy per standard of care ≥ 14 days prior to the start of cycle 1. Patients receive decitabine IV over 1 hour QD on day -3, -5 or -10 to day -1, lymphodepletion chemotherapy with fludarabine IV over 30 minutes QD and cyclophosphamide IV over 60 minutes QD on day -5 to -3 and then receive NEXI-001 IV over 30 minutes QD on days 1, 8 and 15 of cycle 1. Cycles repeat every 33 or 38 days in the absence of disease progression or unacceptable toxicity. If NEXI-001 cells remain and treatment criteria are met, patients may receive and additional cycle of decitabine IV over 1 hour QD on day -5 to -1 and NEXI-001 IV QD on days 1, 8 and 15 in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO during screening, bone marrow aspirate and/or bone marrow biopsy, PET/ CT scan or MRI and blood sample collection throughout the study. Receives: Biological: Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001; Procedure: Biospecimen Collection; Procedure: Bone Marrow Aspiration; Procedure: Bone Marrow Biopsy; Procedure: Computed Tomography; Drug: Cyclophosphamide; Drug: Decitabine; Procedure: Echocardiography; Drug: Fludarabine; Procedure: Leukapheresis; Procedure: Magnetic Resonance Imaging; Procedure: Positron Emission Tomography |
What is being measured
The primary outcome is the main question the study is designed to answer.
Incidence of adverse events (AEs)
AEs will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0, with the following exceptions: cytokine Release Syndrome will be graded according to the consensus criteria published by the American Society for Transplantation and Cellular Therapy, Immune effector Cell-Associated Neurotoxicity Syndrome, acute graft versus host disease (GVHD) grading according to Magic Consortium criteria and chronic GVHD grading according to National Health Institute Consensus criteria.
Measured: Up to 1.5 years
Dose limiting toxicity
Defined as grade 3 or higher non-hematological AE excluding toxicities unequivocally related to underlying disease, intercurrent illness or alternative etiology, and with the following exceptions: grade 3 or higher cytokine release syndrome/neurotoxicity that responds to appropriate medical intervention within 72 hours before improving to < grade 2 and grade 3-4 GVHD if responsive to therapy within 14-21 days.
Measured: Up to completion of cycle 1
Secondary outcomes (9)
Overall response
By the 2022 European Leukemia Net criteria for acute myeloid leukemia (AML)/myelodysplastic syndrome (MDS). Will be analyzed using the Kaplan-Meier method.
Measured: Up to 1.5 years
Complete response
By morphologic, multiparametric flow cytometry, and real time quantitative polymerase chain reaction criteria. Will be analyzed using the Kaplan-Meier method.
Measured: Up to 1.5 years
Duration of response
Will be analyzed using the Kaplan-Meier method.
Measured: From the starting date of response to the date of disease progression, up to 1.5 years
Progression free survival
Will be analyzed using the Kaplan-Meier method.
Measured: From starting study therapy to the first observation of disease progression or date of death, whichever comes first, up to 1.5 years
Overall survival
Will be analyzed using the Kaplan-Meier method.
Measured: From starting study therapy to the date of death, up to 1.5 years
Determine the immunophenotype of NEXI-001 T cells
In peripheral blood (PB) and bone marrow (BM) by flow cytometry techniques.
Measured: Up to 1.5 years
Incidence of acute GVHD
Of grades 2-4 and 3-4 (grading according to Magic Consortium criteria). Will be calculated using death and disease progression as competing risks.
Measured: Up to 1.5 years
Incidence of chronic GVHD
Of all grades (grading according to Lee et al. 2017). Will be calculated using death and disease progression as competing risks.
Measured: Up to 1.5 years
Persistence/antigen specificity of NEXI-001 T cells
In PB and BM by multimer-based staining over time.
Measured: Up to 1.5 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted27 Aug 2024
- Study start7 Jun 2025 (estimated)
- Primary completion12 Dec 2026 (estimated)
- Study completion12 Dec 2026 (estimated)
Why it stopped: cprmc withdrawn
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Recurrent Acute Myeloid LeukemiaStudies of the same condition, open and under way.
- More trials run by City of Hope Medical CenterThe sponsor's other registered studies.
- 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
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Enrolment
- 0 participants (actual)
Sponsor and investigators
- Lead sponsor
- City of Hope Medical Center
- Sponsor type
- University, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Responsible party
- Sponsor
- Investigators
- Monzr M Al Malki, MD, Principal investigator, City of Hope Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06572631
- Sponsor's protocol ID
- 23606
- Other IDs
- NCI-2024-06709, 23606, P30CA033572
- Status last verified
- May 2025
- First submitted
- 23 Aug 2024
- Last updated
- 25 May 2025
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- Yes
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 25 May 2025. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Phase 1b Expansion Study of Multi-Antigen Specific CD8+ T Cells After Decitabine-enhanced Lymphodepletion: An Adoptive Cellular Therapy for Patients With Relapsed or Refractory AML or MDS Following an Allogeneic Hematopoietic Cell Transplantation From Matched HLA Donors
- ClinicalTrials.gov ID
- NCT06572631
- Acronym / sponsor ID
- 23606
- Conditions
- Recurrent Acute Myeloid Leukemia, Recurrent Myelodysplastic Syndrome, Refractory Acute Myeloid Leukemia, Refractory Myelodysplastic Syndrome
- Phase
- Phase 1
- Study type
- Interventional
- Recruitment status
- WithdrawnReason stopped: cprmc withdrawn
- Enrolment
- 0 participants (actual)
- Lead sponsor
- City of Hope Medical CenterUniversity, hospital or other
- Collaborators
- National Cancer Institute (NCI)
- Study start
- 7 Jun 2025 (estimated)
- Primary completion
- 12 Dec 2026 (estimated)
- Study completion
- 12 Dec 2026 (estimated)
- First posted
- 27 Aug 2024 (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 phase I trial tests the safety, side effects and best dose of NEXI-001 when given with decitabine and lymphodepleting chemotherapy in treating patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) that has come back after a period of improvement (relapsed) or that has not responded to previous treatment (refractory) following an allogeneic hematopoietic cell transplantation from a matched donor. NEXI-001 is a type of chimeric antigen receptor T cell therapy in which a patient's T cells (a type of immune system cell) are changed in the laboratory so they will attack cancer cells. T cells are taken from a patient's blood. Then the gene for a special receptor that binds to a certain protein on the patient's cancer cells is added to the T cells in the laboratory. The special receptor is called a chimeric antigen receptor (CAR). Large numbers of the CAR T cells are grown in the laboratory and given to the patient by infusion for treatment of certain cancers. Decitabine is in a class of medications called hypomethylation agents. It works by helping the bone marrow produce normal blood cells and by killing abnormal cells in the bone marrow. Lymphodepleting chemotherapy, with fludarabine and cyclophosphamide, helps kill cancer cells in the body and helps prepare the body for the new CAR-T cells. Giving NEXI-001 with decitabine and lymphodepleting chemotherapy may be safe and tolerable in treating patients with relapsed or refractory AML or MDS following an allogeneic hematopoietic cell transplantation from a matched donor.
Detailed description
PRIMARY OBJECTIVES:
- Characterize the safety of allogeneic CD8+ leukemia-associated antigens specific T cells NEXI-001 (NEXI-001) combined with decitabine.
II. Determine the recommended phase 2 dose (RP2D) for NEXI-001 T cells combined with decitabine.
SECONDARY OBJECTIVES:
- Investigate the preliminary anti-leukemic activity of NEXI-001 T cells combined with decitabine based on:
Ia. Complete response (CR) rate; Ib. Overall response rate (ORR); Ic. Median duration of response; Id. 1-year overall survival (OS); Ie. 1-year progression-free survival (PFS). II. Cumulative incidence of acute graft-versus-host disease (aGVHD) of grades 2-4 and 3-4 at day 100 post first infusion of NEXI-001.
III. Cumulative incidence of chronic graft-versus-host disease (cGVHD) of all grades at 1 year post first infusion of NEXI-001.
IV. Characterize the T cells in the NEXI-001 product by immunophenotype and tumor antigen specificity.
- Characterize NEXI-001 T cells in peripheral blood (PB) and bone marrow (BM) by immunophenotype and tumor antigen specificity.
VI. Expansion and persistence of NEXI-001 T cells in PB and BM.
EXPLORATORY OBJECTIVES:
- Evaluate the effect of the following factors on the safety and efficacy of NEXI-001 T cells combined with decitabine:
Ia. NEXI-001 T-cell immunophenotype; Ib. Persistence of NEXI-001 T cells in PB and BM; Ic. Blood levels of the antigen-specific NEXI-001 T cells; Id. Biomarkers of activation, proliferation, and exhaustion of T cells; Ie. The expression of tumor associated antigen (TAAs) and checkpoint molecules on AML blasts.
OUTLINE: This is a dose-escalation study of decitabine in combination with NEXI-001, fludarabine and cyclophosphamide.
DONOR: Donors undergo leukapheresis on study.
PATIENTS: Patients may receive bridging therapy per standard of care ≥ 14 days prior to the start of cycle 1. Patients receive decitabine intravenously (IV) over 1 hour once per day (QD) on day -3, -5 or -10 to day -1, lymphodepletion chemotherapy with fludarabine IV over 30 minutes QD and cyclophosphamide IV over 60 minutes QD on day -5 to -3 and then receive NEXI-001 IV over 30 minutes QD on days 1, 8 and 15 of cycle 1. Cycles repeat every 33 or 38 days in the absence of disease progression or unacceptable toxicity. If NEXI-001 cells remain and treatment criteria are met, patients may receive and additional cycle of decitabine IV over 1 hour QD on day -5 to -1 and NEXI-001 IV QD on days 1, 8 and 15 in the absence of disease progression or unacceptable toxicity. Patients undergo echocardiography (ECHO) during screening, bone marrow aspirate and/or bone marrow biopsy, positron emission tomography (PET)/computed tomography (CT) scan or magnetic resonance imaging (MRI) and blood sample collection throughout the study.
After completion of study treatment, patients are followed up within 30 days and every 3 months for up to 1 year.
Study design
- Primary purpose
- Treatment
- Allocation
- Not applicable
- Intervention model
- Single group
- Masking
- None (open label)
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| Treatment (NEXI-001, decitabine, chemotherapy) | Experimental | Biological: Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001, Procedure: Biospecimen Collection, Procedure: Bone Marrow Aspiration, Procedure: Bone Marrow Biopsy, Procedure: Computed Tomography, Drug: Cyclophosphamide, Drug: Decitabine, Procedure: Echocardiography, Drug: Fludarabine, Procedure: Leukapheresis, Procedure: Magnetic Resonance Imaging, Procedure: Positron Emission TomographyDONOR: Donors undergo leukapheresis on study. PATIENTS: Patients may receive bridging therapy per standard of care ≥ 14 days prior to the start of cycle 1. Patients receive decitabine IV over 1 hour QD on day -3, -5 or -10 to day -1, lymphodepletion chemotherapy with fludarabine IV over 30 minutes QD and cyclophosphamide IV over 60 minutes QD on day -5 to -3 and then receive NEXI-001 IV over 30 minutes QD on days 1, 8 and 15 of cycle 1. Cycles repeat every 33 or 38 days in the absence of disease progression or unacceptable toxicity. If NEXI-001 cells remain and treatment criteria are met, patients may receive and additional cycle of decitabine IV over 1 hour QD on day -5 to -1 and NEXI-001 IV QD on days 1, 8 and 15 in the absence of disease progression or unacceptable toxicity. Patients undergo ECHO during screening, bone marrow aspirate and/or bone marrow biopsy, PET/ CT scan or MRI and blood sample collection throughout the study. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (50 listed)
- PARTICIPANT: Documented informed consent of the participant and/or legally authorized representative and documented informed consent of the donor
- PARTICIPANT: Agreement to allow the use of archival tissue from diagnostic tumor biopsies (if unavailable, exceptions may be granted with study principal investigator [PI] approval)
- PARTICIPANT: Age: ≥ 18 years
- PARTICIPANT: Eastern Cooperative Oncology Group (ECOG) ≤ 1 or Karnofsky performance score (KPS) ≥ 70
- PARTICIPANT: Confirmed diagnosis of AML/MDS that has relapsed after or is refractory to an allogeneic hematopoietic cell transplantation (HCT) from a matched donor.
Key exclusion criteria (52 listed)
- PARTICIPANT: Patients who have had 2 prior allogeneic (allo) HCTs
- PARTICIPANT: Patients who have received more than 3 anti-leukemic treatments regimens since their allo HCT
- PARTICIPANT: Vaccination with a live virus within six months prior to study treatment.
- PARTICIPANT: Active acute or chronic GVHD
- PARTICIPANT: Known hypersensitivity to any component of the NEXI-001 T-cell product or fludarabine, cyclophosphamide, decitabine, or tocilizumab
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 |
|---|---|---|
| Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001Also: NEXI 001, NEXI-001, NEXI001Given IV | Biological | Treatment (NEXI-001, decitabine, chemotherapy) |
| Biospecimen CollectionAlso: Biological Sample Collection, Biospecimen Collected, Specimen CollectionUndergo blood sample collection | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| Bone Marrow AspirationUndergo bone marrow aspiration | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| Bone Marrow BiopsyAlso: Biopsy of Bone Marrow, Biopsy, Bone MarrowUndergo bone marrow biopsy | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| Computed TomographyAlso: CAT, CAT Scan, Computed Axial Tomography, Computerized Axial TomographyUndergo PET/CT | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| CyclophosphamideAlso: (-)-Cyclophosphamide, 2H-1,3,2-Oxazaphosphorine, 2-[bis(2-chloroethyl)amino]tetrahydro-, 2-oxide, monohydrate, Asta B 518, B 518Given IV | Drug | Treatment (NEXI-001, decitabine, chemotherapy) |
| DecitabineAlso: 5-Aza-2'-deoxycytidine, Dacogen, Decitabine for Injection, DeoxyazacytidineGiven IV | Drug | Treatment (NEXI-001, decitabine, chemotherapy) |
| EchocardiographyAlso: ECUndergo ECHO | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| FludarabineAlso: FluradosaGiven IV | Drug | Treatment (NEXI-001, decitabine, chemotherapy) |
| LeukapheresisAlso: Leukocytopheresis, Therapeutic LeukopheresisUndergo leukapheresis | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| Magnetic Resonance ImagingAlso: Magnetic Resonance, Magnetic Resonance Imaging (MRI), Magnetic resonance imaging (procedure), Magnetic Resonance Imaging ScanUndergo MRI | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
| Positron Emission TomographyAlso: Medical Imaging, Positron Emission Tomography, PET, PET Scan, Positron emission tomography (procedure)Undergo PET/CT | Procedure or surgery | Treatment (NEXI-001, decitabine, chemotherapy) |
Primary outcome
Incidence of adverse events (AEs)
Time frame: Up to 1.5 years
AEs will be graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0, with the following exceptions: cytokine Release Syndrome will be graded according to the consensus criteria published by the American Society for Transplantation and Cellular Therapy, Immune effector Cell-Associated Neurotoxicity Syndrome, acute graft versus host disease (GVHD) grading according to Magic Consortium criteria and chronic GVHD grading according to National Health Institute Consensus criteria.
Dose limiting toxicity
Time frame: Up to completion of cycle 1
Defined as grade 3 or higher non-hematological AE excluding toxicities unequivocally related to underlying disease, intercurrent illness or alternative etiology, and with the following exceptions: grade 3 or higher cytokine release syndrome/neurotoxicity that responds to appropriate medical intervention within 72 hours before improving to < grade 2 and grade 3-4 GVHD if responsive to therapy within 14-21 days.
9 secondary outcomes
Overall response
Time frame: Up to 1.5 years
Complete response
Time frame: Up to 1.5 years
Duration of response
Time frame: From the starting date of response to the date of disease progression, up to 1.5 years
Progression free survival
Time frame: From starting study therapy to the first observation of disease progression or date of death, whichever comes first, up to 1.5 years
Overall survival
Time frame: From starting study therapy to the date of death, up to 1.5 years
Determine the immunophenotype of NEXI-001 T cells
Time frame: Up to 1.5 years
Incidence of acute GVHD
Time frame: Up to 1.5 years
Incidence of chronic GVHD
Time frame: Up to 1.5 years
Persistence/antigen specificity of NEXI-001 T cells
Time frame: Up to 1.5 years
Results and safety
The study was withdrawn before enrolling participants, so there are no results.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 25 May 2025.
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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.
Monzr M Al Malki, MD principal investigator
City of Hope Medical Center
Questions about this trial
What is this clinical trial studying?
A Phase 1 study testing Allogeneic CD8+ Leukemia-associated Antigens Specific T Cells NEXI-001, Biospecimen Collection and Bone Marrow Aspiration in people with Recurrent Acute Myeloid Leukemia and Recurrent Myelodysplastic Syndrome, run by City of Hope Medical Center.
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 50 inclusion and 52 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: withdrawn, as of the sponsor's last update on 25 May 2025. Status can change between updates, so confirm with the study contact before making plans.
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 withdrawn before enrolling participants, so there are no results.
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?
Incidence of adverse events (AEs) (time frame: Up to 1.5 years). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
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 25 May 2025.