Trial Evaluating MGTA-456 in Patients With High-Risk Malignancy

Inclusion Criteria

• •Age, Unit Cell Dose and HLA Match Criteria
• •Subjects must be ≤55 years of age
• •Subjects must weigh \>11 kg
• •Subjects must have a partially HLA matched UCB unit with a pre-cryopreserved TNC dose \>1.0 x 107 per kilogram recipient weight. HLA matching is initially based on a minimum of 5 of 8 HLA alleles at high resolution A, B, C, DRB1 typing; searches will be performed according to the current Magenta Cord Blood Search Algorithm.
• •Eligible Diseases:
• •Acute myelogenous leukemia (AML) in morphological complete remission with:
• •* Minimal residual disease (MRD) by flow cytometry, or
• •* Intermediate to high risk leukemia in first (CR1) based on institutional criteria, eg. not favorable risk AML which is defined as having one of the following:
• •* t(8,21) without cKIT mutation
• •* inv(16) or t(16;16) without cKIT mutation
• •* Normal karyotype with mutated NPM1 but FLT3-ITD wild type
• •* Normal karyotype with double mutated CEBPA
• •* Acute promyelocytic leukemia (APL) in first molecular remission at the end of consolidation
• •* Any second or subsequent CR, or
• •* Secondary AML with prior malignancy that has been in remission for at least 12 months.
• •* Acute lymphocytic leukemia (ALL) at the following stages:
• •* High risk first morphological, cytogenetic and molecular CR with:
• •* MRD by flow cytometry, or
• •* Diagnosis of Philadelphia chromosome (Ph)+ ALL, or
• •* MLL rearrangement at diagnosis with slow early response at Day 14, or
• •* Hypodiploidy (\< 44 chromosomes or DNA index \< 0.81) at diagnosis, or
• •* End of induction M3 bone marrow, or
• •* End of induction M2 with M2-3 at Day 42.
• •* High risk second CR based on institutional criteria (eg, for children, bone marrow relapse \<36 months from induction or T-lineage bone marrow relapse or very early isolated central nervous system (CNS) relapse \<6 months from diagnosis, or slow re-induction (stage M2-3 at day 28 after induction) regardless of length remission. All patients with MRD by flow cytometry.
• •* Any third or subsequent CR.
• •* Secondary ALL
• •* Biphenotypic/undifferentiated leukemia in morphological, cytogenetic and molecular CR .
• •* Chronic Myelogenous Leukemia (CML) in high risk first chronic phase (failure of two tyrosine kinase inhibitors (TKI) or TKI intolerance), accelerated phase or second chronic phase.
• •* Myelodysplasia (MDS) IPSS Int-2 or High risk (i.e. RAEB, RAEBt \<5% blasts) or other high risk features, including multiple cytopenias, high risk cytogenetics or lack of response to standard therapy..
• •* Relapsed large-cell lymphoma, mantle-cell lymphoma and Hodgkin lymphoma that is chemotherapy sensitive and ineligible for an autologous transplant.
• •* Burkitt's lymphoma in CR2 or subsequent CR.
• •* Relapsed T-cell lymphoma that is chemotherapy sensitive in CR/PR that is ineligible for an autologous transplant.
• •Karnofsky score ≥70 (16 years and older), Lansky play score \>50 (children 2-16 years, or 'adequate' score for children \<2 years, as detailed in Appendix II.
• •Adequate organ function defined as:
• •* Renal: Serum creatinine within normal range for age, or if serum creatinine outside normal range for age, then creatinine clearance \>40 ml/min or GFR ≥70 mL/min/1.73 m2.normal for age
• •* Hepatic: Bilirubin \<3x upper limit of normal (ULN) and AST, ALT and alkaline phosphatase \<5x ULN.
• •* Pulmonary function: DLCO, FEV1, FEC (diffusion capacity) \>5030% of predicted (corrected for hemoglobin); if unable to perform pulmonary function tests, then O2 saturation \>95% on room air.
• •Cardiac: No uncontrolled arrhythmia and left ventricular ejection fraction at rest must be \>3545%.
• •Available 'back-up' HSPC graft (e.g, second UCB unit, haploidentical related donor).
• •Females of child bearing potential and sexually active males must agree to use adequate birth control during study treatment.
• •Voluntary written consent signed (adult or parental) before performance of any study-related procedure not part of normal medical care.