The study "GALAXY33" is an open-label, prospective, nonrandomized, one arm phase I clinical trial in which patients with relapsed AML after allogeneic hematopoietic stem cell transplantation will be transplanted with CD33-deleted CD34+ HSC derived from the initially matched family donor.
CRISPR/Cas9-mediated inactivation of CD33 in hematopoietic stem cells (HSC) may broaden the therapeutic index of CD33-directed immunotherapy for patients with AML by rendering healthy hematopoietic stem and progenitor cells (HSPC) resistant to escalating doses and/or shorter dosing intervals of the CD33-specific antibody-drug conjugate (ADC) Gemtuzumab-ozogamicin (GO). In this proof of concept trial, we will develop a platform for genome editing of CD34+ HSC and demonstrate the feasibility, safety and efficacy of this approach for targeted therapy of AML. Upon implementation, the platform shall be used for innovative clinical trials in diverse types of cancer. Outside of leukemias, autologous HSC could be used to ease the procedure. Patients with relapsed AML after allogeneic hematopoietic stem cell transplantation will be transplanted with CD33-deleted CD34+ HSC derived from the initially matched family donor. Upon HSC engraftment, patients will be treated with escalating doses of the anti-CD33 antibodydrug conjugate Gemtuzumab-Ozogamicin (GO). A conditioning regimen containing GO (d-14, d-11, d-8),Fludarabine 30 mg/m2 (d-6 to d-3) and Melphalan 140mg/m2 (d-2) is used prior to transplantation. The clinical trial will be conducted at two trial sites in the University Hospitals in Heidelberg and Dresden. 25 patients will be assessed for eligibility and 12 patients will be allocated into the trial.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
12
CD33-deleted CD34+ hematopoietic stem cells derived from the initially matched family donor
Intrapatient intra-individual dose escalation Level 0: GO day 1 Level 1: GO day 1, day 4 Level 2: GO day 1, day 4, day 7 with repetition after 21 to 28 days up to 84 days.
University Hospital Dresden, Department of Medicine I
Dresden, Germany
University Hospital Heidelberg, Internal Medicine V
Heidelberg, Germany
engraftement of gene edited CD34+HSC
successful engraftement of gene edited CD34+HSC in the bone marrow
Time frame: on day 28
dose-limiting toxicity
dose-limiting toxicity (DLT) of Gemtuzumab-Ozogamicin
Time frame: until EOS (day 90)
toxicities according to the Common Terminology Criteria for Adverse Events (CTCAE v5.0)
frequency and grade of AEs with gene-edited HSC transplantation
Time frame: until EOS (day 90)
Anti-tumor efficacy of study treatment in patients with dCD33+ relapsed AML after allo-SCT
overall response rate (ORR), complete response (CR), partial response (PR)) at day 90 (EOS) after last GO application)
Time frame: until EOS (day 90)
Time to response
Time to response (at least partial response) after the last GO application
Time frame: until EOS (day 90)
Overall response
Duration of overall response (DOR) after the last GO application
Time frame: until EOS (day 90)
Progression-free survival
Progression-free survival (PFS) after the last GO application
Time frame: until EOS (day 90)
Overall survival
Overall survival (OS) after the last GO application
Time frame: until EOS (day 90)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Number of circulating gene edited cells
Number of circulating gene edited cells in the bone marrow and peripheral blood as determined by flow cytometry
Time frame: at screening and days 14, 28, 56, 90