Off-the-shelf NK Cells + SCT for Myeloid Malignancies

The goal of this clinical research study is to learn about the safety and effectiveness of giving KDS-1001 in combination with a standard stem cell transplant to patients with acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), or chronic myeloid leukemia (CML). KDS-1001 is a study product created using certain immune cells called natural killer (NK) cells collected from a third-party donor.

Primary Objective

Assess the safety and effectiveness of "off the shelf" third party NK cells in combination with allogeneic SCT in patients with myeloid malignancies.

Secondary Objectives

To assess NK cell related toxicities To estimate the proportion of patients with engraftment/graft failure. To assess the rate of leukemia relapse, disease-free survival (DFS), overall survival (OS), and GVHD-free, Relapse-free survival (GRFS) after transplantation by one year.

To estimate the non-relapse mortality (NRM) at day 100, day 180 and 1 year post-transplant.

To estimate the cumulative incidence of grade 2-4 and grades 3-4 aGVHD at day 100. To assess the rate of chronic GVHD within the first-year post transplantation. To assess rate of BK, CMV, and Adenovirus infections. To assess MRD. To assess immune reconstitution post-transplant

Eligibility Criteria:
Inclusion Criteria:

1. Patients ages 18 to 70 years old at the time of enrollment.
2. Patients weighing at least 42 kg
3. Patient with the hematologic malignancies described below, as well as an HLA matched related donor, HLA matched unrelated donor, a haploidentical related donor, or a one antigen mismatched unrelated donor. HLA matching includes HLA A, B, C, and DR-B1.
4. Patients must have one of the following diseases:

   Acute myeloid leukemia (AML):

   a. With one or more high-risk features defined as: (i) Greater than 1 cycle of induction therapy required to achieve remission; (ii) Preceding myelodysplastic syndrome (MDS);

   Presence of FLT3 mutations or internal tandem duplication or other mutations designated as adverse-risk by the ELN Leukemia Net AML Classification (see Appendix 2):

   Adverse:
   * t(6;9)(p23;q34.1); DEK-NUP214
   * t(v;11q23.3); KMT2A rearranged
   * t(9;22)(q34.1;q11.2); BCR-ABL1
   * inv(3)(q21.3q26.2) or t(3;3)(q21.3;q26.2); GATA2,MECOM(EVI1)
   * -5 or del(5q); -7; -17/abn(17p)
   * Complex karyotype, monosomal karyotype
   * Wild-type NPM1 and FLT3-ITDhigh
   * Mutated RUNX1
   * Mutated ASXL1
   * Mutated TP53 (iv) FAB M6 or M7 classification; (v) Adverse cytogenetics: -5, del 5q, -7, del7q, abnormalities involving 3q, 9q, 11q, 20q, 21q, 17, +8 or complex karyotype \[\> 3 abnormalities\]; or other mutations designated as adverse-risk by the ELN criteria; (vi) Treatment-related AML (vii) Primary induction failure with partial response to therapy who achieve adequate cytoreduction (viii) Aplastic/hypoplastic marrow with or without detectable persistent disease after induction chemotherapy or after salvage chemotherapy.

   (ix) Have minimal residual disease by flow cytometry, FISH, detection of disease related mutations or cytogenetic abnormality after first course of induction chemotherapy (x) Have relapsed after prior allogeneic hematopoietic transplant

   AND

   b. Patients must be in one of the following (i) CR: complete remission, (ii) CRi: CR with incomplete hematologic recovery, or (iii) MLFS: morphological leukemia-free state with less than 5% bone marrow blasts.

   (iv) If not in either of the above i-iii, then may be in either of the following:
   1. Primary induction failure with partial response to therapy who achieve adequate cytoreduction
   2. Aplastic/hypoplastic marrow with or without detectable persistent disease after induction chemotherapy or after salvage chemotherapy

   Myelodysplastic syndromes (MDS):

   a. De novo MDS with intermediate or high-risk IPSS scores, chronic myelomonocytic leukemia (CMML) or treatment-related MDS. Patients with intermediate-1 features should have failed to respond to hypomethylating agent therapy. .

   Patients must have less than 10% bone marrow blasts

   Chronic myeloid leukemia (CML):
   1. Failed to achieve cytogenetic remission or have cytogenetic relapse after treatment with at least 2 tyrosine kinase inhibitors, or
   2. Accelerated phase or blast phase at any time, or
   3. Intolerant of available TKIs
5. Performance score of at least 70% by Karnofsky or 0 to 1 by ECOG.
6. Adequate major non-hematopoietic organ system function as demonstrated by:

   1. Serum creatinine clearance equal or more than 50 ml/min (calculated with Cockcroft-Gault formula).
   2. Bilirubin equal or less than 1.5 mg/dL except for Gilbert's disease. ALT or AST equal or less than 200 U/L for adults. Conjugated (direct) bilirubin less than 2x upper limit of normal.
   3. Left ventricular ejection fraction equal or greater than 45%.
   4. Diffusing capacity for carbon monoxide (DLCO) equal or greater than 60% predicted corrected for hemoglobin.
7. Ability to understand and willingness to sign the written informed consent document.
8. Sexually active males and females of childbearing potential must agree to use a form of contraception considered effective and medically acceptable by the Investigator while on study.

Exclusion criteria:

1. HIV positive; active hepatitis B or C.
2. Uncontrolled infections; PI is the final arbiter of this criterion.
3. Liver cirrhosis.
4. CNS involvement within 3 months prior to the transplant.
5. Positive pregnancy test in a woman with child bearing potential defined as not post-menopausal for 12 months or no previous surgical sterilization.
6. Inability to comply with medical therapy or follow-up.
7. Patient with a known history of allergic reactions to any constituents of the product, including a known history of allergic reactions to cellular products or DMSO.
8. Other malignancy/cancer diagnosis with active disease or in remission and \<2 years ago, not including nonmelanoma skin cancer
9. Requiring systemic corticosteroids with prednisone dose \>10 mg or equivalent.
10. KDS-1001 Donor specific antibodies (dsa) \>3000 MFI units or C1q positive