Study of Magrolimab Combinations in Participants With Myeloid Malignancies

NCT04778410 — Phase 2, Terminated, 54 participants, Gilead Sciences

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A Phase 2 Multi-Arm Study of Magrolimab Combinations in Patients With Myeloid Malignancies

RegistryNCT04778410
StatusTerminated - Sponsor decision to terminate the study.
PhasePhase 2
Study typeInterventional; non randomized, sequential, masking: none, treatment
Enrollment54 (Actual)
SponsorGilead Sciences (Industry)
ConditionsMyeloid Malignancies
InterventionsMagrolimab, Azacitidine, Venetoclax, Mitoxantrone, Etoposide, Cytarabine, CC-486 (Drug)
Datesstart 2021-06-28, primary completion 2024-03-04, completion 2024-03-04, first posted 2021-03-03, last updated 2025-03-20
Locations21 sites in United States, Australia, United Kingdom

Related Papers Related Patents Related Grants Related Experts
All trials for Myeloid Malignancies All trials of Magrolimab All trials of Azacitidine

-Summary

The goal of this clinical study is to learn more about the safety and dosing of the study drug, magrolimab (Mag), in combination with anti-leukemia therapies in participants with acute myeloid leukemia (AML).

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+Detailed description

The anti-leukemia therapies are defined as follows:

* Venetoclax (Ven)
* Azacitidine (Aza)
* Mitoxantrone, etoposide, and cytarabine (MEC)

This study consists of 3 safety run-in cohorts;

* Safety Run-in Cohort 1 (1L Unfit AML Mag + Ven + Aza)
* Safety Run-in Cohort 2 (R/R AML Mag + MEC)
* Safety Run-in Cohort 3 (Post-chemo Maintenance Mag + CC-486)

Participants will receive treatment at the assigned dose level for at least 4 cycles in the Safety Run-in cohorts, after which they may continue at the assigned dose level or switch to the RP2D upon agreement between the investigator and the sponsor. After completion of each safety run-in cohort and identification of the RP2D for that cohort, participants may be enrolled into the corresponding Phase 2 cohorts;

* Phase 2 Cohort 1 (1L Unfit AML Mag + Ven + Aza)
* Phase 2 Cohort 2 (R/R AML Mag + MEC)
* Phase 2 Cohort 3 (Post-chemo Maintenance Mag + CC-486)

Cycle length is 28 days for both the Safety Run-in and Phase 2 cohorts.

Note: All cohorts are closed to screening and enrollment.

+Arms and interventions

ArmTypeInterventionsDescription
Cohort 1 (1L Unfit AML): Magrolimab + Venetoclax + AzacitidineExperimentalDrug: Magrolimab; Drug: Azacitidine; Drug: VenetoclaxParticipants with newly diagnosed untreated acute myeloid leukemia (AML) who are ineligible for intensive induction chemotherapy will receive magrolimab 1 mg/kg on Days 1, 4; 15 mg/kg on Day 8; 30 mg/kg on Days 11, 15, and then every week (QW) x 5 doses; 30 mg/kg every 2 weeks (Q2W) beginning 1 week after the 5 weekly 30 mg/kg dose in every 28-day cycle along with azacitidine and venetoclax first in the Safety Run-in Cohort. Once the safety of recommended dose of magrolimab is confirmed, the participants in Phase 2 Cohort will be enrolled to receive the treatment.
Cohort 2 (R/R AML): Magrolimab + Mitoxantrone + Etoposide + CytarabineExperimentalDrug: Magrolimab; Drug: Mitoxantrone; Drug: Etoposide; Drug: CytarabineParticipants with relapsed/refractory (RR) AML after intensive induction chemotherapy will receive magrolimab 1 mg/ on Days 1, 4; 15 mg/kg, on Day 8; 30 mg/kg on Days 11, 15, and then QW x 5 doses; 30 mg/kg Q2W beginning 1 week after the 5 weekly 30 mg/kg dose along with mitoxantrone + etoposide + cytarabine (MEC) first in the Safety Run-in Cohort. Once the safety of recommended dose of magrolimab is confirmed, the participants in Phase 2 Cohort will be enrolled to receive the treatment.
Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486ExperimentalDrug: Magrolimab; Drug: CC-486Participants with AML who achieved CR or CRi with MRD positivity following intensive induction chemotherapy will receive magrolimab 1 mg/kg on Days 1, 4; 15 mg/kg on Day 8; 30 mg/kg on Days 11, 15, and then QW x 5 doses; 30 mg/kg Q2W beginning 1 week after the 5 weekly 30 mg/kg dose along with CC-486 as maintenance therapy first in the Safety Run-in Cohort. Once the safety of recommended dose of magrolimab is confirmed, the participants in Phase 2 Cohort will be enrolled to receive the treatment.
  • Magrolimab (Drug), also known as GS-4721: Administered intravenously
  • Azacitidine (Drug): Administered either subcutaneously or IV, 75 mg/milligram per square (m\^2) on Days 1 to 7 or Days 1 to 5, 8 and 9 during every cycle
  • Venetoclax (Drug): Administered orally at a dose of 100 mg on Day 1, 200 mg on Day 2, 400 mg on Days 3-28 during Cycle 1, followed by 400 mg on Days 1-28 during every cycle
  • Mitoxantrone (Drug): Administered intravenously, 8 mg/m\^2 on Days 1-5 during Cycle 1 to Cycle 3
  • Etoposide (Drug): Administered intravenously, 100 mg/m\^2 on Days 1-5 during Cycle 1 to Cycle 3
  • Cytarabine (Drug): Administered intravenously, 1000 mg/m\^2 on Days 1-5 during Cycle 1 to Cycle 3
  • CC-486 (Drug), also known as Onureg: Administered orally, 300 mg on Days 1-14 during each cycle

+Outcome measures

Primary outcomes

  • Complete Remission (CR) Rate (Cohorts 1 and 2) [Up to 2 years]: CR rate was the percentage of participants who achieved CR (CR without minimal residual disease (CRMRD-) or complete remission with positive or unknown minimal residual disease (CRMRD+/unk)) as determined by the investigator based on prespecified criteria while on study prior to initiation of any new anti-cancer therapy. CRMRD- and CRMRD+/unk were defined as neutrophils >1.0 ×10\^9/L; platelets >100 × 10\^9/L and <5% bone marrow blasts. Absence of circulating blasts and blasts with Auer rods; absence of extramedullary disease. CRMRD- status as determined using multiparameter flow cytometry with a sensitivity of < 0.1%. Assessment of leukemia response in participants with acute myeloid leukemia (AML) were conducted based on the European Leukemia Net (ELN) recommendations for AML. Percentages were rounded-off. Clopper-Pearson method was used for outcome measure analysis.
  • Minimal Residual Disease Negative Complete Remission Rate (Cohort 3) [Up to 2 years]: The minimal residual disease (MRD) negative CR rate was defined as the percentage of participants who maintain CR as determined by the investigator based on prespecified criteria and reach MRD negative disease status on 2 consecutive bone marrow assessments, as determined using multiparameter flow cytometry with a sensitivity of < 0.1% while on study prior to initiation of any new anti-AML therapy. Assessment of leukemia response in participants with AML were conducted based on the ELN recommendations for AML. CR was defined in outcome measure #1.
  • Percentage of Participants Experiencing Dose-limiting Toxicities (DLTs) (Safety Run-in Cohorts 1, 2 and 3) [Up to 28 days]: DLTs were defined as any Grade 4 or higher hematologic toxicity or Grade 3 or higher nonhematologic toxicity (that had worsened in severity from pretreatment baseline) during the 4-week DLT assessment period and was related to magrolimab or magrolimab combination.
  • Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs) (Cohorts 1, 2 and 3) [First dose date up to 1.7 years plus 70 days]: TEAEs were defined as any AEs with an onset date on or after the study drug start date and no later than 70 days after the study drug last dosing date or the day before initiation of new anticancer therapy including SCT, whichever comes first. An AE was any untoward medical occurrence in a participant who received study drug without regard to possibility of causal relationship. Percentages were rounded-off.
  • Percentage of Participants Experiencing Treatment-emergent Laboratory Abnormalities (Cohorts 1, 2 and 3) [First dose date up to 1.7 years plus 70 days]: Treatment-emergent laboratory abnormalities were defined as values that increase at least 1 toxicity grade from baseline at any postbaseline time point, up to and including the date of last dose of study drug plus 70 days or the day before initiation of any new anticancer therapy including SCT, whichever comes first. If the relevant baseline laboratory value is missing, any abnormality of at least Grade 1 observed within the time frame specified above will be considered treatment emergent. Percentages were rounded-off.

Secondary outcomes

  • Overall Response Rate (ORR) [Up to 2 years]: ORR was the percentage of participants who achieved CR (CRMRD- or CRMRD+/unk), CRi, CRh, PR, or MLFS as per investigator based on prespecified criteria before starting any new anti-AML therapy (including SCT). CRi and CRh were defined as neutrophils >0.5 x 10\^9/L, platelets > 50 x 10\^9/L (except residual neutropenia (<1.0 × 10\^9/L) or thrombocytopenia (<100 × 109/L) for CRi) and bone marrow blasts <5%; Absence of circulating blasts and blasts with Auer rods; absence of extramedullary disease. PR: Neutrophils >1.0 x 10\^9/L, platelets >100 x 10\^9/L, bone marrow blasts reduced to 5%-25%, and a ≥50% reduction from baseline. Blasts <5% with Auer rods may also be considered a PR. MLFS: Bone marrow blasts <5%, absence of circulating blasts or Auer rods, no extramedullary disease, marrow should not merely be "aplastic"; at least 200 cells or 10% cellularity, and no requirement for hematologic recovery. CR was defined in outcome measure #1. Percentages were rounded-off.
  • Complete Remission or Complete Remission With Partial Hematologic Recovery Rate (CR/CRh) (Cohorts 1 and 2) [Up to 2 years]: CR/CRh rate was the percentage of participants who achieved CR (CRMRD- or CRMRD+/unk) or CRh as determined by the investigator based on prespecified criteria while on study prior to initiation of any new anti-AML therapy (including SCT). CR was defined in outcome measure 1. CRh was defined in outcome measure 6. Percentages were rounded-off. Clopper-Pearson exact method was used in outcome measure analysis.
  • Duration of Response (DOR) (Cohorts 1 and 2) [Up to 2 years]: DOR was measured from the time assessment criteria that were met for CR (CRMRD- or CRMRD+/unk), CRi, CRh, PR, or MLFS, whichever was first recorded, until the first date of AML relapse, progressive disease, or death (including assessments post SCT). Participants who were not observed to have a relapse, progressive disease, or death were censored at the date of their last response assessment. For participants who started taking new anti-AML therapies (except SCT and post SCT maintenance treatment) before relapse/PD/death, duration of response were censored at the last response assessment before the initiation of the new anti-AML therapies.CR was defined in outcome measure #1. CRi, CRh, PR, or MLFS were defined in outcome measure #6. Kaplan-Meier (KM) estimates were used in outcome measure analysis.
  • Duration of Complete Remission (DCR) (Cohorts 1 and 2) [Up to 2 years]: DCR was measured from the time the assessment criteria were first met for CR (CRMRD- or CRMRD+/unk) until the first date of AML relapse or death (including assessments post SCT). Participants who were not observed to have a relapse, progressive disease, or death were censored at the date of their last response assessment. For participants who started taking new anti-AML therapies (except SCT and post SCT maintenance treatment) before relapse/PD/death, duration of response were censored at the last response assessment before the initiation of the new anti-AML therapies. CR was defined in outcome measure #1. KM estimates were used in outcome measure analysis.
  • Duration of CR/CRi (Cohorts 1 and 2) [Up to 2 years]: Duration of CR/CRi was measured from the time the assessment criteria were first met for CR (CRMRD- or CRMRD+/unk) or CRi until the first date of AML relapse or death (including assessments post SCT). Participants who were not observed to have a relapse, progressive disease, or death were censored at the date of their last response assessment. For participants who started taking new anti-AML therapies (except SCT and post SCT maintenance treatment) before relapse/PD/death, duration of response were censored at the last response assessment before the initiation of the new anti-AML therapies. CR was defined in outcome measure #1. CRi was defined in outcome measure #6. KM estimates were used in outcome measure analysis.
  • Duration of CR/CRh (Cohorts 1 and 2) [Up to 2 years]: Duration of CR/CRh was measured from the time the assessment criteria are first met for CR (CRMRD- or CRMRD+/unk) or CRh until the first date of AML relapse or death (including assessments post SCT). Participants who were not observed to have a relapse, progressive disease, or death were censored at the date of their last response assessment. For participants who started taking new anti-AML therapies (except SCT and post SCT maintenance treatment) before relapse/PD/death, duration of response were censored at the last response assessment before the initiation of the new anti-AML therapies. CR was defined in outcome measure #1. CRh was defined in outcome measure #6. KM estimates were used in outcome measure analysis.
  • Event-Free Survival (EFS) (Cohorts 1 and 2) [Up to 2 years]: EFS was defined as the time from the date of the first dose of study treatment to the earliest date of documented relapse from CR, treatment failure (defined as failure to achieve CR during the response assessment window (the first treatment dosing date until before the fifth cycle of magrolimab + venetoclax + azacitidine in Cohort 1 and the first treatment dosing date until before the third cycle of magrolimab + MEC in Cohort 2), or death from any cause within the response assessment window. Response assessments post SCT were included in the analysis. Deaths post SCT or new anti-AML therapies (except SCT and post SCT maintenance) were included. Those who were not observed to have one of these events during the study were censored at the date of their last response assessment during the study. Day 1 of treatment was assigned as the event date for participants with treatment failure. CR was defined in outcome measure #1. KM estimates were used in outcome measure analysis.
  • Relapse-Free Survival (RFS) Rate (Cohort 3) [Up to 2 years]: RFS was defined as the time from the first dose of study treatment until the first date of AML relapse or death from any cause, whichever came first.
  • MRD Negative CR/CRi Rate (Cohort 3) [Up to 2 years]: MRD negative CR/CRi rate was defined as the percentage of participants who maintained CR/CRi as determined by the investigator based on prespecified criteria and reach MRD negative disease status on 2 consecutive bone marrow assessments as determined using multiparameter flow cytometry with a sensitivity of < 0.1% while on study prior to initiation of any new anti-AML therapy. CR was defined in outcome measure #1. CRi was defined in outcome measure #6.
  • Duration of Minimal Residual Disease Negative Complete Remission (Cohort 3) [Up to 2 years]: Duration of MRD negative CR was measured from the time the participant achieved MRD-negative status and maintained CR until the first date of AML relapse, loss of MRD negative status, or death (including assessments post SCT). CR was defined in outcome measure #1.
  • Duration of MRD Negative CR/CRi (Cohort 3) [Up to 2 years]: Duration of MRD negative CR/CRi was measured from the time the participant achieved MRD-negative status (first of the 2 consecutive MRD negative bone marrow assessments) and maintained CR/CRi until the first date of AML relapse, loss of MRD negative status, or death (including assessments post SCT). CR was defined in outcome measure #1. CRi was defined in outcome measure #6.
  • Overall Survival (OS) (Cohorts 1, 2 and 3) [Up to 2 years]: OS was measured from the date of the first dose of study treatment to the date of death from any cause. Those who were not observed to die during the study were censored at last date they were known to be alive. KM estimates were used in outcome measure analysis.
  • Red Blood Cell (RBC) Transfusion Independence Rate (Cohorts 1, 2 and 3) [Up to 2 years]: RBC transfusion independence rate was the percentage of participants who had a 56-day or longer period with no RBC or whole blood transfusion at any time between the date of the first dose and discontinuation of study treatment among all participants who were RBC transfusion-dependent at baseline. RBC transfusion independence rate was reported as 2 categories: 1. Conversion rate: Participants who received an RBC or whole blood transfusion within the 28 days prior to the first dose of study treatment, and were RBC transfusion-independent post-baseline. 2. Maintenance rate: Participants who were RBC transfusion independent at baseline and maintained it post-baseline. Percentages were rounded-off. Clopper-Pearson method were used in outcome measure analysis.
  • Platelet Transfusion Independence Rate (Cohorts 1, 2 and 3) [Up to 2 years]: Platelet transfusion independence rate was the percentage of participants who had a 56-day or longer period with no platelet transfusions at any time between the date of the first dose and discontinuation of study treatment among all participants who were platelet transfusion-dependent at baseline. Platelet transfusion independence rate was reported as 2 categories: 1. Conversion rate: Participants who received an platelet transfusion within 28 days prior to the first dose of study treatment, 2. Maintenance rate: Participants who were platelet transfusion independent at baseline and maintained it post-baseline. Percentages were rounded-off. Clopper-Pearson method were used in outcome measure analysis.
  • Plasma Concentration of Magrolimab in Combination With Anti-leukemia Therapy (Cohorts 1, 2 and 3) [Cohort 1: Predose: Days 1, 8, 29, 57, 113, 169, 253 and 337; Cohort 2: Days 1, 8, 29 and 57]
  • Percentage of Participants With Anti-Magrolimab Antibodies (Cohorts 1 and 2) [Up to 2 years]: Percentages were rounded-off.
  • Levels of Anti-Magrolimab Antibodies (Cohorts 1 and 2) [Up to 2 years]

+Eligibility

Sex: All, ages: 18 Years to any

Key Inclusion Criteria:

All Individuals:

* White blood cell (WBC) count ≤ 20 × 10\^3/microliter (μL) prior to first dose of study treatment. If the individual's WBC count is > 20 × 10\^3/ μL prior to first dose of study treatment, the individual can be enrolled, assuming all other eligibility criteria are met
* For individuals with prior cardiac history, the hemoglobin must be ≥ 9 grams per deciliter (g/dL) prior to initial dose of study treatment. Transfusions are allowed to meet hemoglobin eligibility
* Adequate liver function
* Adequate renal function
* Individual has provided informed consent
* Individual is willing and able to comply with clinic visits and procedures outlined in the study protocol
* Pretreatment blood cross-match completed
* Males and females of childbearing potential who engage in heterosexual intercourse must agree to use protocol- specified method(s) of contraception
* Individuals must be willing to consent to mandatory pretreatment and on-treatment bone marrow biopsies (trephines), unless not feasible as determined by the investigator and discussed with the sponsor

Safety Run-in Cohort 1 and Phase 2 Cohort 1 (Ineligible (1L) Unfit acute myeloid leukemia (AML) Magrolimab + Venetoclax + Azacitidine):

* Newly diagnosed, previously untreated individuals with histological confirmation of AML by world health organization (WHO) criteria who are ineligible for treatment with a standard cytarabine and anthracycline induction regimen due to age, comorbidity, or other factors. Individuals must be considered ineligible for induction therapy defined by the following:

  * ≥ 75 years of age
  * ≥ 18 to 74 years of age with at least 1 of the following comorbidities:

    * Diffusing capacity of the lung of carbon monoxide ≤ 65% or forced expiratory volume in 1 second ≤ 65%
    * Left ventricular ejection fraction (LVEF) ≤ 50%
    * Creatinine clearance (CrCl) < 45 mL/min calculated by the Cockcroft-Gault formula or measured by 24 hours' urine collection
    * Any other comorbidity that the investigator judges to be incompatible with intensive chemotherapy that must be approved by the sponsor medical monitor before study enrollment
* Eastern Cooperative Oncology Group (ECOG) performance status of 2 or 3
* Individuals who have not received prior anti-leukemia therapy for AML (excluding hydroxyurea or oral etoposide), hypomethylating agent (HMA), low-dose cytarabine, and/or venetoclax. Individuals with prior myelodysplastic syndrome (MDS) cannot have received a prior HMA, venetoclax, or a chemotherapeutic agent. Other prior MDS therapies, including but not limited to lenalidomide, erythroid-stimulating agents, or similar red blood cell (RBC) -direct therapies, are allowed
* Individuals who have not received strong and/or moderate cytochrome P450 enzyme (CYP) 3A inducers (such as St. John's Wort) within 7 days prior to the initiation of study treatment
* Individuals who have not consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges) or starfruit within 3 days prior to the initiation of study treatment or are willing to discontinue consumption of these while receiving study drug
* Individuals without malabsorption syndrome or other conditions that preclude enteral route of administration

Safety Run-in Cohort 2 and Phase 2 Cohort 2 (Relapsed/refractory (R/R) AML Magrolimab+Mitoxantrone + Etoposide + Cytarabine (MEC)):

* Individuals with confirmation of AML by WHO criteria who are refractory to or have experienced first relapse after initial intensive chemotherapy. Note: Individuals who are relapsed after or are refractory to more than 1 line of anti-AML treatment are not eligible. Individuals who relapsed after undergoing stem cell transplant may be eligible.
* At least 2 weeks must have elapsed since any prior anti-leukemia agents. Note: Localized non-central nervous system (CNS) radiotherapy, hydroxyurea, and erythroid and/or myeloid growth factors are not criteria for exclusion
* ECOG performance status of 0 to 2
* Individuals with LVEF > 50%, lack of symptomatic congestive heart failure, or clinically significant cardiac arrhythmias
* Must not have been treated with trastuzumab within 7 months prior to the initiation of study treatment
* Individuals who have not previously received maximum cumulative doses of anthracyclines and anthracenediones
* Individuals without degenerative or toxic encephalopathies.
* Individuals who did not undergo hematopoietic SCT in the past 100 days, are not on immunosuppressive therapy post SCT in the 2 weeks prior to the first dose of study treatment, or have no active clinically significant graft-versus-host disease.

Safety Run-in Cohort 3 and Phase 2 Cohort 3 (Post-chemo Maintenance Magrolimab+CC-486):

* Individuals with histological confirmation of AML by WHO criteria who achieved a complete remission (CR) or CR with incomplete hematologic recovery (CRi) with presence of MRD (MRD positive by flow cytometry assay, defined as ≥ 0.1% detectable MRD) after intensive induction chemotherapy with or without consolidation therapy, prior to starting maintenance therapy for newly diagnosed AML, and who are not candidates for hematopoietic stem cell transplantation (SCT) within 1 year of achievement of initial remission
* ECOG performance status of 0 to 2
* Individuals without malabsorption syndrome or other conditions that preclude enteral route of administration

Key Exclusion Criteria:

* Positive serum pregnancy test
* Breastfeeding female
* Known hypersensitivity to any of the study drugs, the metabolites, or formulation excipient
* Individuals receiving any live virus vaccine within 4 weeks prior to initiation of study treatments
* Prior treatment with cluster of differentiation 47 (CD47) or signal regulatory protein alpha (SIRPα) -targeting agents
* Current participation in another interventional clinical trial
* Known inherited or acquired bleeding disorders
* Clinical suspicion of or documented active CNS involvement with AML
* Individuals who have acute promyelocytic leukemia
* Significant disease or medical conditions, as assessed by the investigator and sponsor, that would substantially increase the risk: benefit ratio of participating in the study. This includes, but is not limited to, acute myocardial infarction within the last 6 months, unstable angina, uncontrolled diabetes mellitus, significant active infections, and congestive heart failure New York Heart Association Class III-IV
* Second malignancy, except MDS, treated basal cell or localized squamous skin carcinomas, localized prostate cancer, or other malignancies for which individuals are not on active anti-cancer therapies and have had no evidence of active malignancy for over 1 year. Previous hormonal therapy with luteinizing hormone-releasing hormone (LHRH) agonists for prostate cancer and treatment with bisphosphonates and receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitors are not criteria for exclusion

  * Note: Individuals on maintenance therapy alone who have no evidence of active malignancy for at least ≥ 1 year are eligible.
* Known active or chronic hepatitis B or C infection or human immunodeficiency virus

Note: Other protocol defined Inclusion/Exclusion criteria may apply.

+Posted results

Participant flow

MilestoneSafety Run-in Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + AzacitidineSafety Run-in Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)Safety Run-in Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486Phase 2 Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + AzacitidinePhase 2 Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)Phase 2 Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
Started760000
Completed200000
Not completed560000

Outcome results

  • Complete Remission (CR) Rate (Cohorts 1 and 2) (Primary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 38.9 (17.3 to 64.3); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 25 (12.1 to 42.2) (p 0.1794)
  • Minimal Residual Disease Negative Complete Remission Rate (Cohort 3) (Primary)
  • Percentage of Participants Experiencing Dose-limiting Toxicities (DLTs) (Safety Run-in Cohorts 1, 2 and 3) (Primary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 0; Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 0; Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Percentage of Participants Experiencing Treatment-emergent Adverse Events (TEAEs) (Cohorts 1, 2 and 3) (Primary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 100; Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 97.2; Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Percentage of Participants Experiencing Treatment-emergent Laboratory Abnormalities (Cohorts 1, 2 and 3) (Primary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 100; Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 97.2; Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Overall Response Rate (ORR) (Secondary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 66.7 (41.0 to 86.7); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 38.9 (23.1 to 56.5)
  • Complete Remission or Complete Remission With Partial Hematologic Recovery Rate (CR/CRh) (Cohorts 1 and 2) (Secondary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 44.4 (21.5 to 69.2); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 30.6 (16.3 to 48.1)
  • Duration of Response (DOR) (Cohorts 1 and 2) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 15.9 (2.2 to NA); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 8.7 (6.3 to NA)
  • Duration of Complete Remission (DCR) (Cohorts 1 and 2) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 15.9 (6.7 to NA); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 8.7 (2.3 to NA)
  • Duration of CR/CRi (Cohorts 1 and 2) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 15.9 (3.9 to NA); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 8.7 (2.3 to NA)
  • Duration of CR/CRh (Cohorts 1 and 2) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 15.9 (6.7 to NA); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 8.7 (2.3 to NA)
  • Event-Free Survival (EFS) (Cohorts 1 and 2) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 3.8 (0.0 to 16.8); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 0.0 (NA to NA)
  • Relapse-Free Survival (RFS) Rate (Cohort 3) (Secondary)
  • MRD Negative CR/CRi Rate (Cohort 3) (Secondary)
  • Duration of Minimal Residual Disease Negative Complete Remission (Cohort 3) (Secondary)
  • Duration of MRD Negative CR/CRi (Cohort 3) (Secondary)
  • Overall Survival (OS) (Cohorts 1, 2 and 3) (Secondary), Median, months: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 15.3 (3.1 to NA); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 10.5 (7.1 to 15.4); Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Red Blood Cell (RBC) Transfusion Independence Rate (Cohorts 1, 2 and 3) (Secondary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 30.8 (9.1 to 61.4); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 3.8 (0.1 to 19.6); Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Platelet Transfusion Independence Rate (Cohorts 1, 2 and 3) (Secondary), Number, percentage of participants: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 0.0 (0.0 to 70.8); Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 8.7 (1.1 to 28.0); Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • Plasma Concentration of Magrolimab in Combination With Anti-leukemia Therapy (Cohorts 1, 2 and 3) (Secondary), Mean, μg/mL: Cohort 1 (1L, Unfit AML): Magrolimab + Venetoclax + Azacitidine 0.0 +/- 0.0; Cohort 2 (R/R AML): Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine) 0.0 +/- 0.0; Cohort 3 (Post-Chemo Maintenance): Magrolimab + CC-486
  • 2 more outcome measures not shown.

Adverse events

Time frame: All-cause mortality: Up to 2 years; Adverse events: Up to 1.7 years plus 70 days

ArmDeathsSerious adverse eventsOther adverse events
Cohort 1 (1L, Unfit AML): Safety Run-In Cohort: Magrolimab + Venetoclax + Azacitidine5/7 (71.4%)7/7 (100.0%)7/7 (100.0%)
Cohort 2 (R/R AML): Safety Run-In Cohort: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)6/6 (100.0%)3/6 (50.0%)6/6 (100.0%)
Cohort 1 (1L, Unfit AML): Phase 2 Cohort: Magrolimab + Venetoclax + Azacitidine5/11 (45.5%)11/11 (100.0%)11/11 (100.0%)
Cohort 2 (R/R AML): Phase 2: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)19/30 (63.3%)18/30 (60.0%)29/30 (96.7%)

Serious adverse events by term

TermOrgan systemCohort 1 (1L, Unfit AML): Safety Run-In Cohort: Magrolimab + Venetoclax + AzacitidineCohort 2 (R/R AML): Safety Run-In Cohort: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)Cohort 1 (1L, Unfit AML): Phase 2 Cohort: Magrolimab + Venetoclax + AzacitidineCohort 2 (R/R AML): Phase 2: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)
Febrile neutropeniaBlood and lymphatic system disorders0/71/64/116/30
NeutropeniaBlood and lymphatic system disorders1/71/60/111/30
Atrial fibrillationCardiac disorders0/70/61/110/30
CardiomyopathyCardiac disorders0/70/60/111/30
Supraventricular tachycardiaCardiac disorders0/70/60/111/30
TachycardiaCardiac disorders0/70/60/111/30
Vision blurredEye disorders0/70/60/111/30
Gastric haemorrhageGastrointestinal disorders0/70/60/111/30
PancreatitisGastrointestinal disorders0/70/60/111/30
FatigueGeneral disorders0/70/60/111/30
PyrexiaGeneral disorders0/70/61/111/30
Haemophagocytic lymphohistiocytosisImmune system disorders0/70/60/111/30
Infusion related hypersensitivity reactionImmune system disorders0/70/61/110/30
Bronchopulmonary aspergillosisInfections and infestations0/70/60/111/30
Covid-19Infections and infestations0/70/61/110/30
Device related infectionInfections and infestations1/70/60/110/30
EpididymitisInfections and infestations0/70/61/110/30
Meningitis asepticInfections and infestations0/70/61/110/30
Neutropenic sepsisInfections and infestations0/70/61/110/30
Perirectal abscessInfections and infestations0/71/60/110/30
PneumoniaInfections and infestations1/70/60/110/30
Pseudomonal bacteraemiaInfections and infestations1/70/60/110/30
SepsisInfections and infestations2/71/61/116/30
Septic shockInfections and infestations0/70/60/111/30
Testicular abscessInfections and infestations0/70/61/110/30
Lumbar vertebral fractureInjury, poisoning and procedural complications1/70/60/110/30
Thermal burnInjury, poisoning and procedural complications0/70/61/110/30
Flank painMusculoskeletal and connective tissue disorders1/70/60/110/30
EncephalopathyNervous system disorders0/70/61/110/30
Haemorrhage intracranialNervous system disorders0/70/61/110/30
Lacunar strokeNervous system disorders0/70/61/110/30
SyncopeNervous system disorders0/70/61/110/30
Nephropathy toxicRenal and urinary disorders1/70/60/110/30
Genital haemorrhageReproductive system and breast disorders1/70/60/110/30
Acute respiratory failureRespiratory, thoracic and mediastinal disorders1/71/60/110/30
DyspnoeaRespiratory, thoracic and mediastinal disorders0/70/61/110/30
Pulmonary embolismRespiratory, thoracic and mediastinal disorders0/70/62/110/30
Respiratory failureRespiratory, thoracic and mediastinal disorders0/70/61/110/30
HypotensionVascular disorders0/70/61/111/30

Other adverse events by term

TermOrgan systemCohort 1 (1L, Unfit AML): Safety Run-In Cohort: Magrolimab + Venetoclax + AzacitidineCohort 2 (R/R AML): Safety Run-In Cohort: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)Cohort 1 (1L, Unfit AML): Phase 2 Cohort: Magrolimab + Venetoclax + AzacitidineCohort 2 (R/R AML): Phase 2: Magrolimab + MEC (Mitoxantrone + Etoposide + Cytarabine)
AnaemiaBlood and lymphatic system disorders3/72/66/1114/30
Febrile neutropeniaBlood and lymphatic system disorders2/73/63/1112/30
LeukopeniaBlood and lymphatic system disorders1/70/60/112/30
NeutropeniaBlood and lymphatic system disorders2/70/61/112/30
Splenic infarctionBlood and lymphatic system disorders0/70/61/110/30
ThrombocytopeniaBlood and lymphatic system disorders2/70/60/113/30
Atrial fibrillationCardiac disorders1/70/62/110/30
Cardiac failureCardiac disorders0/71/61/111/30
PalpitationsCardiac disorders0/70/61/110/30
Pericardial effusionCardiac disorders0/70/61/110/30
Sinus bradycardiaCardiac disorders0/71/60/111/30
Sinus tachycardiaCardiac disorders0/71/62/114/30
TachycardiaCardiac disorders0/70/61/113/30
HydroceleCongenital, familial and genetic disorders0/71/60/110/30
VertigoEar and labyrinth disorders1/70/60/110/30
Conjunctival haemorrhageEye disorders1/70/60/110/30
Vision blurredEye disorders1/70/61/110/30
Visual impairmentEye disorders0/70/61/110/30
Vitreous degenerationEye disorders0/70/61/110/30
Abdominal painGastrointestinal disorders1/72/64/119/30
Abdominal pain upperGastrointestinal disorders0/70/60/113/30
Abdominal tendernessGastrointestinal disorders0/70/61/110/30
Anal fistulaGastrointestinal disorders0/71/60/111/30
Anal incontinenceGastrointestinal disorders1/70/62/110/30
ConstipationGastrointestinal disorders2/71/66/118/30
DiarrhoeaGastrointestinal disorders3/73/66/1110/30
Dry mouthGastrointestinal disorders0/71/60/112/30
DyspepsiaGastrointestinal disorders0/70/61/114/30
DysphagiaGastrointestinal disorders0/70/60/113/30
Gastrooesophageal reflux diseaseGastrointestinal disorders0/71/62/114/30
GlossodyniaGastrointestinal disorders0/70/61/110/30
HaematocheziaGastrointestinal disorders0/70/62/110/30
HaemorrhoidsGastrointestinal disorders1/72/60/115/30
Mouth haemorrhageGastrointestinal disorders0/70/61/110/30
NauseaGastrointestinal disorders4/74/67/1114/30
Oesophageal painGastrointestinal disorders0/70/60/112/30
Oral painGastrointestinal disorders0/70/62/114/30
ProctalgiaGastrointestinal disorders1/70/60/112/30
Salivary hypersecretionGastrointestinal disorders0/70/61/110/30
StomatitisGastrointestinal disorders0/72/60/117/30
Tongue discolourationGastrointestinal disorders0/70/61/110/30
ToothacheGastrointestinal disorders0/71/60/110/30
VomitingGastrointestinal disorders0/72/63/1110/30
AstheniaGeneral disorders1/70/61/110/30
Catheter site painGeneral disorders0/70/61/111/30
Chest painGeneral disorders0/70/62/111/30
ChillsGeneral disorders1/72/62/116/30
FatigueGeneral disorders3/72/64/119/30
Injection site rashGeneral disorders0/70/61/111/30
Localised oedemaGeneral disorders0/72/60/112/30
MalaiseGeneral disorders0/70/60/112/30
Non-cardiac chest painGeneral disorders0/70/61/113/30
Oedema peripheralGeneral disorders2/71/63/115/30
PainGeneral disorders0/71/62/112/30
PyrexiaGeneral disorders1/73/66/1116/30
ThirstGeneral disorders0/70/61/110/30
Hepatic failureHepatobiliary disorders0/70/61/110/30
Hepatic infarctionHepatobiliary disorders0/70/61/110/30
Hepatic lesionHepatobiliary disorders0/70/61/110/30
HyperbilirubinaemiaHepatobiliary disorders1/70/60/113/30

149 more terms not shown.

+Locations (21)

FacilityCityCountryStatus
University of Alabama at BirminghamBirmingham, AlabamaUnited States
City of Hope (City of Hope National Medical Center, City of Hope Medical Center)Duarte, CaliforniaUnited States
USC/Norris Comprehensive Cancer CenterLos Angeles, CaliforniaUnited States
Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer InstituteLos Angeles, CaliforniaUnited States
Stanford Cancer CenterPalo Alto, CaliforniaUnited States
Sylvester Comprehensive Cancer CenterMiami, FloridaUnited States
The University of Chicago Medical CenterChicago, IllinoisUnited States
Karmanos Cancer InstituteDetroit, MichiganUnited States
Washington University School of MedicineSt Louis, MissouriUnited States
Roswell Park Cancer InstituteBuffalo, New YorkUnited States
Levine Cancer InstituteCharlotte, North CarolinaUnited States
Cleveland Clinic FoundationCleveland, OhioUnited States
OU Health, Stephenson Cancer CenterOklahoma City, OklahomaUnited States
Baylor University Medical CenterDallas, TexasUnited States
MD Anderson Cancer CenterHouston, TexasUnited States
Swedish Cancer InstituteSeattle, WashingtonUnited States
Froedtert Hospital & the Medical College of WisconsinMilwaukee, WisconsinUnited States
Austin HealthHeidelberg, VictoriaAustralia
The Alfred HospitalMelbourne, VictoriaAustralia
Royal Perth HospitalPerth, Western AustraliaAustralia
Oxford University Hospitals NHS Foundation Trust, Churchill HospitalOxfordUnited Kingdom

+Publications

  • Mannis GN, Abboud C, Daver NG, Guru Murthy GS, Wang ES, Bradley TJ, et al. Tolerability and Efficacy of Magrolimab Plus Mitoxantrone, Etoposide, and Cytarabine (MEC) in Patients with Acute Myeloid Leukemia (AML) Refractory/Relapsed (R/R) After Induction Chemotherapy (IC). European Hematology Association (EHA) 13-16 June 2024.
  • Results publication: Mannis GN, Abboud CN, Daver NG, Murthy GSG, Wang ES, Bradley TJ, Yaghmour G, Vachhani P, Balasubramanian SK, Chua CC, Fong CY, Asch AS, Dong M, Li S, Bagheri T, Doshi P, Vyas P, Malki MMA. Phase 2 Multi-Arm Study of Magrolimab Combinations in Patients With Acute Myeloid Leukaemia. EJHaem. 2025 May 13;6(3):e70051. doi: 10.1002/jha2.70051. eCollection 2025 Jun. PMID 40364806

+Study documents

+Investigators

  • Gilead Study Director, Study director, Gilead Sciences