Crenolanib in Combination With Sorafenib in Patients With Refractory or Relapsed Hematologic Malignancies

Each course of therapy will be 28 days (±5 days), unless disease progression is seen while on
the combination of crenolanib with sorafenib. Patients may receive subsequent courses (up to
a total of 365 days) if there is no disease progression or unacceptable toxicity.

In Day 1 of Course 1, crenolanib is given once in the morning followed by characterization of
the pharmacokinetic profile over the following 24-hour period. Starting with day 2 of Course
1, crenolanib will be given 3 times per day through day 28. On Days 8 to 28 of Course 1,
sorafenib will be given once per day. Inter-patient dose escalation or de-escalation of
crenolanib will be performed based on tolerability and toxicity.

Response will be assessed on days 8 and at end of course. If disease progresses prior to day
8, then sorafenib can be given before day 8.

In subsequent courses (up to 365 days), crenolanib and sorafenib are given on days 1 through
28. The treating physician may increase or decrease the sorafenib dose and frequency of
administration per the trial's dosing table on the basis of effects and tolerability. If
necessary, the crenolanib dose can be decreased per protocol.

Maintenance therapy must start no sooner than 30 days and no later than 120 days after
hematopoietic stem cell therapy (HSCT). Single agent crenolanib will start at the last dose
tolerated prior to HSCT. Crenolanib maintenance can be given for up to 365 days and
additional therapy can be provided after discussion after discussion with the PI, in patients
who continue to benefit after 1 year.

Inclusion Criteria - Initial Enrollment:

- Participant has a relapsed or refractory hematologic malignancy (with any measurable
disease) with FLT3-ITD or TKD mutations and one of the following diagnoses:

- Acute myeloid leukemia (AML)

- AML with prior myelodysplastic syndrome (MDS)

- Myeloperoxidase (MPO)-positive mixed phenotype acute leukemia

- Participant's disease has relapsed after, is refractory to induction and/or salvage
therapy, or has relapsed after hematopoietic stem cell transplant (HSCT).

- Participant disease tested positive for FLT3-ITD or -TKD within 60-day screening
period.

- Participant's age is 1 to 25 years, inclusive (St. Jude participants must be aged 1 to
25 years, inclusive).

- Karnofsky or Lansky performance score is > 60%. The Lansky performance score should be
used for participants < 16 years and the Karnofsky performance score for participants
≥ 16 years.

- Adequate organ function defined as:

- Bilirubin ≤1.5 x upper limit of normal (ULN)

- ALT ≤ 3 x ULN and AST ≤ 3 x ULN

- Serum creatinine ≤1.5 x ULN

- Participant must have recovered from the acute side effects of all prior anti-cancer
therapy, and:

- At least 2 weeks have elapsed since prior systemic cytotoxic chemotherapy (except
intrathecal chemotherapy, hydroxyurea, low-dose cytarabine, and/or low dose
maintenance therapy such as vincristine, mercaptopurine, methotrexate or
glucocorticoids), and

- If the participant received a prior allogeneic HSCT, at least 30 days have
elapsed and there is no evidence of clinically significant graft versus host
disease requiring treatment and/or have > grade 2 persistent non-hematologic
toxicity related to a transplant

Exclusion Criteria - Initial Enrollment:

- Concurrent chemotherapy, or targeted anti-cancer agents, other than hydroxyurea,
low-dose cytarabine, intrathecal therapy and/or low dose maintenance therapy such as
vincristine, mercaptopurine, methotrexate or glucocorticoids.

- Patient with concurrent severe and/or uncontrolled medical conditions that, in the
opinion of the investigator, may impair participation in the study or the evaluation
of safety and/or efficacy.

- Known HIV infection or active hepatitis B (defined as hepatitis B surface
antigen-positive) or C (defined as hepatitis C antibody-positive).

- Prior crenolanib treatment for a non-leukemic indication.

- Major surgical procedures within 14 days of Day 1 administration of crenolanib.

- Pregnant or lactating (female participant of childbearing potential must have negative
serum or urine pregnancy test required within 7 days prior to start of treatment).

- Male or female participant of reproductive potential must agree to use appropriate
methods of contraception for the duration of study treatment and for at least 30 days
after last dose of protocol treatment

- Inability or unwillingness or research participant or legal guardian/representative to
give written informed consent.

Inclusion Criteria - Maintenance Therapy After HSCT:

- Patient must have received crenolanib on this protocol prior to HSCT to continue on to
maintenance.

- Patient must be within 30 - 120 days after hematopoietic stem cell transplant (HSCT).

- Response to previous treatment on this protocol: at least resistant disease with
clinical benefit or better response.

- Patient is off or on a stable dose of immunosuppressive drugs for management or
prophylaxis of graft-versus-host-disease (GVHD) (defined as no escalation of therapy
for GVHD) within 14 days prior to starting crenolanib.

- Patient must have recovered from acute side effects of HSCT, defined as having 2 non-hematological toxicity related to the transplant (exceptions are alopecia and
other non-acute toxicities).

- Adequate hematopoietic recovery (ANC >500/mm^3 and platelet count >50,000/mm^3)

- Research participant or legal guardian/representative is able and willing to give
written informed consent.