Phase I Trial of Universal Donor NK Cell Therapy in Combination With ALT803

Primary Objective:

To determine the maximum tolerated dose of ex vivo expanded non-HLA matched donor NK cells in
combination with ALT-803

Secondary Objectives:

- Describe safety profile / toxicity of combining ALT-803 with NK cell adoptive therapy.

- Determine antitumor activity of allogeneic NK cells with ALT-803 support.

- Determine if a lymphocyte depleting regimen is adequate for preventing early elimination
of HLA-mismatched donor NK cells by host T-cells.

Study Design:

This is a phase I study with "3+3" design with three planned dose levels of NK cells and a
fixed dose of ALT-803. Three patients will be enrolled sequentially to each dose level,
starting with dose level 1. Patients will be segregated to either receive ALT803 as cytokine
support after NK cell infusion (starting with same dose level as Level 1) or no cytokine
administration. Patients in the arm receiving ALT803 will be either hematologic malignancy
patients (Cohort A) or Colon/Soft tissue sarcoma patients (Cohort B). Absence of dose
limiting toxicity (DLT) in the DLT assessment period of 28 days must be documented for all
patients enrolled a cell dose without ALT803 before the next cohort of patients to receive
cytokines at that dose level can be enrolled. Patients can also be enrolled in parallel to
the next cell dose level without cytokines.

Inclusion Criteria:

- Patients must have histologic confirmation of relapsed and or refractory hematologic
malignancy, locally advanced or metastatic colon/rectal carcinoma, or refractory
and/or relapsed soft tissue sarcomas and have failed at least one standard line of
therapy.

- Patients will be eligible if they have either declined standard treatment regimens or
if there is no standard approach to curative salvage therapy per National
Comprehensive Cancer Network (NCCN) guidelines in the setting of relapsed/refractory
disease.

- In addition, patients for whom a potential 29-day delay in treatment will not
interfere with the subject's potential therapeutic options can be eligible per the
treating physician's discretion.

Malignancies can include:

- Acute myeloid leukemia

- Myelodysplastic syndrome

- Acute lymphoblastic leukemia

- Chronic myeloid leukemia

- Chronic lymphocytic leukemia

- Non Hodgkin Lymphoma

- Hodgkin Lymphoma

- Myeloproliferative syndromes

- Plasma cell myeloma

- Colon/rectal carcinoma

- Soft tissue sarcomas including but not limited to Ewing's sarcoma and Rhabdomyosarcoma

- Patients must have recovered from acute toxicities of prior chemotherapy or stem
cell transplant. Any prior non-hematologic vital organ toxicity (cardiac,
pulmonary, hepatic, renal) of previous therapy must have resolved to grade 1 or
less.

- All previous chemotherapy or radiation must be completed at least 3 weeks prior
to study entry. Immunologic therapy must be completed at least 3 weeks prior to
study entry. Patients with prior stem cell transplant must be greater than 365
days post-transplant.

- Eastern Cooperative Oncology Group (ECOG) performance status ≤2

- Organ function criteria (There is no exclusion for the presence of cytopenias),

- Serum total bilirubin <2 mg/dl (except if known Gilbert syndrome and normal
transaminases)

- Aspartate aminotransferase (AST) (SGOT) < 2.5 X institutional upper limit of
normal

- Alanine aminotransferase (ALT) (SGPT) < 2.5 X institutional upper limit of
normal

- Pulmonary function (DLCO) >40% of the expected value corrected for alveolar
volume and hemoglobin

- Serum Creatinine ≤ 1.5 X institutional upper limit of normal

- Subjects must have the ability to understand and the willingness to sign a
written informed consent document.

- Women of child-bearing potential and men must agree to use adequate contraception
(double barrier method of birth control or abstinence) 4 weeks prior to study
entry and for the duration of study participation. Women of child-bearing age
must have documented negative pregnancy test prior to start of lympho-depleting
regimen.

Exclusion Criteria:

- Subjects receiving any other investigational agents.

- Subjects for whom a potential 29-day delay in treatment will interfere with the
subject's potential therapeutic options.

- Patients with untreated malignant involvement of the central nervous system (CNS)
should be excluded from this clinical trial because of their poor prognosis and
because they often develop progressive neurologic dysfunction that would confound the
evaluation of neurologic and other adverse events. Head imaging will be necessary to
document absence of CNS involvement in patients with colon/rectal cancer and soft
tissue sarcomas. Patients with hematologic malignancies who have undergone treatment
for malignant involvement of the CNS must have no evidence of residual disease by
imaging or CSF sampling prior to study enrollment.

- History of allergic reactions to chemotherapy agents used in this protocol as part of
lymphodepletion regimen (Fludarabine and Cyclophosphamide)

- Patients with uncontrolled intercurrent illness including, but not limited to ongoing
active uncontrolled infection, symptomatic congestive heart failure, unstable angina
pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would
limit compliance with study requirements.

- Pregnant or breastfeeding women are excluded from this study.

- HIV-positive patients on combination antiretroviral therapy are ineligible because of
the potential for pharmacokinetic interactions with chemotherapeutic agents. In
addition, these patients are at increased risk of lethal infections when treated with
marrow suppressive therapy. Appropriate studies will be undertaken in patients
receiving combination antiretroviral therapy when indicated.

- Chronic active untreated hepatitis B or C infection.

- Recipients of previous allogeneic transplants who have rash involving more than 10%
body surface area attributed to graft versus host disease (GVHD) (> Grade 1 GVHD of
skin). Stem cell transplant recipients will be excluded if they are still receiving
immunosuppression including steroids for GVHD or have active GVHD in any organ (except
for Grade 1 only of skin, not requiring treatment).