Each potential participant must satisfy all of the following criteria to be enrolled in the study:

AGE

1. >=18 years (or the legal age of consent in the jurisdiction in which the study is taking place) at the time of informed consent.

TYPE OF PARTICIPANT AND DISEASE CHARACTERISTICS

2. Criterion modified per Amendment 2

2.1 Criterion modified per Amendment 4

2.2 Criterion modified per Amendment 5

2.3 Muscle-invasive or recurrent, non-muscle-invasive urothelial carcinoma of the bladder.

a. Mixed histology tumors are allowed if urothelial differentiation is predominant (ie, < 20% variant histology). However, the presence of micropapillary, signet ring cell, plasmacytoid, neuroendocrine, or sarcomatoid features are exclusionary.
b. High-risk papillary disease (Cohorts 1 and 2 [Part 2 only]), defined as histologically confirmed high-grade Ta/T1 lesion. Concurrent CIS is not allowed. All visible tumor must be completely resected prior to the start of study treatment and documented on screening cystoscopy.
c. Intermediate-risk papillary disease (Cohort 3, and Cohort 5 [Part 2 only]) defined as all previous tumors being low grade, Ta or T1, and no previous CIS. Cystoscopic documentation of recurrence is sufficient. Negative urine cytology for high grade urothelial carcinoma is required. Visible disease must be present at the time of first TAR-210 insertion.
d. Muscle-invasive disease (Cohort 4 [Part 2 only]) cT2-T3a, N0. Participants must have a total tumor size <= 3 cm after TURBT at cystoscopic assessment within 8 weeks prior to the start of study treatment or must have a second debulking TURBT to reduce the tumor(s) to <= 3 cm in order to be eligible.

^a In Spain, Cohort 4 must have had a TURBT within 6 weeks prior to initiation of treatment (Day 1). See Section 10.14 (Appendix 14) Country/Territory-Specific Requirements.

3 Criterion modified per Amendment 4

3.1 Cohorts 1-4: Activating tumor FGFR mutation or fusion, as determined bylocal* or central testing, approved by the sponsor prior to the start of study treatment.

Cohort 5: Valid results negative for any of the sponsor-approved activating tumor FGFR mutations or fusions (See Appendix 12: Section 10.12), as determined by local* or central testing of tissue and central testing of urine prior to the start of study treatment.

* Local tissue-based results (if already existing) from next-generation sequencing (NGS) or polymerase chain reaction (PCR) tests performed in CLIA-certified or equivalent laboratories, or results from commercially available PCR or NGS tests.

4. Criterion modified per Amendment 2

4.1 Criterion modified per Amendment 4

4.2. Cohorts 1 and 2: BCG experienced, or participants with no BCG experience because BCG was not available as a treatment option in the participant’s location within the previous 2 years and is currently unavailable. Participants who received an abbreviated course of BCG due to toxicity are still eligible. BCG experienced is defined as:

- Recurrent high-grade Ta/T1 disease within 18 months of completion of prior BCG therapy
- Prior BCG (minimum treatment requirements):
1) At least 5 of 6 full doses of an initial induction course. Full dose BCG defined as 1 full vial containing a minimum of 1 x 10^8 colony forming units.

Note: Cohorts 3 and 5 have no predefined prior BCG or intravesical chemotherapy requirement.

5. Cohort 1 only: Refuses or is not eligible for RC

6. Cohorts 2 and 4: Willing and eligible for RC

7. Cohort 4: Refuses (and understands the risks and benefits of doing so) cisplatin-based combination chemotherapy or is deemed ineligible for cisplatin-based chemotherapy by meeting at least one of the following criteria:
- Creatinine clearance (CrCl) < 60 mL/min
- NCI-CTCAE v.5.0 Grade >= 2 audiometric hearing loss
- NCI-CTCAE v.5.0 Grade >= 2 peripheral neuropathy

8 Criterion modified per Amendment 4

8.1 Eastern Cooperative Oncology Group (ECOG) performance status score of <=2 (Cohorts 1, 3 and 5) or <=1 (Cohorts 2 and 4) (see Section 10.9 for ECOG scoring)

9. Adequate bone marrow, liver, and renal function:

a. Bone marrow function (without the support of growth factors or transfusions in preceding 2 weeks):
- Absolute neutrophil count (ANC) >= 1,000/mm^3
- Platelet count >= 75,000/mm^3
- Hemoglobin >= 8.0 g/dL
b. Liver function:
- Total bilirubin <= 1.5 x the upper limit of normal (ULN) OR direct bilirubin <= 1.5 x ULN for participants with Gilbert’s syndrome who have total bilirubin levels > 1.5 x ULN
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) <= 2.5 x ULN
c. Renal function:
- Estimated glomerular filtration rate > 30 mL/min calculated using the Modified Diet in Renal Disease (MDRD) formula (see Appendix 11)

SEX AND CONTRACEPTIVE/BARRIER REQUIREMENTS

10 Criterion modified per Amendment 4

10.1 A participant of childbearing potential must have a negative highly sensitive serum (eg, beta-human chorionic gonadotropin [ß-hCG]) pregnancy test at screening and a negative urine test (or serum test if required by local regulations) within 72 hours of the first dose (ie, first insertion) of study treatment, and must agree to further serum or urine pregnancy tests during the study.

11 Criterion modified per Amendment 4

11.1 A participant of childbearing potential must practice at least 1 highly effective method of contraception (details in Appendix 4: Contraceptive and Barrier Guidance)throughout the study and through 90 days after the last of study treatment.

Note: If the participant becomes of childbearing potential after start of the study the participant must comply with this criterion.

A participant must agree not to be breastfeed or plan to become pregnant during the study and for at least 90 days after removal of the last TAR-210 system.

A participant must agree not to donate gametes (ie, eggs or sperm) or freeze gametes for future use for the purposes of assisted reproduction during the study and for at least 90 days after removal of the last TAR-210 system. Participants should consider preservation of gametes prior to study treatment as anti-cancer treatments may impair fertility.

12. Criterion modified per Amendment 4

12.1 A participant must wear a condom) when engaging in any activity that allows for passage of ejaculate to another person during the study and for a minimum of 90 daysafter removal of the last TAR-210 system.

If a participant’s partner is of childbearing potential, the participant must use condoms (with or without spermicidal foam/gel/film/cream/suppository) and the partner must also be practicing a highly effective method of contraception (see Appendix 4: Contraceptive and Barrier Guidance). A vasectomized participant must still use a condom (with or without spermicide), but the partner is not required to use contraception.

A participant must also agree not to plan to father a child while enrolled in this study or within 90 days after removal of the last TAR-210 system.

INFORMED CONSENT

13. Must sign an informed consent form (ICF) indicating that the participant understands the purpose of, and procedures required for, the study and is willing to participate in the study.

14. Willing and able to adhere to the lifestyle restrictions specified in this protocol

Any potential participant who meets any of the following criteria will be excluded from participating in the study:

MEDICAL CONDITIONS

1. Concurrent extra-vesical (ie, urethra, ureter, renal pelvis) transitional cell carcinoma of the urothelium.

2. Prior treatment with an FGFR inhibitor.

3. Known hypersensitivity to any study component including:

- Erdafitinib (or other drug excipients) or chemically related drugs,
- TAR-210 device constituent materials,
- UPC materials.

Refer to the TAR-210 IB for complete information on excipients, device constituent materials, and UPC materials.

4. Received pelvic radiotherapy =6 months prior to the planned start of study treatment. If received pelvic radiotherapy >6 months prior to the start of study treatment, there must be no cystoscopic evidence of radiation cystitis.

5. Presence of any bladder or urethral anatomic feature that in the opinion of the investigator may prevent the safe placement, indwelling use, or removal of TAR-210.

6. Indwelling urinary catheter. Intermittent catheterization is acceptable.

7. Cystoscopic evidence of bladder perforation unless such perforation has resolved prior to dosing.

8. Bladder post-void residual volume (PVR) > 350 mL after second voided urine.

9. History of clinically significant polyuria with recorded 24-hour urine volumes > 4,000 mL.

10 Subjects with active bladder stones or history of bladder stones < 6 months prior to the start of study treatment.

11. Active malignancies (ie, progressing or requiring treatment change in the last 24 months) other than the disease being treated under study. Potential allowed exceptions include the following (othersmay be allowedwith sponsor approval):

a. skin cancer (non-melanoma or melanoma)that is considered completely cured.
b. non-invasive cervical cancer that is considered completely cured.
c. adequatelytreated lobular carcinoma in situ (LCIS) and ductalCIS
d. history of localized breast cancer and receiving antihormonal agents
e. history of localized prostate cancer (N0M0) and receiving androgen deprivationtherapy
f. Localized prostate cancer (N0M0):
- with a Gleasonscore of6, treatedwithin the last24 months or untreated and under surveillance,
- with a Gleason score of3+4 that has been treated more than 6 months prior to full study Screening and considered to have a very low risk of recurrence,
- or history of localized prostate cancer and receiving androgen deprivation therapy and considered to have a very low risk of recurrence.

12. Current central serous retinopathy or retinal pigment epithelial detachment of any grade.

13. History of uncontrolled cardiovascular disease including:

- Any of the following within 3 months prior to the start of study treatment: unstable angina, myocardial infarction, ventricular arrhythmias or clinically significant atrial arrythmias (eg, atrial fibrillation with uncontrolled rate), cardiac arrest, or known congestive New York Heart Association Class III-IV heart failure (Appendix 10), cerebrovascular accident, or transient ischemic attack.

- Pulmonary embolism or other venous thromboembolism within 1 month prior to the planned start of study treatment.

14. Active or chronic hepatitis B or C infection according to the following criteria:

- Seropositive for hepatitis B: defined by a positive test for hepatitis B surface antigen [HBsAg]. Participants with resolved infection (ie, participants who are HBsAg negative with antibodies to total hepatitis B core antigen [anti-HBc] with or without the presence of hepatitis B surface antibody [anti-HBs]) must be screened using real-time polymerase chain reaction (RT-PCR) measurement of hepatitis B virus (HBV) DNA levels. Those who are RT-PCR positive will be excluded. Participants with anti-HBs positivity as the only serologic marker AND a known history of prior HBV vaccination do not need to be tested for HBV DNA by RT-PCR.

- Hepatitis C infection defined by a positive hepatitis C antibody (anti-HCV) test. Participants who test positive for anti-HCV are eligible if RNA viral load is undetectable (spontaneous recovery or after completing treatment for hepatitis C virus infection).

15. Major surgery within 4 weeks before Day 1 (TURBT is not considered major surgery)

16. Criterion modified per Amendment 4

16.1 Active bacterial, viral, fungal infection, including urinary tract infection*, requiring oral or systemic therapy within 7 days prior to Day 1.

*Urinary tract infection is defined as a symptomatic infection with a positive urine culture with a bacterial count of >= 105 colony forming units (CFU)/mL in urine voided from women, or >= 1 04 CFU/mL in urine voided from men, or in straight-catheter urine from women. Symptoms may include dysuria, urgency, frequency, and/or systemic symptoms such as fever, chills, elevated white blood cell, and/or abdominal/flank pain. Participants free from symptoms for 7 days with no culture evidence of >= 105 CFUs may be eligible.

17. Toxicity from prior anticancer therapy has not resolved to baseline levels or to Grade <= 1 (except alopecia, vitiligo, peripheral neuropathy, or endocrinopathies that are stable on hormone replacement, which may be Grade 2).

18. Known human immunodeficiency virus (HIV)-positive participants with 1 or more of the following:

- Not receiving highly active antiretroviral therapy (ART)
- Had a change in ART within 6 months of the start of screening
- Receiving ART that may interfere with study treatment (consult the sponsor for review of medication prior to the start of study treatment)
- CD4+ count < 350 at screening
- Acquired immunodeficiency syndrome (AIDS)-defining opportunistic infection within 6 months of start of screening
- Not agreeing to start ART and be on ART > 4 weeks prior to the start of study treatment. Only participants who have HIV viral load <400 copies/mL at the end of the 4-week period and agree to continue on ART, would be eligible (to ensure ART is tolerated and HIV controlled).

PRIOR/CONCURRENT CLINICAL STUDY EXPERIENCE

19. Received an investigational intervention (including investigational vaccines) or used an invasive investigational medical device within 28 days before the planned start of study treatment or is currently enrolled in an investigational study.

20. Prior anticancer therapy within 4 weeks before the planned start of study treatment. Exception: a single intravesical chemotherapy treatment immediately after TURBT is allowed.

21. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.

NOTE: Investigators should ensure that all study enrollment criteria have been met at screening. If a participant’s clinical status changes (including any available laboratory results or receipt of additional medical records) after screening but before the first dose of study treatment is given such that the participant no longer meets all eligibility criteria, then the participant should be excluded from participation in the study. Section 5.4, Screen Failures, describes options for retesting. The required source documentation to support meeting the enrollment criteria are noted in Appendix 3: Regulatory, Ethical, and Study Oversight Considerations.

Each potential participant must satisfy all of the following criteria (except as indicated for specific cohort[s])to be enrolled in the study:

1. = 18 years of age.

2. Criterion modified per Amendment 1

2.1 Criterion modified per Amendment 2

2.2 Diagnosis of acute myeloid leukemia (AML) according to World Health Organization criteria:
- De novo or secondary AML
- Relapsed /refractory (Arm A only) or newly diagnosed AML
- Participants may receive emergency leukapheresis and/or 1 dose of 1-2 g/m^2 cytarabine as cytoreductive therapy according to local practice guidelines prior to first dose of study treatment to control hyperleukocytosis (see Section 6.8.1). If possible, these treatments should not be given until after the screening bone marrow assessment; however, these treatments must be discontinued = 24 hours prior to start of study treatment).
- Harboring KMT2A or NPM1 alterations

3. Updated per Amendment 1

3.1 COHORT B1 ONLY: Must be newly diagnosed and INELIGIBLE for intensive chemotherapy based on the following criteria:
- = 75 years of age or
- = 18 to < 75 years of age with =1 of the following comorbidities:
- Eastern Cooperative Oncology Group (ECOG) performance status of 2 (see Appendix 11.13)
- Cardiac comorbidity NYHA Class I or II
- Severe pulmonary comorbidity (baseline pulmonary disease), defined as documented pulmonary disease with lung diffusing capacity for carbon monoxide = 65 % of expected or forced expiratory volume in 1 second = 65 % of expected Comorbidity that, in the investigator’s opinion, makes the participant unsuitable for intensive chemotherapy, which must be documented and approved by the sponsor before enrollment

4. COHORT C1 ONLY: Must be = 18 to < 75 years of age, newly diagnosed and ELIGIBLE for intensive chemotherapy

5. Criterion modified per Amendment 2

5.1 Pretreatment clinical laboratory values meeting the following criteria -listed below:

HEMATOLOGY
- White blood cell (WBC) count: = 25 x 10^9/L (hydroxyurea may be used to lower WBC count at screening and during study; cytoreductive therapy may be considered with sponsor approval; see Criterion 2.2 and Section 6.8.1)

Chemistry
- Aspartate aminotransferase (AST) and alanine aminotransferase (ALT): = 2.5 x upper limit of normal (ULN)
- Total bilirubin < 1.5 x ULN (participants with elevated bilirubinemia, such as Gilbert’s syndrome, may enroll if conjugated bilirubin is within clinically acceptable range and total bilirubin = 3 x ULN).
- Renal function: Estimated or measured glomerular filtration rate = 40 mL/min/1.73m^2 per MDRD formula (Levey 2006; see Section 11.14)

6. Criterion modified per Amendment 2/EEA-1

6.1 ECOG performance status grade of 0, 1 or 2 (See Appendix 13; Oken 1982). See Appendix 11.18.1 for ECOG requirements for participants in France.

7. A woman of childbearing potential must have a negative highly sensitive serum Beta-human chorionic gonadotropin at screening and within 48 hours prior to the first dose of study
treatment.

8. Criterion modified per Amendment 1

8.1 Criterion modified per Amendment 2

8.2 A woman of childbearing potential must agree to all the following during the study and for 6 months after the last dose of study treatment (see Appendix 5: Contraceptive and
Barrier Guidance):
- Use a barrier method of contraception
- Use a highly effective preferably user-independent method of contraception
- Not to donate eggs (ova, oocytes) or freeze for future use for the purposes of assisted reproduction
- Not plan to become pregnant
- Not to breast-feed

9. Criterion modified per Amendment 2

9.1 A male must agree to all the following during the study and for 3 months after the last dose of study treatment or for 6 months following the last dose of daunorubicin:
- Wear a condom when engaging in any activity that allows for passage of ejaculate to another person.
- Not to donate sperm or freeze for future use for the purpose of reproduction.
- In addition, the participant should be advised of the benefit for a female partner to use a highly effective method of contraception as condom may break or leak.

10. Must sign an informed consent form (ICF) indicating participant understands the purpose of the study and procedures required for the study and is willing to participate in the study. Consent is to be obtained prior to the initiation of any study-related tests or procedures that are not part of standard of care for the participant’s disease.

11. Willing and able to adhere to the prohibitions and restrictions specified in this protocol.

Any potential participant who meets any of the following criteria will be excluded from participating in the study:

1. Acute promyelocytic leukemia according to WHO 2016 criteria (Arber 2016).

2. Leukemic involvement of the central nervous system

3. Recipient of solid organ transplant

4. Criterion modified per Amendment 2

4.1 Any prior treatment with a menin-KMT2A inhibitor (exception: participants with prior menin-KMT2A inhibitor exposure may be considered for enrollment with sponsor approval)

5. Criterion modified per Amendment 2

5.1 Cardiovascular disease that is uncontrolled, increases risk for Torsades de Pointes or that was diagnosed within 6 months prior to the first dose of study treatment including, but not limited to:
a. Myocardial infarction
b. Severe or unstable angina
c. Clinically significant cardiac arrhythmias, including bradycardia (< 50 beats per minute)
d. Currently uncontrolled (persistent) hypertension: systolic blood pressure = 140 mm Hg; diastolic blood pressure > 90 mm Hg
e. Acute neurologic events such as stroke or transient ischemic attack, intracranial or subarachnoid hemorrhage, intracranial trauma
f. Venous thromboembolic events (eg, pulmonary embolism) within 1 month prior to the first dose of study treatment (uncomplicated Grade = 2 deep vein thrombosis is not considered exclusionary)
g. Congestive heart failure (NYHA class III to IV) (AHA 1994)
h. Pericarditis or clinically significant pericardial effusion
i. Myocarditis
j. Endocarditis
k. Clinically significant hypokalemia, hypomagnesemia, hypocalcemia (corrected for hypoalbuminemia)
l. COHORT C1 ONLY:
- Reached cumulative dose of any combination of anthracyclines or anthracenediones of 550 g/m^2
- LVEF < 50 %
6. QTc according to Fridericia’s formula (QTcF) for males = 450 msec or for females = 470 msec. Participants with a family history of Long QT syndrome are excluded.
NOTE: For participants with documented wide QRS interval (eg, due to a bundle branch block), alternate methods of calculating a corrected QT interval may be appropriate for eligibility determination if recommended by a consulting cardiologist and approved by the sponsor, provided there is no evidence or history of a repolarization abnormality.

7. Any toxicity (except for alopecia, stable peripheral neuropathy, thrombocytopenia, neutropenia, anemia) from previous anticancer therapy that has not resolved to baseline or to Grade 1 or less.

8. Pulmonary compromise that requires the need for supplemental oxygen use to maintain adequate oxygenation.

9. Reported temperature > 100.4 Grad F/38 Grad C within 48 hours prior to the first dose of study treatment.

10. Known allergies, hypersensitivity, or intolerance to any assigned study treatment (combination agent or JNJ-75276617), or its excipients.

11. Exclusion criteria related to stem cell transplant:
- Received prior treatment with allogenic bone marrow or stem cell transplant = 3 months before the first dose of study treatment
- Has evidence of graft versus host disease
- Received donor lymphocyte infusion =1 month before the first dose of study treatment
- Requires immunosuppressant therapy (exception: daily doses = 10 mg prednisone or equivalent are allowed for adrenal replacement)

NOTE: Participants must discontinue all immunosuppressive therapy, including calcineurin inhibitors, at least 4 weeks before the first dose of study treatment and remain clinically stable.

12. Criterion modified per Amendment 2

12.1 Chemotherapy, targeted therapy, immunotherapy, or radiotherapy within 2 weeks or 5 half-lives (whichever is longer) before the planned first dose of study treatment (EXCEPT when used as cytoreductive therapy to control hyperleukocytosis as detailed in inclusion criterion 2 above).

13. Administration of:
- live-attenuated vaccine within 4 weeks before the first dose of study treatment or planned during the course of study treatment; or
- investigational vaccine within 2 weeks before the first dose of study treatment.

NOTE: Approved non-live vaccines (eg, influenza) or non-live vaccines authorized for emergency use (eg, SARS-CoV-2 [COVID-19]) by local health authorities are allowed.

14. Received investigational treatment or used an invasive investigational medical device within 2 weeks before the planned first dose of study treatment or is currently receiving active treatment on an investigational study.

15. Major surgery (eg, requiring general anesthesia) within 2 weeks prior to first dose of study treatment or has not recovered from surgery. Must not have major surgery planned during the time the participant is receiving study treatment. Participants with recent or planned surgical procedures utilizing only local anesthesia may participate.

16. Requires a prohibited medication that cannot be discontinued or substituted, or temporally interrupted during the study.

17. Known to be positive or tests positive at screening for human immunodeficiency virus (HIV).

18. Active or chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection (as defined below) or clinically active infectious liver disease:
a. Positive hepatitis B (hepatitis B virus [HBV]) surface antigen (HbsAg).

NOTE: Participants with a prior history of HBV demonstrated by positive hepatitis B core antibody are eligible if they have at screening
1) a negative HbsAg and
2) a HBV DNA (viral load) below the lower limit of quantification, per local testing.
Participants with a positive HbsAg due to recent vaccination are eligible if HBV DNA (viral load) is below the lower limit of quantification, per local testing.

b. Positive hepatitis C antibody (anti-hepatitis C virus [HCV]).

NOTE: Participants with a prior history of HCV, who have completed antiviral treatment and have subsequently documented HCV RNA below the lower limit of quantification per local testing are eligible.

19. Any serious underlying medical or psychiatric conditions, such as seizure disorder or psychiatric conditions (eg, alcohol or drug abuse), dementia, or altered mental status.

20. Evidence within 7 days prior to the first dose of study treatment of any active or uncontrolled infection.

21. Inability to take an orally administered drug, or medical disorder or prior surgical resection that may affect the absorption of an oral agent. Such conditions include, but are not limited to, malabsorption syndrome, symptomatic inflammatory bowel disease, partial or complete bowel obstruction, or resection of the stomach or small bowel. If any of these conditions exist, the investigator should discuss with the sponsor to determine participant eligibility.

22. Any condition for which, in the opinion of the investigator, participation would not be in the best interest of the participant (eg, compromise the well-being) or that could prevent, limit, or confound the protocol-specified assessments.

23. Received strong cytochrome P450 3A (CYP3A) inducers or inhibitors within 7 days prior to initiation of study treatment.

24. Active malignancies (defined as those progressing or requiring treatment change in the last 24 months) other than the disease being treated under study.
Note: participants with non-melanoma skin cancers treated within the last 24 months that are considered cured are allowed.

NOTE: Investigators must ensure that all study enrollment (inclusion/exclusion) criteria have been met at screening, and prior to the first dose of study treatment. If a participant’s clinical status
changes (including any available laboratory results or receipt of additional medical records) after screening but before the first dose of study treatment is given such that the participant no longer meets all eligibility criteria, then the participant must be excluded from participation in the study and the sponsor notified. Section 5.4, Screen Failures, describes options for retesting. The required source documentation to support meeting the enrollment criteria are noted in Appendix 3:
Regulatory, Ethical, and Study Oversight Considerations.

Subjects are eligible to be included in the study only if all of the following criteria apply:

101 Subject has provided informed consent prior to initiation of any study specific activities/procedures and/or the subject’s legally acceptable representative has provided informed consent prior to any study-specific activities/procedures being initiated when the subject has any kind of condition that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent.

111 Subjects enrolled in SC1 and SC2 comparison cohort (Ph-IIC) must provide consent to participate in the additional PK sample collection requirements.

102 Age >= 18 years at time of informed consent.

Disease Status:
All subjects must fulfill at least 1 of inclusion criteria 103, 104, or 105 for eligibility. For Ph-IIM cohort (subjects with MRD+ ALL [phase 2]) only: Subjects will be eligible for Ph-IIM if they have B-ALL and meet the MRD criteria defined in inclusion criterion 109 below. With the exception of disease status criteria (ie, inclusion criteria 103, 104, 105, 106) Ph-IIM cohort subjects must satisfy all other inclusion criteria to be eligible.

103 Subjects with B-precursor ALL with any of the following:
- Either refractory to primary induction therapy or refractory to at least 1 salvage therapy OR
- In untreated first, second, third or greater relapse or refractory relapse
- First Relapse is defined as achievement of first CR (CR1) during upfront therapy then relapse during or after continuation therapy
- Primary Refractory disease is defined as the absence of CR after standard induction therapy
- Refractory relapse is defined as lack of CR after salvage treatment
- Second relapse or later relapse is defined as relapse after achieving a second CR (CR2) in first or later salvage
- Refractory to salvage is defined as no attainment of CR after salvage.

104 Relapsed or Refractory at any time after first salvage therapy.

105 Relapse at any time after allogeneic HSCT.

106 Greater than or equal to 5% blasts in the BM (Exception: Isolated Non-CNS extramedullary disease [EMD]).

107 Eastern Cooperative Oncology Group (ECOG) Performance Status <= 2.

108 Subjects with relapse or refractory B Cell ALL Ph+ disease and that are intolerant or refractory to prior tyrosine kinase inhibitors (TKIs) are eligible.

109 For subjects in the MRD cohorts only (Ph-IIM cohort), BMB must be < 5% and >= 0.1%. This will replace inclusion criterion 106 for subjects in this cohort.

112 Subjects with Isolated (< 5% BMB) Non-CNS Extra Medullary Disease (EMD) are eligible in phase 2 cohorts Ph-IIR and Ph-IIM only.

Subjects are excluded from the study if any of the following criteria apply:

DISEASE RELATED

201 Active ALL in the CNS. Presence of 5 white blood cells (WBC) per cubic millimeter in cerebrospinal fluid (CSF) with lymphoblasts present (confirmed by CSF analysis) and/or clinical signs of CNS leukemia. If CSF leukemia is present subjects will have to receive intrathecal therapy and have documented negative CSF prior to enrolling.

OTHER MEDICAL CONDITIONS

202 History or presence of clinically relevant CNS pathology or event such as epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson’s disease, cerebellar disease, organic brain syndrome, psychosis or severe (>= grade 3) CNS events including ICANS from prior CD19 CART or other T cell engager therapies.

204 Current autoimmune disease or history of autoimmune disease with potential CNS involvement.

205 Active acute or chronic graft versus host disease requiring systemic treatment with immunosuppressive medication.

206 Known hypersensitivity to blinatumomab or to any component of the product formulation.

207 Known infection with human immunodeficiency virus (HIV) or chronic infection with hepatitis B virus or hepatitis C virus.

208 Symptoms and/or clinical signs and/or radiological and/or sonographic signs that indicate an acute or uncontrolled chronic infection, any other concurrent diseaseor medical condition that could be exacerbated by the treatment or would seriously complicate compliance with the protocol.

210 History of malignancy other than ALL within 3 years prior to start of protocol-specified therapy except for:
- Malignancy treated with curative intent and with no known active disease present for 3 years before enrollment and felt to be at low risk for recurrence by the treating physician.
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
- Adequately treated cervical carcinoma in situ without evidence of disease.
- Adequately treated breast ductal carcinoma in situ without evidence of disease.
- Prostatic intraepithelial neoplasia without evidence of prostate cancer

211 Allogeneic HSCT within 12 weeks before the start of protocol-specified therapy

212 Cancer chemotherapy within 2 weeks before the start of protocol-specified therapy. With the exception of intrathecal chemotherapy and/or low dose maintenance therapy for example vinca alkaloids, mercaptopurine, methotrexate, or hydroxyurea (any low dose chemotherapy as stated above must be discontinued before starting pre-phase) or pre-phase chemotherapy and/or dexamethasone as outlined in Section 6.1.2.1 and Section 6.1.2.2, respectively.

213 Immunotherapy (eg, rituximab, alemtuzumab) within 4 weeks before start of protocol-specified therapy. Prior failed CD19 directed therapy such as prior blinatumomab or CD19 CAR T cells will be allowed (with demonstrated continued CD19+ expression) if treatment ended > 4 weeks prior to start of protocol therapy and no prior CNS complications (see exclusion criteria 202).

PRIOR/CONCURRENT CLINICAL STUDY EXPERIENCE

214 Currently receiving treatment in another investigational device or drug study, or less than 30 days since ending treatment on another investigational device or drug study. Other investigational studies are not permitted while participating in this study.

DIAGNOSTIC ASSESSMENTS

215 Abnormal screening laboratory values as defined below:
- Total bilirubin > 3.0 mg/dL prior to start of treatment (unless related to Gilbert’s or Meulengracht disease)
- Estimated Creatinine clearance < 60 mL/min.

OTHER EXCLUSIONS

216 Female subject is pregnant or breastfeeding or planning to become pregnant or breastfeed during treatment and for an additional 96 hours after the last dose of protocol-specified therapy.

217 Female subjects of childbearing potential unwilling to use 1 highly effective method of contraception during treatment and for an additional 96 hours after the last dose of protocol-specified therapy. Refer to Section 11.5 for additional contraceptive information.

218 Female subjects of childbearing potential with a positive pregnancy test assessed during Screening by a serum pregnancy test and/or urine pregnancy test.

219 Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures to the best of the subject and investigator’s awareness.

1. Male or female participants, age = 18 years.

2. HLA type of participant must match at HLA B and C loci, based on high resolution typing, to 4 digits (i.e., HLA-B*07*02), with the available Allo-RevCAR01-T batches.

3. Participants with CD123+ AML (defined as = 20% of leukemic cells expressing CD123 at any point in the course of disease) for whom all standard or life-extending therapies have failed and for whom no potentially curative therapies are available or who are intolerant to such therapies.
a. Participants with MRD+ AML are eligible but must meet the following criteria:
i. MRD positivity must be based on assays and markers supported by consensus guidelines [Heuser et al., 2021] and in the judgment of the investigator must confer negative prognostic risk highly likely to result in relapse.
ii. Must have received or be ineligible for allogeneic stem cell transplant.
iii. Must be approved by the Sponsor for inclusion in the study.

4. Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.

5. Life expectancy of at least 3 months in the judgment of the investigator.

6. Adequate renal and hepatic laboratory assessments:
a. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) = 2.5 x upper limit of normal (ULN)
b. Total bilirubin = 1.5 x ULN (unless related to Gilbert’s syndrome)
c. Serum creatinine = 1.5 x ULN or serum creatinine clearance > 60 mL/min (male); > 50 mL/min (female) (only if creatinine > 1.5 x ULN)

7. Adequate cardiac function, i.e., left ventricular ejection fraction (LVEF) of = 50% as assessed by transthoracic 2-dimensional echocardiography.

8. Permanent venous access existing (e.g., port-system) or willing to have such a device inserted.

9. Able to give written informed consent.

10. Weight = 45 kg.

11. A woman of childbearing potential (WOCBP) may be enrolled ifshe has a negative serum pregnancy test at screening visit and is routinely using a highly effective method of birth control (pearl index of = 1 required) resulting in a low failure rate (e.g., hormonal contraception, intrauterine device, total sexual abstinence, or sterilization) for as long as Allo-RevCAR01-T persistence is detected but at least until 12 months from lymphodepletion therapy. Male participants must also practice a highly effective method of birth control and should not father a child or donate sperm at least until 6 months after end of lymphodepletion therapy.

1. Acute promyelocytic leukemia (t15;17).

2. History of AML in the central nervous system.

3. Bone marrow failure syndromes (e.g., Fanconi anemia, Kostman syndrome, Shwachman syndrome).

4. Cardiac disease: heart failure (New York Heart Association III or IV); unstable coronary artery disease, myocardial infarction, or serious cardiac ventricular arrhythmias requiring anti-arrhythmic therapy within the last 6 months prior to study entry.

5. Active pulmonary disease with clinically relevant hypoxia (need for oxygen inhalation).

6. Parkinson’s disease or epilepsy.

7. Stroke, seizure, or intracranial hemorrhage in the past 12 months.

8. History or presence of disseminated intravascular coagulation (DIC) or thromboembolism within 3 months prior to start of treatment.

9. Active infectious disease considered by investigator to be incompatible with protocol or being contraindications for lymphodepletion therapy (in individual cases, after consultation with the Sponsor, this may not include past, non-acute, non-clinically significant infectious diseases for which there is still serological evidence).

10. Toxicity from prior anticancer treatment has not resolved to Grade = 1 or baseline.

11. Allogeneic stem cell transplantation within last 2 months or GvHD requiring immunosuppressive therapy.

12. Vaccination with live viruses < 2 weeks prior to lymphodepletion therapy.

13. Major surgery within 28 days prior to start of R-TM123 infusion.

14. Prior malignancy in the past 3 years or any malignancy requiring ongoing active therapy other than adjuvant endocrine therapy. Participants with resected or ablated tumors, such as basal cell carcinoma of skin, carcinoma-in-situ of the cervix, or other tumors considered cured by local treatment may be considered for the study with Sponsor approval.

15. Treatment with any investigational drug substance or experimental therapy within 4 weeks or 5 half-lives (whichever is shorter) of the substance prior to lymphodepletion.

16. Treatment with anti-leukemic therapy within 4 weeks or 5 half-lives (whichever is shorter) prior to lymphodepletion.

17. Prior treatment with gene modified cell products.

18. Use of checkpoint inhibitors within 5 half-lives of the specific drug.

19. Autoimmune diseases requiring systemic steroids or other systemic immunosuppressants.
Note: Physiologic steroid replacement not exceeding 10 mg prednisolone equivalent per day is allowed.

20. Pregnant or breastfeeding women.

21. Psychologic disorders with treatment modifications required within the last 3 months, drug and/or significant active alcohol abuse as per investigator’s medical judgement.
Depression or anxiety due to presence of the underlying malignancy may be exempted with Sponsor approval.

22. History of human immunodeficiency virus (HIV) or active/chronic infection with hepatitis C virus (HCV) or hepatitis B virus (HBV).

23. Presence of autoantibodies against lupus La protein (La)/ Sjögren syndrome type B antigen (SS-B) or presence or history of autoimmune diseases associated with such antibodies (e.g., systemic lupus erythematosus, Sjögren syndrome/systemic lupus erythematosus overlap syndrome, subacute cutaneous lupus erythematosus, neonatal lupus, primary biliary cirrhosis, Sjögren’s syndrome).

24. Known hypersensitivity to cellular component (Allo-RevCAR01-T) and/or TM (R-TM123) excipients or to compounds of the lymphodepletion therapy, tocilizumab, or corticosteroids.

25. Evidence that the participant is not likely or able to follow the study protocol (e.g., lacking compliance) in the judgment of the investigator.

26. Participant unable to understand the informed consent and possible consequences of the participation in the clinical trial in the judgement of the investigator.

1. Subjects must be = 18 years of age.

2. Subjects must have an Eastern Cooperative Oncology Group (ECOG) performance status of <= 2.

3. Subjects must voluntarily sign and date an informed consent form.

4. Subjects must have had documented multiple myeloma requiring treatment as defined by the criteria below:
Monoclonal plasma cells in the bone marrow > 10% and/or presence of a biopsy proven plasmacytoma at some point in their disease his tory requiring treatment according diagnostic criteria (IMWG up dated criteria 2014, Rajkumar et al. 2014) with measurable disease at screening (serum M-protein > 500 mg/dL or urine M-protein 200 mg/24h, in case of oligosecretory MM serum free light chain > 10mg/dL and abnormal kappa/lambda free light chain ratio)

5. Cytogenetics/FISH confirming t(11;14); in case of prior testing, provision of original findings report is necessary

6. Prior treatment requirements:
Phase 1:
a. Subjects must have received at least 4 prior treatments (induction, high-dose, consolidation and maintenance is considered as one treatment line) and are refractory to at least one proteasome inhibitor, at least one immunomodulatory drug and at least one monoclonal anti-CD38 antibody.
b. Subjects must have documented evidence of progressive disease during their last treatment.

Phase 2:
c. Subjects must have received at least 1 prior treatment line (induction, high-dose, consolidation and maintenance is considered as one treatment line). All patients have to have received at least one proteasome inhibitor and at least one immunomodulatory agent and
at least one anti-CD38 monoclonal antibody.
d. Subjects must have documented evidence of progressive disease on or after the last treatment line.

Phase 1 + 2
e. Subjects with a history of autologous SCT are eligible for study participation provided the following eligibility criteria are met:
i. ASCT was >100 days prior to initiating study treatment, and
ii. No active bacterial, viral, or fungal infection(s) present.

7. Subjects must have adequate organ function, defined as follows:
a. Hemoglobin >= 8.0. g/dL (without transfusion of red blood cells for the past 14 days)
b. Absolute neutrophil count >= 1.5 x 10^9/L (without growth factor support for the past 14 days)
c. Platelet count more or equal 75 x 10^9/L (without growth factor or platelet stimulating agents for the past 14 days)
d. Adequate hepatic function per local laboratory reference range as follows:
i. Aspartate aminotransferase (AST) <= 2,5 x upper limit of normal (ULN);
ii. Alanine aminotransferase (ALT) <= 2.5 x ULN
iii. Total bilirubin <= 1.5 x ULN, except in subjects with congenital bilirubinemia, such as Gilbert syndrome. Isolated bilirubin >=1.5 x ULN is acceptable if bilirubin is fractionated and direct bilirubin < 35%.
e. Subject must have adequate renal function as demonstrated by eGFR >= 30 mL/min/ 1.73 m^2 as calculated by Modified Diet in Renal Disease (MDRD) formula
f. Spot urine (albumin/creatinine ratios (spot urine) < 500 mg/g (56 mg/mmol) OR Urine Dipstick Negative/trace (if >= 1+ only eligible if confirmed < 500 mg/g (56 mg/mmol) by albumin/creatinine ratio (spot urine from first void)
g. Corrected serum calcium <= 14 mg/dL (<= 3,5 mmol/L); or free ionized calcium < 6,5 mg/dL (< 1,6 mmol/L)

8. A female participant is eligible to participate if she is not pregnant or breast feeding, and at least one of the following conditions applies:

a. Is not a woman of childbearing potential (WOCBP)

OR

b. Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of < 1% per year), preferably with low user dependency (as described in Appendix 14.1.4) before and during the intervention period and for at least 5 months after the last dose of study intervention and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction during this period. The investigator should evaluate the effectiveness of the contraceptive method in relationship to the first dose of study intervention.

A WOCBP must have a negative highly sensitive serum pregnancy test (as required by local regulations) within 72 hours before the first dose of study
intervention and agree to use a highly effective method of contraception before and during the study and for 5 months after the last dose of IMP. Additional requirements for pregnancy testing during and after study intervention are provided in Section Pregnancy Testing and the SoA.

Non-childbearing potential must be clearly documented and be confirmed previously and is defined as follows (by other than medical reasons):

c. >= 45 years of age and has not had menses for > 1 year

d. Patients who have been amenorrhoeic for < 2 years without history of a hysterectomy and oophorectomy must have a follicle stimulating hormone value in the postmenopausal range upon screening evaluation.

e. Post-hysterectomy, post-bilateral oophorectomy, or post-tubal ligation (> 6 weeks post-surgery). Documented hysterectomy or oophorectomy must be confirmed with medical records of the actual procedure or confirmed by an ultrasound. Tubal ligation must be confirmed with medical records of the actual procedure.

9. Male participants are eligible to participate if they agree to the following during the intervention period and for 6 months after the last dose of study treatment to allow for clearance of any altered sperm:

a. Refrain from donating sperm
PLUS either:
b. Be abstinent from heterosexual intercourse as their preferred and usual lifestyle (abstinent on a long term and persistent basis) and agree to remain abstinent.
OR
c. Must agree to use contraception/barrier as detailed below:Agree to use a male condom, even if they have undergone a successful vasectomy, and female partner to use an additional highly effective contraceptive method with a failure rate of < 1% per year as when having sexual intercourse with a woman of childbearing potential (including pregnant females).

10. All subjects must agree to refrain from donating blood while on study drug and for 28 days after discontinuation from this study treatment.

11. All subjects must agree not to share study medication.

12. All prior treatment-related toxicities (defined by National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI-CTCAE), version 5.0)
must be <= Grade 1 at the time of enrolment except for alopecia.

Patients are excluded from the study if any of the following criteria are met at screening or on Day 1:

1. Subject has received prior Venetoclax and/or anti BCMA treatment.

2. Participant has used an investigational drug or approved systemic anti-myeloma therapy within 14 days or five half-lives, whichever is shorter, preceding the first
dose of study drug. The only exception is emergency use of a short course of corticosteroids (equivalent of Dexamethasone 40 mg/day for a maximum of 4 days) up to 7 days before treatment.

3. Participant has had plasmapheresis or radiation therapy within 7 days prior to first dose of study treatment.

4. Participant has current corneal epithelial disease except mild changes in corneal epithelium.

5. Participant has current unstable liver or biliary disease defined by the presence of ascites, encephalopathy, coagulopathy, hypoalbuminemia, esophageal or
gastric varices, persistent jaundice, or cirrhosis.
Note: Stable non-cirrhotic chronic liver disease (including Gilbert’s syndrome or asymptomatic gallstones) or hepatobiliary involvement of malignancy is acceptable if otherwise meets entry criteria.

6. Participant has a presence of active renal condition (infection, requirement for dialysis or any other condition that could affect participant’s safety). Participants with isolated proteinuria resulting from MM are eligible, provided they fulfil inclusion criteria
.
7. Participant has had major surgery <= 4 weeks prior to initiating study treatment. Kyphoplasty is not considered a major surgery.

8. Participant must not use contact lenses while participating in this study. Bandage contacts may be prescribed by an eye care professional if needed.

9. Participant has any evidence of active mucosal or internal bleeding or other gastrointestinal disease that may significantly alter the absorption of oral drugs.

10. Participant has evidence of cardiovascular risk including any of the following:

a. Evidence of current clinically significant uncontrolled arrhythmias, including clinically significant ECG abnormalities such as 2nd degree (Mobitz Type II) or 3rd degree atrioventricular (AV) block.

b. History of myocardial infarction, acute coronary syndromes (including unstable angina), coronary angioplasty, or stenting or bypass grafting within three (3) months prior to screening.

c. Class III or IV heart failure as defined by the New York Heart Association functional classification system [NYHA, 1994] (see Appendix II)

d. Uncontrolled hypertension

e. Left ventricular Ejection Fraction <= 50%

11. Participant has known immediate or delayed hypersensitivity reaction or idiosyncratic reactions to IMPs or drugs chemically related to IMPs, or any of the components of the study treatment

12. Participant has an invasive malignancy other than disease under study, within 5 years before trial inclusion, except
- Adequately treated in situ carcinoma of the cervix uteri or the breast;
- Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin;
- Prostate cancer Gleason grade 6 or lower AND with stable Prostate Specific Antigen (PSA) levels off treatment; or
- Previous malignancy with no current evidence of disease, and which was confined and surgically resected (or treated with other modalities) with curative intent and unlikely to impact survival during the duration of the study.

13. Participant is pregnant or lactating

14. Participants who have had prior allogeneic stem cell transplant.

15. Participants with symptomatic amyloidosis, active POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder, skin changes) or active plasma cell leukaemia at the time of screening.

16. Participants with any serious and/or unstable pre-existing medical, psychiatric disorder or other conditions (including lab abnormalities) that could interfere with participant’s safety, obtaining informed consent or compliance to the study procedures.

17. Subject is known to be seropositive for human immunodeficiency virus (HIV) or hepatitis B (defined by a positive test for hepatitis B surface antigen (HBsAg) or antibodies to hepatitis B surface and core antigen (anti HBs and anti HBc re spectively), or hepatitis C (anti-HCV antibody positive or HCV RNA quantitation positive).

18. Current immune or inflammatory conditions requiring immunosuppressive treatment (e.g. systemic lupus erythematosus, rheumatoid arthritis).

19. Subject must not have received any live vaccines within 8 weeks prior to first dose of study treatment.

20. Subject must not use or anticipate the use of prohibited medications or foods during study participation.

21. Subject does not have a history of or show any signs of known meningeal/central nervous system involvement by myeloma

22. Evidence of other clinically significant uncontrolled condition(s) including, but not limited to:

a. Uncontrolled and/or active systemic infection (viral, bacterial or fungal) requiring treatment.

b. Any concurrent medical or psychiatric condition or disease (e. g. uncon trolled diabetes, acute diffuse infiltrative pulmonary disease) that is likely to interfere with the study procedures or results, or that in the opinion of the investigator, would constitute a hazard for the participating in this study.

23. Subject is known or suspected of not being able to comply with the study protocol (eg. because of alcoholism, drug dependency, or psychological disorder). Subject has any condition for which, in the opinion of the investigator, participation would not be in the best interest of the subject (e. g., compromise the wellbeing) or that could prevent, limit or confound the protocol-specified assessments.

24. Treatment with any of the following within 7 days prior to the first dose of study drug:
a. moderate or strong cytochrome P450 3A (CYP3A) inhibitors (see Appendix VII for examples)
b. moderate or strong CYP3A inducers (see Appendix VII for examples)

25. Administration or consumption of any of the following within 3 days prior to the first dose of study drug:
a. grapefruit or grapefruit products
b. Seville oranges (including marmalade containing Seville oranges)
c. star fruit

26. Participation in any other clinical trial (with the exclusion of observational studies).

Each patient eligible to participate in this study must meet all the applicable criteria:

1. Provision of signed and dated written informed consent prior to any study-specific procedures, sampling, or analyses

2. Age 18 years or older

3. Confirmed diagnosis of one of the following by 2016 World Health Organization criteria (Arber et al 2016; see Appendix 19):

a. AML, nonacute promyelocytic leukemia and either of the following disease activity criteria:

i. TN and unfit for intensive chemotherapy as defined by one of the following (TN AML patients who are unfit for intensive chemotherapy may not be enrolled in countries such as the US, France, Germany, Italy, and Spain, if a Bcl-2 inhibitor is available as standard of care; in other countries, patients with no access or who havecontraindications to available standard of care may be eligible per investigator’s assessment of benefit/risk):
(1) Age >= 65 years
(2) Severe cardiac disorder (eg, congestive heart failure requiring treatment, ejection fraction <= 50%, or chronic stable angina)
(3) Severe pulmonary disorder (eg, diffusion capacity for carbon monoxide, [DLCO] <= 65%, or forced expiratory volume in 1 second [FEV1] = 65%)
(4) Creatinine clearance < 50 mL/min
(5) Liver disease with bilirubin > 1.5 x upper limit of normal (ULN) unless patient has documented Gilbert syndrome

ii. R/R to >= 1 prior lines of systemic therapy as defined by 2017 European LeukemiaNet (ELN) response criteria (Döhner et al 2017, see Appendix 12). In France, patients with R/R AML with FLT3 internal tandem duplication (ITD) or tyrosine kinase domain (TKD) mutation confirmed using a validated test, after induction chemotherapy, must have received gilteritinib, if eligible.

iii. HMA-failure AML – received >= 1 cycle of hypomethylating agent and had disease progression (Döhner et al 2017, see Appendix 12) or no >= partial remission (PR) or hematologic improvement (HI) after 4 cycles after receiving > 75% of planned dose

b. MDS (bone marrow blast > 5% and that meets one of the following disease activity criteria:

i. TN with Revised International Prognostic Scoring System score > 3.5 (intermediate, high, or very high)
NOTE: TN MDS patients will not be enrolled in France or Germany to the BGB-11417 monotherapy cohort.

ii. R/R to >= 1 prior lines of systemic therapy as defined by modified International Working Group (IWG) 2006 criteria for relapse, or failure, or disease progression (Cheson et al 2006, see Appendix 14)

iii. HMA-failure MDS– received >= 1 cycle of hypomethylating agent and had disease progression (Cheson et al 2006, see Appendix 14) or no >= PR or HI after 4 cycles after receiving > 75% of planned dose

c. MDS/MPN including chronic myelomonocytic leukemia (CMML), 2016 World Health Organization classification subtypes CMML-1 or CMML-2, or other MDS/MPN requiring treatment, with bone marrow blast > 5% and meets one of the following criteria:
i. TN
NOTE: TN MDS/MPN patients will not be enrolled in France or Germany to the BGB-11417 monotherapy cohort.
ii. R/R to >= 1 prior lines of systemic therapy as defined by modified IWG 2006 criteria for relapse, or failure, or disease progression (Cheson et al 2006, see Appendix 14)
iii. HMA-failure MDS/MPN– received at least 1 cycle of hypomethylating agent and had disease progression (Cheson et al 2006, see Appendix 14) or no >= PR or HI after 4 cycles after receiving > 75% of planned dose

4. Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2

5. Adequate organ function defined as:

a. Creatinine clearance >= 50 mL/min (or between 30 and 49 mL/min in unfit AML cohort) as estimated by one of the following:

i. Cockcroft-Gault equation:
(1) (140 - age) x mass (kg)/72 x creatinine (mg/dL); multiply by 0.85 if female
(2) (140 - age) x mass (kg) x 1.23 if male (or 1.04 if female)/creatinine (µmol/L)

ii. CKD-EPI equation

iii. 24-hour urine collection

b. Adequate liver function indicated by:

i. Aspartate aminotransferase/serum glutamic-oxaloacetic transaminase <= 3 x ULN

ii. Alanine aminotransferase/serum glutamic-pyruvic transaminase <= 3 x ULN

iii. Total bilirubin level <= 1.5 x ULN (or <= 3 x ULN in unfit AML cohort) unless patient has documented Gilbert syndrome. Total bilirubin may exceed this value for patients with documented Gilbert syndrome, but direct bilirubin must be <= 1.5 x ULN.

6. Women of childbearing potential must have a negative serum pregnancy test <= 7 days before the first dose of study drug. In addition, they must use a highly effective method of birth control initiated before the first dose of study drug, for the duration of the study treatment period, and for >= 90 days after the last dose of BGB-11417 and >= 180 days after the last dose of azacitidine. See Appendix 18 for highly effective methods of birth control and the definition of childbearing potential. Patients using hormonal contraceptives (eg, birth control pills or devices) must also use a barrier method of contraception (eg, condoms).

7. Nonsterile men must use a highly effective method of birth control for the duration of the study treatment period and for >= 90 days after the last dose of study drug. During this same period, they must not donate sperm. See Appendix 18 for highly effective methods of birth control and the definition of sterile.

8. Life expectancy of > 12 weeks

9. Ability to comply with the requirements of the study

Each patient eligible to participate in this study must NOT meet any of the following exclusion criteria:

1. A diagnosis of acute promyelocytic leukemia

2. Prior malignancy within the past 2 years, except for curatively treated localized skin cancer, superficial bladder cancer, carcinoma in situ of the cervix or breast, or localized Gleason score <= 6 prostate cancer

3. Antecedent MPN including myelofibrosis, essential thrombocytosis, polycythemia vera, or chronic myelogenous leukemia with or without BCR-ABL1 translocation and AML with BCR-ABL1 translocation

4. Known central nervous system involvement by leukemia

5. White blood cell (WBC) count > 25 x 10^9/L (treatment with hydroxyurea or leukapheresis are allowed for cytoreduction until initiation of study drug)

6. Autologous stem cell transplant <= 3 months prior to screening or chimeric antigen T-cell therapy <= 6 months prior to screening

7. Prior allogeneic stem cell transplant with active graft-versus-host disease (GVHD), or requiring immunosuppressive drugs for treatment of GVHD, or have taken calcineurin inhibitors within 4 weeks prior to consent

8. Use of the following substances prior to the first dose of study drug:

a. <= 28 days prior to the first dose of study drug
- Any biologic and/or immunologic-based therapy (including, but not limited to, monoclonal antibody therapy and/or cancer vaccine therapy)

b. <= 14 days prior to the first dose of study drug
- Systemic chemotherapy or radiation therapy (except for hydroxyurea used for cytoreduction)

c. <= 7 days prior to the first dose of study drug
- Any tyrosine kinase inhibitor, isocitrate dehydrogenase (IDH1/2) inhibitor or other targeted small molecule (with 5 half-lives <= 7 days) given with antineoplastic intent

9. Active fungal, bacterial, and/or viral infection requiring systemic therapy
NOTE: Oral antibiotics for minor bacterial infections are allowed.

10. Prior therapy with a Bcl-2 inhibitor or azacitidine

a. For R/R AML patients: prior therapy with a Bcl-2 inhibitor or azacitidine except for HMA-failure (see inclusion criteria 3a)

b. For R/R MDS or MDS/MPN patients: prior therapy with a Bcl-2 inhibitor or azacitidine except for HMA-failure (see inclusion criteria 3b and 3c)

11. Major surgery = 28 days before the first dose of study treatment

12. Toxicity from prior anticancer therapy that has not recovered to <= Grade 1 (except for alopecia, anemia, neutropenia, and thrombocytopenia)

13. Clinically significant cardiovascular disease includes the following:

a. Myocardial infarction <= 6 months before screening

b. Unstable angina <= 3 months before screening

c. New York Heart Association Class III or IV congestive heart failure (see Appendix 9)

d. History of clinically significant arrhythmias (eg, sustained ventricular tachycardia, ventricular fibrillation, torsades de pointes)

e. Heart rate-corrected QT interval > 480 milliseconds based on Fridericia’s formula

f. History of Mobitz II second-degree or third-degree heart block without a permanent pacemaker in place

g. Uncontrolled hypertension at Screening, defined as systolic blood pressure > 170 mmHg and diastolic blood pressure > 105 mmHg by >= 2 consecutive measurements

14. Chronic respiratory disease that requires continuous oxygen; history of significant renal, neurologic, psychiatric, endocrinologic, metabolic, immunologic, hepatic, or cardiovascular disease; or any other medical condition that, in the opinion of the investigator, would adversely affect his/her participation in this study

15. Known history of infection with human immunodeficiency virus (HIV). Serologic status reflecting active viral hepatitis B or viral hepatitis C infection as follows:

a. Presence of hepatitis B surface antigen (HBsAg) or hepatitis B core antibody (HBcAb)
NOTE: Patients with presence of HBcAb, but absence of HBsAg are eligible only if hepatitis B virus (HBV) DNA is undetectable by an assay with sensitivity <= 20 IU/mL. If so, patients may undergo either regularly scheduled monitoring of HBV DNA or less frequent monitoring of HBV DNA while on prophylactic antiviral medication as defined by regional standard of care (see Section 6.11.4).

b. Presence of hepatitis C virus (HCV) antibody
NOTE: Patients with presence of HCV antibody are eligible only if HCV RNA is undetectable and if they are willing to undergo monitoring for HCV reactivation (see Section 6.11.4).

16. Current pregnancy or lactation

17. Inability to swallow tablets or disease significantly affecting gastrointestinal function such as malabsorption syndrome, resection of the stomach or small bowel, bariatric surgery procedure, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction

18. Receiving treatment with any moderate or strong CYP3A4 inhibitor (<= 7 days or 5 half-lives,whichever is longer) or moderate or strong CYP3A4 inducer (<= 14 days or 5 half-lives, whichever is longer) before the first dose of BGB-11417 (see Appendix 10)

19. History of stroke or intracranial hemorrhage = 6 months before the first dose of study drug

20. History of hypersensitivity to an excipient of the BGB-11417 tablet, azacitidine, or for the Part 3 DDI cohort only, posaconazole

21. History of a severe bleeding disorder such as hemophilia A, hemophilia B, or von Willebrand disease, or history of unexplained spontaneous bleeding requiring blood transfusion or other medical or surgical intervention

22. Receiving treatment with drugs known to prolong the QT/QTc interval (see Appendix 17)

23. Receiving treatment with warfarin

24. Vaccination with a live vaccine = 35 days before first dose of study drug
NOTE: Seasonal vaccines for influenza are generally inactivated vaccines and are allowed. Intranasal vaccines are live vaccines and are not allowed.

25. Inability to comply with study procedures

26. Concurrent treatment with sirolimus, HMG-CoA reductase inhibitors that are primarily metabolized through CYP3A4 (eg, atorvastatin, lovastatin, and simvastatin) and/or ergot alkaloids while receiving posaconazole (Part 3 DDI cohort only).

Each patient who is eligible to participate in this study must meet all the following criteria:

1. Provision of signed and dated written informed consent prior to any study-specific procedures, sampling, or data collection.

2. Age >= 18 years.

3. Confirmed diagnosis (per World Health Organization [WHO] guidelines, unless otherwise noted) of one of the following:

a. Patients with MZL (Parts 1a, 1b, 1c, and Phase 2 Cohort 4 only) and all of the following:

i. Extranodal, splenic, or nodal MZL

ii. R/R MZL is defined as disease that relapsed after, or was refractory to, >= 2 prior lines of therapy (a line of therapy is considered = 2 consecutive cycles of a systemic anticancer regimen)
(1) For patients enrolling at US sites ONLY: patients must have been treated with a covalently binding BTK inhibitor and an anti-CD20 monoclonal antibody in any line of therapy to be eligible for the study.
(2) For patients enrolling at EU sites ONLY: patients must have been treated with an anti-CD20 monoclonal antibody in any line of therapy to be eligible for the study.
(3) For patients enrolling at United Kingdom (UK) sites in Parts 1a, 1b, and 1c
ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

iii. Active disease requiring treatment

b. Patients with FL (Parts 1a, 1c, or Phase 2 Cohort 5 only) and all of the following:

i. Grade 1, 2, or 3a based on the WHO 2008 classification of tumors of hematopoietic and lymphoid tissue

ii. R/R FL is defined as disease that relapsed after, or was refractory to, >= 2 prior lines of therapy (a line of therapy is considered >= 2 consecutive cycles of a systemic anticancer regimen)
Note: prior therapy must include = 1 line of therapy containing an anti-CD20 monoclonal antibody
(1) For patients enrolling at UK sites in Parts 1a, and 1c ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

iii. Active disease requiring treatment

c. Patients with R/R MCL (Parts 1a, 1b, and Phase 2 Cohort 2 only) and all of the following:

i. Blastoid or nonblastoid-variant R/R MCL

ii. R/R MCL is defined as disease that relapsed after, or was refractory to, >= 2 prior lines of systemic therapy (a line of therapy is considered >= 2 consecutive cycles of a systemic anticancer regimen).
(1) Patients must have been treated with a covalently binding BTK inhibitor (eg, ibrutinib, acalabrutinib, or zanubrutinib; as monotherapy or in combination with other anticancer agents) in any line of therapy and anti-CD20 monoclonal antibody in any line of therapy to be eligible for the study.
(2) For patients enrolling at UK sites in Parts 1a, and 1b ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

iii. Requiring treatment in the opinion of the investigator

d. Patients with R/R CLL/SLL (Parts 1a, 1b, and Phase 2 Cohort 1 ONLY) and all of the following:

i. R/R CLL/SLL diagnosis that meets the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria (Hallek et al 2018)

ii. R/R CLL/SLL is defined as disease that relapsed after, or was refractory to, >= 2 prior lines of therapy (a line of therapy is considered >= 2 consecutive cycles of a systemic anticancer regimen)
(1) In Part 1a and 1b, patients enrolling at the US, EU, and Australian sites ONLY must have been treated with a covalently binding BTK inhibitor (eg, ibrutinib, acalabrutinib, or zanubrutinib; as monotherapy or in combination with other anticancer agents) in any line of therapy.
(2) In Part 1a and 1b, for enrollment at UK sites ONLY, enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

iii. In Phase 2, all patients must have been treated with a covalently binding BTK inhibitor (eg, ibrutinib, acalabrutinib, or zanubrutinib; as monotherapy or in combination with other anticancer agents) and a Bcl-2 inhibitor (eg venetoclax as monotherapy or in combination with other anticancer agents) in any line of therapy.
(1) Once 85 patients who have not been previously treated with a non-covalent BTK inhibitor (eg, pirtobrutinib or nemtabrutinib) have been enrolled, patients will berequired to have received a prior non-covalent BTK inhibitor in any line of therapy.

iv. Requiring treatment as defined by history of = 1 of the following criteria:
(1) Requires treatment in the opinion of the investigator or meets criteria for initiation of a subsequent line of therapy per the 2018 iwCLL criteria, including substantial persistent disease burden following a prior line of therapy or the lack of resolution of the indication for a prior line of therapy
(2) Evidence of progressive marrow failure as manifested by the development or worsening of anemia and/or thrombocytopenia
(3) Massive (ie, >= 6.0 cm below left costal margin), progressive, or symptomatic splenomegaly
(4) Massive (ie, >= 10.0 cm in longest diameter), progressive, or symptomatic lymphadenopathy
(5) Progressive lymphocytosis with an increase of = 50% over a 2-month period or a lymphocyte doubling time (LDT) of < 6 months. The LDT may be determined by linear regression extrapolation of absolute lymphocyte counts obtained at intervals of 2 weeks over an observation period of 2 to 3 months; patients with initial blood lymphocyte counts < 30 x 10^9 /L (30,000/µL) may require a longer observation period to determine the LDT. Factors contributing to lymphocytosis or lymphadenopathy other than R/R CLL/SLL (eg, infection, steroid administration, BTK inhibitor treatment) should be excluded
(6) Autoimmune complications, including anemia or thrombocytopenia that respondpoorly to steroids or other systemic therapies
(7) Symptomatic or functional extranodal involvement (eg, skin, kidney, lung, spine)
(8) Disease-related symptoms defined as any of the following:
a. Unintentional weight loss >= 10% within the previous 6 months
b. Significant fatigue (ie, ECOG Performance Status 2 or worse; cannot work or unable to perform usual activities)
c. Fevers >= 100.5 F or 38 C for >= 2 weeks without evidence of infection
d. Night sweats for >= 1 month without evidence of infection

e. Patients with WM (Part 1a, 1b, 1c, and Phase 2 Cohort 3 only) and all of the following:

i. Clinical and definitive histological diagnosis

ii. R/R WM is defined as disease that relapsed after, or was refractory to, >= 2 prior lines of therapy (a line of therapy is considered >= 2 consecutive cycles of a systemic anticancer regimen)

iii. >= 1 line of therapy containing an anti-CD20 monoclonal antibody
(1) For patients enrolling at US and EU sites ONLY: patients must also have been treated with a covalently binding BTK inhibitor in any line of therapy to be eligible for the study.
(2) For patients enrolling at UK sites in Parts 1a, 1b, and 1c ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

iv. Meeting >= 1 criterion for treatment according to consensus panel criteria from the Seventh International Workshop on Waldenström Macroglobulinemia (Dimopoulos et al 2014):

f. Patients with DLBCL (Part 1a, 1c, and Phase 2 Cohort 6 only) and all of the following:
- Non-Germinal Center B-cell DLBCL Not Otherwise Specified (Non-GCBDLBCL NOS), as defined by IHC per the Hans algorithm (Hans et al 2004). A previously locally performed gene-expression profiling assay designed to identify the lymphoma cell-of-origin, such as the NanoString Lymphoma Subtyping Test (Seattle, WA, USA), may be substituted to determine nonGCB pathology.

i. Relapsed after, or was refractory to, = 2 prior lines of systemic therapy (a line of therapy is considered = 2 consecutive cycles of a systemic anticancer regimen)
(1) Patients must have been treated with an anthracycline based regimen and an anti-CD20-based regimen
(2) Patients who are not candidates for or refuse intensive chemotherapy, hematopoietic stem cell transplant, and CAR-T-based regimens are eligible for this study
(3) Patients who have previously received allogenic or autologous stem cell transplantation or CAR-T-based regimens are eligible for this study
(4) Patients must not require concurrent CNS-directed therapy or prophylaxis with systemic or intrathecal chemotherapy or radiotherapy
(5) Systemic chemotherapy followed by autologous or allogeneic SCT will be considered as 1 line of systemic therapy
(6) For patients enrolling at UK sites in Parts 1a, and 1c ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

g. Patients with Richter’s transformation to DLBCL (Parts 1a, 1c, and Phase 2 Cohort 7 ONLY) and all of the following:

i. History of R/R CLL/SLL diagnosis that meets the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) criteria (Hallek et al 2018).
(1) Patients enrolling at US, EU and Australian sites ONLY must have been treated with a covalently binding BTK inhibitor (eg, ibrutinib, acalabrutinib, or zanubrutinib; as monotherapy or in combination with other anticancer agents) in any line of therapy for prior R/R CLL/SLL diagnosis or for RT diagnosis
(2) For patients enrolling at UK sites in Parts 1a, and 1c ONLY: enrollment is limited to patients who are intolerant of or refuse standard therapy, or for whom no approved therapy with demonstrated clinical benefit is indicated or available.

ii. Confirmed histopathological diagnosis of RT to DLBCL

iii. R/R RT is defined as disease that relapsed after, or was refractory to, >= 1 prior line of therapy (a line of therapy is considered >= 2 consecutive cycles of a systemic anticancer regimen) administered for RT

4. For patients who have previously received a BTK inhibitor:
a. Parts 1a, 1b, and 1c only: Patients who have experienced disease progression during or after >= 1 regimen containing a covalently binding BTK inhibitor are eligible for the
dose-finding cohorts

b. Parts 1a, 1b, 1c, and Phase 2: Patients may (but do not have to) have been treated with non-covalently binding BTK inhibitor(s) to be eligible

c. Parts 1a, 1b, 1c, and Phase 2: Received treatment with a BTK inhibitor as monotherapy or in combination with other anticancer agents for >= 8 consecutive weeks (Note – patients who discontinued BTK inhibitor for intolerance are NOT required to have received previous BTK inhibitor therapy for >= 8 consecutive weeks)

d. Parts 1a, 1b, 1c, and Phase 2: Discontinued the previous BTK inhibitor due to disease progression, toxicity, or intolerance OR experienced progression after completing treatment with the BTK inhibitor

e. Phase 2, Cohorts 1 & 2 only: Received only 1 regimen containing a covalently binding BTK inhibitor (Note: Patients may have received treatment with 2 different covalently binding BTK inhibitors if the initial covalently binding BTK inhibitor was discontinued secondary to an event other than disease progression.)

f. Phase 2 Cohort 1 (CLL/SLL) only: patients may have previously discontinued the previous BTK inhibitor (either covalent or non-covalently binding) or Bcl-2 inhibitor due to disease progression, toxicity, completion of treatment course, or intolerance OR experienced progression after completing treatment with the BTK inhibitor or Bcl-2 inhibitor

5. All patients in Parts 1a, 1b, 1c, and Phase 2 must have measurable disease defined as follows:

a. R/R CLL/SLL: >= 1 lymph node > 1.5 cm in longest diameter and measurable in 2 perpendicular dimensions (assessed by computed tomography [CT]/magnetic resonance imaging [MRI]). NOTE: The presence of measurable disease is NOT required for patients with CLL in Part 1a and Part 1b only

b. NHL: >= 1 lymph node > 1.5 cm in longest diameter OR 1 extranodal lesion > 1.0 cm in the longest diameter, measurable in 2 perpendicular dimensions (assessed by CT/MRI)
i. For patients with MZL, isolated splenomegaly is considered measurable disease for the purposes of eligibility for this study (assessed by CT/MRI)
ii. For patients with R/R MCL in Parts 1a and 1b, isolated splenomegaly is considered measurable disease for the purposes of eligibility for this study (assessed by CT/MRI)

c. WM: serum or plasma IgM level > 0.5 g/dL

6. ECOG Performance Status of 0 to 2 (For EU only: ECOG Performance Status of 0 to 1).

7. Adequate organ function defined as follows (based on the results during the screening period):

a. Absolute neutrophil count (ANC) >= 1.0 x 10^9/L. There is an exception for patients with bone marrow involvement, in which case ANC must be >= 0.75 x 10^9/L. Patients in either scenario must be free from growth factor support as evidenced by an ANC dated >= 14 days following the most recent administration of peg-filgrastim (or other pegylated myeloid growth factors) and = 4 days following the most recent administration of filgrastim or other myeloid growth factors.

b. Platelets >= 50 x 10^9/L (>= 50,000/mm^3); patients with platelet count < 50 x 10^9/L (< 50,000/mm^3) secondary to bone marrow infiltration by the underlying malignancy are eligible for the study if their platelet count is >= 25 x 10^9/L (>= 25,000/mm^3). Patients must be free from growth factor support for >= 7 days and/or transfusion for >= 3 days.

c. Hemoglobin >= 80 g/L (independent of growth factor support or transfusion, defined as no growth factor support for >= 7 days and/or transfusion for >= 3 days); patients may have hemoglobin < 80 g/L without growth factor or transfusion as above if the reduced hemoglobin is secondary to bone marrow infiltration by the underlying malignancy

d. Coagulation meeting all of the following:
International normalized ratio (INR) <= 1.5 (patients on therapeutic anticoagulation may have an INR that is > 1.5 as long as it is within the therapeutic range for the medication that they are receiving. Note: Use of warfarin or other vitamin K antagonists is NOT permitted for patients in this study; see exclusion criterion 24.)

Activated partial thromboplastin time (aPTT) <= 1.5 x upper limit of normal (ULN) (patients on therapeutic anticoagulation may have aPTT > 1.5 x ULN as long as it is within the therapeutic range for the medication that they are receiving).

EU Only: patients on anticoagulation must be on a stable dose for 7 days or longer prior to start of study medication for Parts 1a and 1b.

Note: Patients with factor inhibitors that prolong prothrombin time/activated partial thromboplastin time without increasing the bleeding risk or those with lupus anticoagulant or acquired von Willebrand’s syndrome due to WM can be enrolled. In countries other than the UK, a discussion with the medical monitor or designee is required before enrollment.

e. Glomerular filtration rate (GFR) or creatinine clearance (CrCl) >= 45 mL/min as estimated by one of the following:

i. Cockcroft-Gault equation:
(1) (140 - age) x mass (kg)/72 x creatinine (mg/dL); multiply by 0.85 if female
(2) (140 - age) x mass (kg) x 1.23 if male (or 1.04 if female)/creatinine (µmol/L)

ii. Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation (2021):
(1) eGFR =142*min(standardized Scr /K, 1)^a *max(standardized Scr /K, 1)^-1.200 *0.9938^Age *1.012 [if female]
(a) Scr (serum creatinine) = mg/dL; k = 0.7 (females) or 0.9 (males)
(b) a = -0.241 (females) or -0.302 (males)
(c) min = indicates the minimum of Scr/k or 1, and
(d) max = indicates the maximum of Scr/k or 1

iii. CKD-EPI Creatinine-Cystatin Equation (2021)
(1) eGFRcr-cys = 135 x min(Scr/k, 1)^a x max(Scr/k, 1)^-0.544 x min(Scys/0.8, 1)^-0.323 x max(Scys/0.8, 1)^-0.778 x 0.9961^Age x 0.963 [if female]
(a) k = 0.7 (females) or 0.9 (males)
(b) a = -0.219 (female) or -0.144 (male)
(c) min(Scr/k, 1) is the minimum of Scr/k or 1.0
(d) max(Scr/k, 1) is the maximum of Scr/k or 1.0
(e) Scys = standardized serum cystatin C in mg/L

iv. Nuclear medicine scan

v. 24-hour urine collection

f. Adequate pancreatic function
i. Serum or plasma amylase <= 1.5 x ULN
ii. Serum or plasma lipase <= 1.5 x ULN

g. Adequate liver function indicated by the following:
i. Aspartate aminotransferase (AST)/serum or plasma glutamic-oxaloacetic transaminase <= 2 x ULN
ii. Alanine aminotransferase (ALT)/serum or plasma glutamic-pyruvic transaminase <= 2 x ULN
iii. Total bilirubin level <= 1.5 x ULN (unless documented Gilbert’s syndrome) and direct bilirubin level <= 1.0 x ULN for patients with documented Gilbert’s syndrome

8. Women of childbearing potential must have 2 negative pregnancy tests: a serum or plasma test within 10 to 14 days before the first dose of BGB-16673 and a serum, plasma, or urine pregnancy test within 24 hours prior to the first dose of BGB-16673. In addition, they must use a highly effective method of birth control initiated before the first dose of
the study drug, for the duration of the study treatment period, and for >= 30 days after the last dose of the study drug. See Appendix 18 for highly effective methods of birth control and the definition of childbearing potential.

9. Nonsterile men must use a highly effective method of birth control for the duration of the study treatment period and for >= 30 days after the last dose of the study drug. During this same period, they must not donate sperm. See Appendix 18 for highly effective methods of birth control and the definition of sterile.

10. Life expectancy of > 6 months

11. Ability to provide written informed consent and to understand and comply with the requirements of the study. Patients with psychiatric conditions or cognitive dysfunction that would preclude providing independent informed consent are NOT eligible for the study.

Each patient who is eligible to participate in this study must NOT meet any of the following exclusion criteria:

1. Prior malignancy (other than the disease under study) within the past 2 years, except in situ malignancies that have been curatively resected, localized breast cancer treated with curative intent with no evidence of active disease for more than 3 years and receiving adjuvant hormonal therapy, localized Gleason score = 6 prostate cancer undergoing observation or treatment with androgen depravation, or any other cancer treated with curative intent, not on adjuvant treatment, and in the opinion of the investigator is unlikely to recur

2. Requires ongoing systemic treatment for any other malignancy (except as noted in Exclusion Criteria 1).

3. Any life-threatening illness, medical condition, organ system dysfunction, need for profound anticoagulation, or bleeding disorder, which, in the investigator’s opinion, could compromise the patient’s safety or confound the interpretation of safety or efficacy data

4. Requires ongoing systemic (defined as >= 10 mg/day of prednisone or equivalent) corticosteroid treatment. Systemic corticosteroids must be discontinued >= 7 days before the first day of study drug treatment. For patients in Phase 1 or Phase 2 Cohorts 6 and 7, a short course (<= 7 days prior to start of study drug treatment) is allowed if needed to control lymphoma-related symptoms and it is tapered off within 5 days after initiation of study treatment. (Note: Use of inhaled corticosteroids for primary pulmonary disorders and topical or ophthalmic corticosteroids are not considered systemic treatments and DO
NOT meet protocol exclusion criteria)

5. Current or history of central nervous system involvement including the brain, spinal cord, leptomeninges, and cerebrospinal fluid (as documented by imaging, cytology, or biopsy) by B-cell malignancy, regardless of whether patient had received treatment for central nervous system disease.

6. Known active plasma cell neoplasm, prolymphocytic leukemia, T-cell lymphoma
(including T-cell/histiocyte-rich large B-cell lymphoma), Burkitt lymphoma, AIDSrelated B-cell lymphoma, Castleman disease, post-transplant lymphoproliferative disorders, hairy cell leukemia, GCB DLBCL, EBV+ DLBCL NOS, primary DLBCL of the CNS, primary cutaneous DLBCL – leg type, DLBCL associated with chronic inflammation, primary mediastinal (thymic) large B-cell lymphoma, intravascular large B-cell lymphoma, ALK+ large B-cell lymphoma, primary effusion lymphoma, high grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, high-grade B-cell lymphoma – NOS, B-cell lymphoma unclassifiable with features intermediate between DLBCL and classical Hodgkin lymphoma, or history of or currently suspected transformation of an indolent lymphoma to an aggressive histology (except for patients with Richter Transformation to DLBCL who are eligible for Part 1a, 1c, or Phase 2 Cohort 7 and patients with history of follicular lymphoma transforming to non-GCB DLBCL who are eligible for Part 1a, 1c, or Phase 2 Cohort 6).

7. Prior autologous stem cell transplant unless >= 3 months after transplant

8. Prior CAR-T unless >= 6 months after cell infusion

9. Prior allogeneic stem cell transplant <= 6 months before the first dose of the study drug
(Note: patients who have previously received allogeneic stem cell transplant must have no signs or symptoms of graft versus host disease and must not be receiving immunosuppressive therapy.)

10. Use of the following substances prior to the first dose of the study drug:

a. <= 28 days (or 5 half-lives, whichever is shorter) before the first dose of the study drug:
i. Any biologic and/or immunologic-based anticancer therapy(ies) including experimental therapy(ies) (including but not limited to monoclonal antibody therapy such as rituximab and/or cancer vaccine therapy)

b. <= 14 days (or 5 half-lives, whichever is shorter) before the first dose of the study drug:
i. Systemic chemotherapy or radiation therapy

c. <= 7 days before the first dose of the study drug:
i. Corticosteroid given with antineoplastic intent (symptom control will not be considered as antineoplastic intent)

d. <= 7 days (or 5 half-lives, whichever is shorter) before the first dose of the study drug:
i. BTK inhibitor, tyrosine kinase inhibitor, or other targeted small molecules given with antineoplastic intent

11. Receiving treatment with a strong CYP3A inhibitor (< 7 days or 5 half-lives, whichever is longer) or strong CYP3A inducer (= 14 days or 5 half-lives, whichever is longer) before the first dose of BGB-16673 OR requiring long-term use of strong CYP3A inhibitors or inducers. For a list of selected strong CYP3A inhibitors or inducers, see Appendix 10.

12. Receiving treatment with proton-pump inhibitors <= 5 days before the first dose of BGB-16673. Patients receiving proton-pump inhibitors who switch to H2-receptor antagonists or antacids are eligible for enrollment in this study; refer to Section 8.3 for detailed instructions.

13. Active fungal, bacterial, and/or viral infection requiring systemic therapy. Note: Patients with infections that are managed by oral antibiotics who are otherwise clinically stable are not excluded from study participation

14. Coadministration of herbal or homeopathic medication administered with antineoplastic intent is not permitted while on study treatment. Patients must discontinue all herbal or homeopathic medications being administered with antineoplastic intent >= 28 days prior to initiating study treatment

15. Major surgery <= 4 weeks before the first dose of study treatment

16. Toxicity from prior anticancer therapy that has not recovered to <= Grade 1 (except for alopecia, ANC, absolute lymphocyte count, hemoglobin, and platelet count; for guidance regarding ANC, absolute lymphocyte count, hemoglobin, and platelet count, see inclusion criteria above)

17. Clinically significant cardiovascular disease including the following:
a. Myocardial infarction <= 6 months before screening
b. Unstable angina <= 3 months before screening
c. History of or active clinically significant arrhythmias (eg, sustained ventricular tachycardia, ventricular fibrillation, Torsades de Pointes)
d. New York Heart Association class III or IV congestive heart failure (see Appendix 8)
e. Heart rate-corrected QT interval based on Fridericia’s formula (QTcF) > 480 milliseconds. Patients with bundle branch block can be allowed after discussion with the medical monitor
f. History of or active Mobitz II second- or third-degree heart block without a permanent pacemaker in place
g. Uncontrolled hypertension as indicated by >= 2 consecutive blood pressure measurements, at screening, showing systolic blood pressure > 170 mmHg and diastolic blood pressure > 105 mmHg. For Parts 1a and 1b, EU only: uncontrolled Grade 3 hypertension is defined as systolic blood pressure >= 160 mmHg and diastolic blood pressure >= 100 mmHg, or lower grade hypertension where dose of antihypertensives, if administered, is not stable for at least 14 days.

18. Known infection with human immunodeficiency virus (HIV) or serologic status reflecting active hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus(HCV) infection as follows:

a. Presence of viral hepatitis B surface antigen (HBsAg) or viral hepatitis B core antibody (HBcAb)
Note: Patients with the presence of HBcAb, but the absence of HBsAg, are eligible if HBV DNA is undetectable (the limit of detection for HBV DNA must have a sensitivity of < 20 IU/mL), and patients must be willing to undergo monitoring for HBV reactivation (see Section 6.12.6). Patients who are positive for hepatitis B surface antibody (HBsAb) secondary to a history of vaccination against HBV are eligible.

b. Presence of HCV antibody
Note: Patients with the presence of HCV antibody are eligible if HCV RNA is undetectable (the limit of detection for HCV RNA testing must have a sensitivity of< 15 IU/mL), and patients must be willing to undergo monthly monitoring for HCV reactivation (see Section 6.12.6).

c. Presence of HAV IgM antibody (patients with a history of HAV infection that has resolved are eligible for the study)

19. Pregnant or lactating women

20. Unable to swallow capsules or disease significantly affecting gastrointestinal function such as malabsorption syndrome, resection of the stomach or small bowel, bariatric surgery procedure, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction

21. Inability to comply with study procedures

22. History of stroke or intracranial hemorrhage <= 6 months before the first dose of the study drug

23. Concurrent treatment for the disease under study outside this clinical study

24. Requires treatment with warfarin or other vitamin K antagonists

25. Ongoing drug-induced liver injury, alcoholic liver disease, nonalcoholic steatohepatitis, primary biliary cirrhosis, ongoing extrahepatic obstruction caused by cholelithiasis, cirrhosis of the liver, or portal hypertension

26. History of a severe bleeding disorder such as hemophilia A, hemophilia B, von Willebrand disease (see inclusion criterion 7d regarding patients with acquired von Willebrand’s syndromedue to WM), or history of spontaneous bleeding requiring blood transfusion or other medical intervention

27. NOTE: Original exclusion criterion 27 has been removed.

28. Vaccination with a live vaccine = 35 days before the first dose of the study drug
Note: Seasonal vaccines for influenza are generally inactivated vaccines and are allowed. Intranasal vaccines are live vaccines and are not allowed.

29. Prior treatment with BGB-16673 or any other compound where the mechanism of action involves increased degradation of BTK

30. Known hypersensitivity to any component or excipient of BGB-16673

31. Concurrent participation in another therapeutic clinical trial (for any indication)

5.1 SHARED INCLUSION CRITERIA

Participants across all Arms (unless noted) are eligible to be included in the study only if all the following criteria apply:

- Capable of giving signed informed consent as described in Appendix 1, which includes compliance with the requirements and restrictions listed in the Informed Consent Form and in this protocol

- Age >= 18 years at the time of signing the Informed Consent Form

- Ability to comply with the study protocol and procedures and required hospitalizations, in the investigator’s judgement

- Have a diagnosis of CLL requiring treatment according to the iwCLL criteria (Hallek et al. 2018)

- Participants must meet the following criteria for R/R CLL per iwCLL 2018 criteria
- Relapse is defined as evidence of disease progression in a patient who has previously achieved a CR or partial response (PR) for >= 6 months.
- Refractory disease is defined as treatment failure or as progression within 6 months from the last dose of therapy.

- Previously treated with at least two lines of therapy, including at least one prior BTKi and/or venetoclax-based regimen

- Screening flow cytometry or immunohistochemistry (IHC) evidence of CD20 positive disease as per local review (dim expression of CD20 is acceptable)

- Eastern Cooperative Oncology Group (ECOG) performance score (PS) of <= 2

- Adequate BM function independent of growth factor or transfusion support, within 2 weeks of screening, at screening as follows unless cytopenia is clearly due to marrow involvement of CLL:
- Platelet count >=75,000/mm^3; in cases of thrombocytopenia clearly due to marrow involvement of CLL (per the discretion of the investigator), platelet count should be >= 30,000/mm^3
- ANC >= 1000/mm^3 unless neutropenia is clearly due to marrow involvement of CLL (per the discretion of the investigator)
- Total hemoglobin >= 9 g/dL unless anemia is due to marrow involvement of CLL (per the discretion of the investigator)

- Adequate liver function as indicated by a total bilirubin, AST, and ALT <= 2 times the institutional ULN value
- In patients with CLL involvement of the liver; AST and ALT < 5 times institutional ULN and total bilirubin < 3 times institutional ULN
- In patients with Gilbert’s syndrome; total bilirubin < 3 times institutional ULN
- Measured or estimated creatinine clearance >= 45 mL/min by institutional standard method

- Life expectancy > 6 months

- Resolution to Grade <= 1 for clinically significant toxicities attributable to prior therapies before commencement of the first study drug administration with the following exceptions:
- Any grade alopecia or vitiligo
- Grade 2 peripheral sensory or motor neuropathy
- Endocrinopathy managed and controlled using replacement therapy

- Patients who have a negative HIV test at screening, with the following exception, applicable to Arms A and B only:
Patients with a positive HIV test at screening are eligible provided that, prior to enrollment, they are stable on anti-retroviral therapy for at least 4 weeks, have a CD4 count >=200/µL, have an undetectable viral load, and have not had a history of an opportunistic infection attributable to AIDs within the past 12 months.

- For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraceptive methods that result in a failure rate of < 1% per year, and agreement to refrain from donating eggs, during the treatment period and for at least 3 months after the last dose of mosunetuzumab and 3 months after the last dose of tocilizumab (if applicable)

A woman is considered to be of childbearing potential if she is postmenarchal, has not reached a postmenopausal state (>=12 continuous months of amenorrhea with no identified cause other than menopause), and is not permanently infertile due to surgery (i.e., removal of ovaries, fallopian tubes, and/or uterus) or another cause as determined by the investigator (e.g., Müllerian agenesis). The definition of childbearing potential may be adapted for alignment with local guidelines or regulations.

Examples of contraceptive methods with a failure rate of < 1% per year include bilateral tubal ligation, male sterilization, hormonal contraceptives that inhibit ovulation, hormone-releasing intrauterine devices, copper intrauterine devicesand double-barrier method: condom + diaphragm or cervical cup with spermicidal contraceptive sponge, jellies, or cream.

The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the individual. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not adequate methods of contraception. If required per local guidelines or regulations, locally recognized adequate methods of contraception and information about the reliability of abstinence will be described in the local Informed Consent Form.

- For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm, as defined below:

With a female partner of childbearing potential or pregnant female partner, men must remain abstinent or use a condom during the treatment period and for 2 months after the final dose of tocilizumab (if applicable), to avoid exposing the embryo. Men must refrain from donating sperm during this same period.

The reliability of sexual abstinence should be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the individual. Periodic abstinence (e.g., calendar, ovulation, symptothermal, or postovulation methods) and withdrawal are not adequate methods of preventing drug exposure. If required per local guidelines or regulations, information about the reliability of abstinence will be described in the local Informed Consent Form.

5.1.1 Inclusion Criteria Specific to Arm B

In addition to the above inclusion criteria, participants considered for Arm B must meet the following inclusion criterion:

- Participants must have been taking a BTKi for at least 12 months, have demonstrated evidence of progressive disease while receiving the BTKi and requireadditional salvage therapy as assessed by their treating physician. Participants should be able to continue their previously prescribed BTKi at a stable dose throughout the study screening period and for the first two cycles of mosunetuzumab administration.

5.2 SHARED EXCLUSION CRITERIA

Participants across all Arms (unless noted) are excluded from the study if any of the following criteria apply:

- Pregnant or breastfeeding, or intending to become pregnant during the study orwithin 3 months after the final dose of mosunetuzumab and tocilizumab or within 30 days after the final dose of venetoclax (if applicable)

Women of childbearing potential must have a negative serum pregnancy test result within 14 days prior to initiation of study treatment. If a serum pregnancy test has not been performed within 14 days prior to receiving first study treatment, a negativeurine pregnancy test result (performed within 7 days prior to study treatment) must be available.

- Participants who have received any of the following treatments prior to study entry:
- Treatment with mosunetuzumab or other CD20/CD3-directed bispecificantibodies
- Allogeneic stem cell transplant

- Participants who have received any of the following treatments, whether investigational or approved, within the respective time periods prior to initiation ofstudy treatment:
- Radiotherapy within 2 weeks prior to the first dose of study treatment
- Autologous stem cell transplant within 100 days prior to first study treatment
- CAR T-cell therapy within 30 days before first study treatment
- Prior use of any monoclonal antibodies, radioimmunoconjugates, or antibody drug conjugates for anti-CLL treatment within 4 weeks before first dose of study treatment
- Systemic immunosuppressive medications (including, but not limited to, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor agents) within 2 weeks prior to first dose of study treatment

Systemic corticosteroid treatment <= 20 mg/day prednisone or equivalent andinhaled corticosteroids are permitted.

Administration of acute, low-dose, systemic immunosuppressant medications (e.g., single dose of dexamethasone for nausea or B-symptoms) is permitted.

The use of mineralocorticoids for management of orthostatic hypotension and corticosteroids for management of adrenal insufficiency is permitted.

- Any other anti-cancer therapy, whether investigational or approved, including but not limited to chemotherapy, within 4 weeks, prior to initiation of study treatment.
Except participants to be enrolled into Arm B where overlapping therapy with an approved BTKi is permitted (Section 5.1.1)
- Prior cancer immunotherapy not explicitly described in this protocol
Eligibility is determined by the investigator. The Medical Monitor is available to advise as needed.

- Received a live, attenuated vaccine within 4 weeks before first dose of study treatment, or in whom it is anticipated that such a live attenuated vaccine will be required during the study period or within 5 months after the final dose of study treatment

- Transformation of CLL to aggressive NHL (e.g., Richter’s transformation, prolymphocytic leukemia, or diffuse large B cell lymphoma [DLBCL]) or CNS involvement by CLL

- History of severe allergic or anaphylactic reactions to humanized or murine monoclonal antibody therapy (or recombinant antibody-related fusion proteins)

- Presence of idiopathic, autoimmune, or drug-induced interstitial lung disease (ILD)and drug induced or auto-immune pneumonitis

- Contraindication to tocilizumab

- History of prior malignancy, except for conditions as listed below if patients have recovered from the acute side effects incurred as a result of previous therapy:
- Malignancies treated with curative intent and with no known active disease present for >= 2 years before enrollment
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
- Adequately treated cervical carcinoma in situ without evidence of disease
- Surgically/adequately treated low grade, early stage, localized prostate cancerwithout evidence of disease

- Participants with infections requiring IV treatment with antibiotics or hospitalization (Grade 3 or 4) within the last 4 weeks prior to enrollment or known active bacterial, viral (including SARS-CoV-2), fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of nail beds) at study enrollment

- Evidence of any significant, concomitant disease that could affect compliance with the protocol or interpretation of results, including, but not limited to:
- Significant cardiovascular disease (e.g., New York Heart Association Class III or IV cardiac disease, myocardial infarction within the previous 6 months, unstable arrhythmia, or unstable angina)
- Significant pulmonary disease (such as obstructive pulmonary disease or history of bronchospasm)
-Clinically significant history of liver disease, including viral or other hepatitis, or cirrhosis
- Current or past history of CNS disease, such as stroke, epilepsy, CNS vasculitis, or neurodegenerative disease

Participants with a history of stroke who have not experienced a stroke or transient ischemic attack in the past 1 year and have no residual neurologic deficits as judged by the investigator are allowed.

Participants with a history of epilepsy who have had no seizures in the past 2 years with or without anti-epileptic medications can be eligible only for the expansion cohort

- History of confirmed progressive multifocal leukoencephalopathy (PML)
- Positive test results for chronic hepatitis B infection (defined as positive hepatitis B surface antigen [HBsAg] serology)

Participants with occult or prior hepatitis B infection (defined as positive total hepatitis B core antibody and negative HBsAg) may be included if hepatitis B virus (HBV) DNA is undetectable at the time of screening.These participants must be willing to undergo monthly DNA testing and appropriate prophylactic antiviral therapy as indicated.

- Acute or chronic hepatitis C virus (HCV) infection

Participants who are positive for HCV antibody must be negative for HCV by polymerase chain reaction (PCR) to be eligible for study participation.

- Known or suspected chronic active Epstein-Barr virus infection
- Known or suspected history of HLH
- History of autoimmune disease, including, but not limited to, myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, granulomatosis with polyangiitis, Sjögren syndrome, Guillain-Barre syndrome, multiple sclerosis, vasculitis, or glomerulonephritis (see Appendix 6)

Participants with a history of autoimmune-related hypothyroidism on a stable dose of thyroid replacement hormone may be eligible.

Participants with controlled Type 1 diabetes mellitus who are on an insulin regimen are eligible for the study.

Participants with a history of disease-related immune thrombocytopenic purpura or autoimmune hemolytic anemia may be eligible

Participants with a remote history of, or well-controlled autoimmune disease, with a treatment-free interval from immunosuppressive therapy for 12 months may be eligible after review by the investigator. The Medical Monitor is available to advise as needed.

- Evidence of other clinically significant uncontrolled condition(s) including but not limited to active or uncontrolled systemic infection (e.g., viral, bacterial, or fungal)

- Recent major surgery within 4 weeks prior to first study treatment administration, with the exception of protocol-mandated procedures (e.g., tumor biopsies and bone marrow biopsies)

- Participants with a left ventricular ejection fraction (LVEF) < 40%

- Participants who are in dependence to the Sponsor or an investigator

- Any serious medical condition or abnormality in clinical laboratory tests that, in the investigator's judgment, precludes an individual's safe participation in and completion of the study

- Positive SARS-CoV-2 test within 7 days prior to enrollment. PCR or rapid antigen test result is acceptable


5.2.1 Exclusion Criteria Specific to Arm C

In addition to the above exclusion criteria, participants considered for Arm C are excluded if the following criteria are met:

- Have received venetoclax therapy within 12 months prior to first study treatment administration

- Patients with known infection with HIV or human T-cell leukemia virus 1 (HTLV1)

- In countries where mandatory testing by health authorities is required, HIV testing will be performed.

- HTLV testing is required in patients from endemic countries (Japan, countries in the Caribbean basin, South America, Central America, sub-Saharan Africa, and Melanesia).

- Patients with uncontrolled autoimmune hemolytic anemia or immune thrombocytopenia

- Patients who have received the following agents:

- Strong and moderate CYP3A inhibitors within 7 days prior to the initiation of study treatment

- Strong and moderate CYP3A inducers within 7 days prior to the initiation of study treatment

- Steroid therapy for anti-neoplastic intent with the exception of inhaled steroids for asthma, topical steroids, or replacement/stress corticosteroids within 7 days prior to the first dose of study drug administration

- Consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or star fruit within 3 days prior to the first dose of study drug and throughout venetoclax administration

- Inability to swallow a large number of tablets

- Malabsorption syndrome or other condition that precludes enteral route of administration

- Known allergy to both xanthine oxidase inhibitors and rasburicase

1) Signed Written Informed Consent

a) Participants or their legally acceptable representatives (see Appendix 2), must have signed and dated an (IRB)/Independent Ethics Committee (IEC)–approved written ICF in
accordance with regulatory, local, and institutional guidelines. This must be obtained before the performance of any protocol-related procedures that are not part of normal
patient care.

b) Participants must be willing and able to comply with scheduled visits, treatment schedule, laboratory testing, and other requirements of the study.

2) Type of Participant and Target Disease Characteristics

a) A fresh pre-treatment and on-treatment tumor biopsy must be provided for biomarkeranalysis. Participants must have a tumor that can be biopsied at an acceptable clinical risk
as judged by the investigator to be eligible. An unsuccessful fresh tumor biopsy at screening will not exclude participants from receiving study treatment. For participants in Parts 2A and 2B, a repeat biopsy at screening or on-treatment from the same or an alternative site will be required if clinically feasible (at the discretion of the investigator), and the initial attempt was unsuccessful in obtaining adequate tissue for biomarker analysis. Only 1 repeat attempt may be performed at each time point, if clinically feasible. An unsuccessful fresh tumor biopsy at screening (whether or not repeat is clinically feasible) will not exclude participants from receiving study treatment. Please refer to the laboratory manual for additionaldetails. The biopsy must be a core biopsy, an excisional biopsy, or a surgical specimen.

b) Participants must have measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 (Appendix 5) and, in addition, have at least 1 lesion accessible for biopsy. Fine needle biopsy, cytology, and bone lesion biopsies are not acceptable.

c) Participants must have an Eastern Cooperative Oncology Group Performance Status of 0 or 1 (Appendix 6).

d) Participants must have experienced radiographically documented progressive disease on or after the most recent therapy.

e) Study participants will be expected to have received standard-of-care therapies (except forPart 1C, where participants with prior docetaxel use for the advanced/metastatic setting will be excluded), including an available PD-(L)1 inhibitor known to be effective in the tumor type for which they are being evaluated.

f) Participants must have advanced or metastatic disease and have received, be refractory to, not be a candidate for, or be intolerant to existing therapy(ies) known to provide clinical benefit for the condition of the participant. Eligible tumor types for each Part are listed below:
- Parts 1A and 1B: NSCLC, SCCHN, MSS-CRC, gastric/GEJ adenocarcinoma, cervical cancer (SCC or adenocarcinoma), RCC, UC, PDAC, melanoma, OC, orTNBC.
- Parts2A and 2B: NSCLC, SCCHN, gastric/GEJadenocarcinoma, orup to 3 additional tumor types from Parts 1A and 1B may be considered based on emerging data.
- Part 1C: NSCLC, SCCHN, gastric/GEJ adenocarcinoma, OC, or TNBC.

g) Participants with NSCLC:
i) Histologically confirmed NSCLC meeting stage criteria for stage IIIB, stage IV, or recurrent disease.
ii) Participants must have recurrent or progressive disease during or after platinum doublet-based chemotherapy for advanced or metastatic disease, OR must have recurrent or progressive disease within 6 months after completing platinum-based chemotherapy for local disease.
iii) Participants must have received and progressed on or after anti-PD-(L)1 therapy, if available.
iv) Status for actionable mutations (eg, epidermal growth factor [EGFR], anaplastic lymphoma kinase [ALK], ROS oncogene 1 [ROS1], rearranged during transfection [RET], etc.) must be known (when testing is available as per country/region standard of care practices); participants with actionable mutations must have received and progressed on, have been intolerant to, or not be a candidate for standard tyrosine kinase inhibitors (as available per country/region standard-of-care practices)

h) Participants with SCCHN:
i) Participants must have histologically confirmed, recurrent, or metastatic SCCHN (oral cavity, pharynx, larynx), andnot amenable to local therapy with curative intent. Any other cancers of the head and neck, including nasopharyngeal cancer, salivary gland, and neuroendocrine tumors, are excluded.
ii) Participants must have progressed on or after, or been intolerant to a platinum containing regimen.
iii) Prior curative radiation therapy must have been completed at least 4 weeks prior to first study drug administration. Prior focal palliative radiotherapy must have been completed at least 2 weeks before study drug administration.
iv) Historical human papillomavirus (HPV) status for oropharyngeal cancers must be documented. HPV status should have been determined using p16 immunohistochemistry (IHC) or HPV polymerase chain reaction (PCR).
v) Participants must have received and progressed on or after anti-PD-(L)1 therapy, if available.

i) Participants with MSS-CRC:

i) Participants must have received and then progressed on or after, or have been intolerant or refractory to at least 1 standard systemic therapy for metastatic and/or unresectable disease (or have progressed within 6 months of adjuvant therapy).
(1) Prior treatment with fluoropyrimidine, oxaliplatin, and irinotecan given as a single regimen or over multiple regimens is required.
(2) Prior treatment with an anti-angiogenic therapy (eg, bevacizumab) is required.

ii) Participants must have known MSI status or mismatch repair status.
(1) If the MSI molecular test and MMR IHC test results are both available, then both MSS and MMR proficiency will be required for study entry. Patients with MSIhigh or MSI-low or MMR deficiency will not be eligible.

iii) KRAS, NRAS and BRAF status, if known, should be documented.
(1) If RAS wild-type, prior treatment with an anti-EGFR therapy (eg, cetuximab or panitumumab) is required.

j) Participants with gastric/GEJ adenocarcinoma:

i) Participants must have received and then progressed, relapsed, or been intolerant to at least 1 standard treatment regimen in the advanced or metastatic setting (or have progressed within 6 months of adjuvant therapy).

ii) Participants with known human epidermal growth factor receptor 2 (HER2)-positive gastric cancer must have received prior treatment with a HER2 inhibitor (eg, trastuzumab).

iii) If available, MSI status or mismatch repair status should be documented.

k) Participants with cervical cancer (SCC or adenocarcinoma):

i) Must have received and then progressed, relapsed, or been intolerant to platinum-based chemotherapy with or without bevacizumab in the advanced or metastatic setting.

ii) If available, MSI status or mismatch repair status should be documented.

l) Participants with renal cell carcinoma (RCC):

i) Participants must have histologically confirmed, recurrent, or metastatic RCC, and not amenable to local therapy with curative intent.

ii) Participant had progression or refractory disease during or after at least 2 lines of therapy, including a prior anti-PD-(L)1 therapy.

m) Participants with urothelial carcinoma (UC):

i) Participants must have histologically confirmed, recurrent, or metastatic UC, and not amenable to local therapy with curative intent.

ii) Must have received and then progressed, relapsed, been intolerant to, or ineligible for at least 1 platinum-containing chemotherapy regimen OR be within 12 months of perioperative (neo-adjuvant or adjuvant) treatment with a platinum agent in the setting of cystectomy for localized muscle-invasive UC.

iii) Must be resistant or refractory to anti-PD-(L)1-based immunotherapy.

n) Participants with pancreatic adenocarcinomas (PDAC):

i) Participants must have histologically confirmed, recurrent, unresectable or metastatic PDAC, and not amenable to local therapy with curative intent.

ii) Participants must have received and progressed or been intolerant to (or not be a candidate for) at least 1 prior standard
chemotherapy.

o) Participants with melanoma:

i) Participants must have cutaneous, acral, mucosal, or unknown primary melanoma.Participants with uveal/ocular melanoma are not eligible.

ii) Participants must have histologically confirmed, recurrent, or metastatic melanoma, and not amenable to local therapy with curative intent.

iii) Participants must have received and then progressed, relapsed, or been intolerant to at least 1 standard treatment regimen in the advanced or metastatic setting, including a prior anti-PD-(L)1 therapy, if available.

iv) Participants must have known BRAF status. If indicated, participants must have been offered mutation-directed therapy that has proven survival benefit.

p) Participants with ovarian carcinomas (OC):

i) Participants must have histologically or cytologically confirmed, recurrent, or metastatic epithelial ovarian cancer, primary peritoneal carcinoma or fallopian tube cancer, and not amenable to local therapy with curative intent.

ii) Participants must have received and then progressed, relapsed, or been intolerant to platinum-based chemotherapy, OR must have recurrent or progressive disease within 6 months after completing platinum-based chemotherapy.

iii) Participants with BRCA1/2 mutation must have received treatment with a PARP inhibitor, if available.

q) Participants with triple negative breast cancer (TNBC):

i) Participants must have histologically confirmed, recurrent, or metastatic TNBC, and not amenable to local therapy with curative intent.

ii) Must have progression or refractory disease during or after at least 1 chemotherapy regimen for the treatment of locally advanced or metastatic disease.

iii) Participants with BRCA1/2 mutation must have received treatment with a platinum-containing regimen (if eligible) and a PARP inhibitor, if available.

iv) If PD-L1 positive (defined as combined positive score = 10), prior treatment with immune checkpoint inhibitor is required.

3) Age and Reproductive Status

Investigators shall counsel women of childbearing potential (WOCBP) on the importance of pregnancy prevention, the implications of an unexpected pregnancy, and the potential of fetal toxicity occurring due to transmission of study drug to a developing fetus.

- The investigator shall evaluate the effectiveness of the contraceptive method in relationship to the first dose of study treatment.

- Local laws and regulations may require the use of alternative and/or additional contraception methods.

a) Female Participants

i) Females, ages = 18 or local age of majority at the time of consent.

ii) Women who are not of childbearing potential are exempt from contraceptive requirements.

iii) Women participants must have documented proof that they are not of childbearing potential.

iv) WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IU/L or equivalent units of human chorionic gonadotropin [hCG]) within 24 hours prior to the start of study treatment. An extension up to 72 hours prior to the start of study treatment is permissible in situations where results cannot be obtained within the standard 24-hour window.

v) Additional requirements for pregnancy testing during and after study treatment are located in Section 2, Schedule of Activities.

vi) The investigator is responsible for review of medical history, menstrual history, and recent sexual activity to decrease the risk for inclusion of a woman with an early undetected pregnancy.

vii) WOCBP must agree to follow instructions for method(s) of contraception defined in Appendix 4 and as described below and included in the ICF.

viii) WOCBP are permitted to use hormonal contraception methods (as described in Appendix 4).

ix) A female participant is eligible to participate if she is not pregnant or breastfeeding, and at least 1 of the following conditions applies:

(1) Is not a WOCBP OR

(2) Is a WOCBP and using a contraceptive method that is highly effective (with a failure rate of <1% per year), with low user dependency, as described in Appendix 4 during the treatment period and for at least 3 months after the last treatment with BMS-986340 monotherapy or for at least 6 months after the last dose of study treatment if receiving BMS 986340 in combination with nivolumab or with docetaxel and agrees not to donate eggs (ova, oocytes) for the purpose of reproduction for the same time period.

b) Male Participants

i) Males, age = 18 years or local age of majority at the time of consent.

ii) Male participants receiving BMS-986340 monotherapy and BMS-986340 in combination with nivolumab should maintain their usual practice with regard to contraception (if any); however, no specific contraceptive measures are required.

iii) Male participants receiving BMS-986340 in combination with docetaxel who are sexually active with a WOCBP must agree to follow instructions for method(s) of contraception as defined in Appendix 4 and as described below.

(1) Male participants will be required to always use latex or other synthetic condom during any sexual activity (eg, vaginal, anal, oral) with WOCBP, even if the participants have undergone a successful vasectomy or if their partner is already pregnant or breastfeeding. Males should continue to use a condom during the intervention period and for at least 3 months after the last dose of study intervention.

(2) Female partners of males participating in the study should be advised to use highly effective methods of contraception during the intervention period and for at least 3 months after the last dose of study intervention in the male participant.

(3) Male participants must refrain from donating sperm during the intervention period and for at least 3 months after the last dose of study intervention.

(4) Breastfeeding partners should be advised to consult their health care providers about using appropriate highly effective contraception during the time participant is required to use condoms.

1) Medical Conditions

a) Women who are pregnant or breastfeeding.

2) Medical History and Concurrent Diseases

a) Primary central nervous system (CNS) malignancy.

b) Untreated CNS metastases. Participants are eligible if CNS metastases have been treated and participants have neurologically returned to baseline (except for residual signs or symptoms related to the CNS treatment). In addition, participants must have been either off corticosteroids, or on a stable or decreasing dose of = 10 mg daily prednisone (or equivalent) for at least 2 weeks prior to the first dose of study treatment. Imaging performed within 28 days prior to the first dose of study treatment must document radiographic stability of CNS lesions and be performed after completion of any CNS-directed therapy

c) Leptomeningeal metastases.

d) Concurrent malignancy (present during screening) requiring treatment or history of prior malignancy active within 2 years prior to the first dose of study treatment (ie, participants with a history of prior malignancy are eligible if treatment was completed at least 2 years before the first dose of study treatment and the participant has no evidence of disease). Participants with history of prior early-stage basal/squamous cell skin cancer or noninvasive or in situ cancers who have undergone definitive treatment at any time are also eligible.

e) Participants with an active, known, or suspected autoimmune disease. Participants with type 1 diabetes mellitus, hypothyroidism only requiring hormone replacement, skin disorders (such as vitiligo, psoriasis, or alopecia) not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger are permitted to enroll.

f) Participants with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalent) within 14 days or other immunosuppressive medications within 30 days of the first dose of study treatment. Inhaled or topical steroids, and adrenal replacement steroid doses > 10 mg daily prednisone equivalent, are permitted in the absence of active autoimmune disease.

g) Prior organ or tissue allograft.

h) Toxicity (except for alopecia) related to prior anti-cancer therapy and/or surgery, unless the toxicity is either resolved, returned to baseline or Grade 1, or deemed irreversible.

i) Any major surgery within 4 weeks of study drug administration. Participants must have recovered from the effects of major surgery or significant traumatic injury at least 14 days before the first dose of study treatment.

j) Uncontrolled or significant cardiovascular disease including, but not limited to, any of the following:

i) Myocardial infarction or stroke/transient ischemic attack within the past 6 months.

ii) Uncontrolled angina within the past 3 months.

iii) Any history of clinically significant arrhythmias (such as ventricular tachycardia,ventricular fibrillation, or torsades de pointes).

iv) History of other clinically significant heart disease (eg, cardiomyopathy, congestiveheart failure with New York Heart Association functional classification III to IV pericarditis or significant pericardial effusion).

v) Cardiovascular disease-related requirement for daily supplemental oxygen therapy.

vi) QT interval corrected for heart rate using Fridericia’s formula (QTcF) prolongation> 480 msec, except for right bundle branch block.

vii) History of myocarditis, regardless of etiology.

k) History of or with active interstitial lung disease or pulmonary fibrosis.

l) Evidence of active infection that requires systemic antibacterial, antiviral, or antifungal therapy = 7 days prior to the first dose of study treatment (except for viral infections that
are presumed to be associated with the underlying tumor type required for study entry).

m) Known human immunodeficiency virus (HIV) positive with an acquired immune deficiency syndrome (AIDS)-defining opportunistic infection within the last year, or a current CD4 count <350 cells/µL. Participants with HIV are eligible if:

i)They have received antiretroviral therapy for at least 4 weeks prior to the first dose of study treatment, as clinically indicated, while enrolled on study.

ii) They continue on antiretroviral therapy as clinically indicated while enrolled on study.

iii) CD4 counts and viral load are monitored per standard of care by a local health care provider.

NOTE: Testing for HIV must be performed at sites where mandated locally. HIV positive participants must be excluded where mandated locally.

n) Participants with serious or uncontrolled medical disorders.

o) Receipt of packed red blood cells or platelet transfusion within 2 weeks of the first dose of study treatment.

p) Any significant acute or chronic medical illness which would interfere with study treatment or follow-up.

q) Any known or underlying medical or psychiatric condition and/or social reason that, in the opinion of the Investigator or Sponsor, could make the administration of studytreatment hazardous to the participants or could adversely affect the ability of the participant to comply with or tolerate the study.

r) Any condition, including active or uncontrolled infection, or the presence of laboratory abnormalities, which places the subject at unacceptable risk if he/she were to participate in the study.

s) Previous SARS-CoV-2 infection within 10 days for mild or asymptomatic infections or 20 days for severe/critical illness prior to Cycle 1 Day 1.

i) Acute symptoms must have resolved, and, based on investigator assessment in consultation with the Medical Monitor, there are no sequelae that would place the participant at a higher risk of receiving study treatment.

3) Prior/Concomitant Therapy

a) Cytotoxic agents, unless at least 4 weeks have elapsed from last dose of prior anti-cancer therapy and prior to the first administration of study drug.

b) Non-cytotoxic agents, unless at least 4 weeks or 5 half-lives (whichever is shorter) have elapsed from the last dose of prior anti-cancer therapy and prior to the first administration of study drug. If 5 half-lives is shorter than 4 weeks, agreement with the Sponsor/Medical Monitor (or designee) is mandatory.

c) Prior immune therapy treatments, unless at least 4 weeks or 5 half-lives (whichever is shorter) have elapsed from the last dose of immune therapy and initiation of study therapy.
See Section 6.1 for additional requirements for prior immunotherapy treatments.

d) Treatment with any live / attenuated vaccine within 30 days of first study treatment.

e) Previous SARS-CoV-2 vaccine within 7 days of Cycle 1 Day 1. For vaccines requiring more than 1 dose, the full series (eg, both doses of a 2-dose series) should be completed prior to Cycle 1 Day 1, when feasible, and when a delay in Cycle 1 Day 1 would not put the study participant at risk.

f) Has participated in a study of an investigational agent and has received study therapy or has used an investigational device within 28 days or 5 half-lives (whichever is shorter) of administration of BMS-986340.

g) Treatment with complementary medications (eg, herbal supplements or traditional Chinese medicines) to treat the disease under study within 2 weeks prior to first study treatment. Refer to Section 7.7.1 for prohibited therapies.

h) Prior radiation therapy within 2 weeks prior to first study treatment. Participants must have recovered (ie, Grade = 1 or at baseline) from radiation-related toxicities prior to first study treatment.

i) Prior therapy with an anti-CCR8 antibody.

j) For Part 1C only: Participants must not have been previously treated with docetaxel in the unresectable or metastatic setting.

4) Physical and Laboratory Test Findings

a) White blood cells (WBC) < 2000/µL.

b) Neutrophils < 1500/µL (stable off any growth factor within 4 weeks of first study treatment administration).

c) Platelets < 100 x 10^3/µL (transfusion to achieve this level is not permitted within 2 weeks of first study treatment administration).

d) Hemoglobin < 9.0 g/dL (transfusion to achieve this level is not permitted within 2 weeks of first study treatment administration).

e) Serum creatinine > 1.5 x ULN, unless creatinine clearance = 40 mL/min (measured or calculated using the Cockroft-Gault formula).

f) Aspartate aminotransferase (AST)/alanine aminotransferase (ALT): > 3.0 x ULN. For participants in Part 1C receiving docetaxel: AST and/or ALT > 1.5 x ULN concomitant with alkaline phosphatase > 2.5 x ULN.

g) Total bilirubin > 1.5 x ULN (except participants with Gilbert’s syndrome, who must have a total bilirubin level of < 3.0 x ULN). For participants in Part 1C receiving docetaxel: total bilirubin > 1 x ULN.

h) Any positive test result for hepatitis B virus (HBV) indicating presence of virus; eg, hepatitis B surface antigen (HBsAg, Australia antigen) positive.

i) Any positive test result for hepatitis C virus (HCV) indicating presence of active viral replication (detectable HCV-RNA). Note: Participants with positive HCV antibody and an undetectable HCV RNA are eligible to enroll

5) Allergies and Adverse Drug Reaction

a) History of allergy, hypersensitivity, or serious adverse reaction to monoclonal antibodies or related compounds.

b) History of life-threatening toxicity related to prior immune therapy (eg, anti-CTLA-4 or anti-PD-1/PD-L1 treatment or any other antibody or drug specifically targeting T cell co stimulation or immune checkpoint pathways) except those that are unlikely to re-occur with standard countermeasures (eg, hypothyroidism).

c) History of any significant drug allergy (such as anaphylaxis or hepatotoxicity) except for history of infusion reaction to paclitaxel or oxaliplatin.

d) History of allergy or hypersensitivity to study drug components.

6) Other Exclusion Criteria

a) Prisoners or participants who are involuntarily incarcerated. (Note: Under specific circumstances and only in countries where local regulations permit, a person who has been
imprisoned may be included as a participant. Strict conditions apply and BMS approval is required.)

b) Participants who are compulsorily detained for treatment of either a psychiatric or physical (eg, infectious disease) illness.

Eligibility criteria for this study have been carefully considered to ensure the safety of the study participants and that the results of the study can be used. It is imperative that participants fully meet all eligibility criteria.

Patient Inclusion Criteria

Patients suffering from hematological malignancies and eligible for haploidentical allogeneic stem cell transplantation. Patients will be included prior start of conditioning for HCT.
Inclusion criteria for IMP infusions will be rechecked on day 30+/-2 after HCT prior to IMP administration.


Patient population:
- Patients suffering from hematological malignancies and eligible for haploidentical allogeneic stem cell transplantation. Patients will be included prior start of conditioning for HCT. Inclusion criteria for IMP infusions will be rechecked on day 30 after HCT prior to IMP administration.

Inclusion criteria indications:
- Adult and pediatric patients with hematological malignancies in complete remission (CR), partial remission (PR) or with stable disease
- Acute myeloid leukemia (AML):
- Patients with high-risk AML in CR1
- Patients with relapsed or primary therapy-refractory AML
- Acute lymphoid leukemia (ALL):
- Patients with high-risk ALL in CR1
- Patients with relapsed or primary refractory ALL
- Hodgkin’s disease: Patients with relapsed or primary refractory Hodgkin’s disease
- Non-Hodgkin’s lymphoma: Patients with relapsed or primary refractory Non-Hodgkin’s lymphoma
- Myelodysplastic Syndrome (MDS)/ Myeloproliferative Syndrome (MPS):
- Patients with refractory MDS/MPS
- Multiple myeloma (MM): Patients with relapsed or refractory multiple myeloma

Additional patient inclusion criteria:
- Decision for haplo-identical HHCT with TCR /ß and CD19 depleted stem cell grafts has been made according to hospital routine prior to inclusion of the patient into this study. Patient scheduled for haploidentical transplantation according to hospital routine with an TCRalpha/beta depleted haploidentical stem cell graft
- No signs of acute GVHD on day 30 (day of infusion of DLI/IMP) after haploidentical HHCT
- Patients aged =1 year to <=65 years
For safety reasons, dose escalation part within this study should only be performed for adults and older children (>6 years). The second part of the study, with already evaluated safe dose level, also younger children (>=1 year) can be included.
- Karnofsky (patients >16 years)/Lansky (patients <=16 years) index >60%
- Patient in good clinical condition without concomitant diseases significantly increasing the risk of transplantation, see exclusion criteria
- Pediatric patients without uncontrollable, progressive infections at the time of transplantation
- Informed consent given (patient or legal representative).

Exclusion criteria for patients:
- Age >65 years or <1 year
- Patients with progressive disease prior HCT
- <3 months after preceding hematopoietic cell transplantation (HCT)
- Treatment with T-cell or IL-2 targeted medication (e.g. alemtuzumab, basiliximab) within 60 days prior to study product infusion
- Continuous treatment with prednisolone (or alternative glucocorticosteroid e.g. dexamethasone, short term use <=3 days for other indication as GVHD allowed) within two weeks prior study product infusion (DLI)Known allergy/hypersensitivity to any component of the study product
- Treatment with another investigational drug within one month before inclusion
- History of neurological impairment (active seizures, severe peripheral neuropathy, signs of leukencephalopathy, active CNS infection)
- Note: For patients with HLH or Malignant Osteopetrosis or other patients with heavy pretreatment with irradiation or intrathecal chemotherapy pre-transplant CNS MRI and neurological consultation are mandatory.
- Fungal infections with radiological and clinical progression
- Liver function abnormalities with bilirubin >2 mg/dL and elevation of transaminases higher than 400 U/L
- Chronic active viral hepatitis
- Ejection fraction <40% or Shortening fraction <20% on echocardiography. Patients with > grade II hypertension by CommonToxicity Criteria (CTC)
- Creatinine clearance below threshold defined for stem cell transplantation according to local clinical standard
- Respiratory failure necessitating supplemental oxygen
- HIV infection
- Female patients who are pregnant or breast feeding
- or adults of reproductive potential not willing to use an effective method of birth control during study treatment and for at least 12 months thereafter
Note: Women of childbearing potential must have a negative serum pregnancy test at study entry.
- Subject (male or female) is not willing to use highly effective birth control methods according to the Clinical Trial Faciliation Group (CTFG) recommendations (https://www.hma.eu/fileadmin/dateien/Human_Medicines/01-About_HMA/Working_Groups/CTFG/2014_09_HMA_CTFG_Contraception.pdf) during the treatment and for 6 months after last transplantation (male or female). Such methods include combined hormonal contraception associated with inhibition of ovulation, progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device (IUD), intrauterine hormone-releasing system (IUS), bilateral tubal occlusion, vasectomised partner1, sexual abstinence2.

1 Vasectomised partner is a highly effective birth control method provided that partner is the sole sexual partner of the WOCBP trial participant and that the vasectomised partner has received medical assessment of the surgical success.

2 In the context of this guidance sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the subject.

- Concurrent severe or uncontrolled medical disease (e.g. uncontrolled diabetes, congestive heart failure, myocardial infarction within 6 months prior to the study, unstable and uncontrolled hypertension, chronic renal disease, or active uncontrolled infection) which by assessment of the treating physician could compromise participation in the study
- Patients with a history of psychiatric illness or a condition which could interfere with their ability to understand the requirements of the study (this includes alcoholism/drug addiction)
- Patients unwilling or unable to comply with the protocol or unable to give informed consent

Donor Selection

Donor selection is done as part of standard of care in haploidentical transplantation. All apheresis centers will use a Health Questionnaire based on the current version of the “Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur Anwendung von Blutprodukten".

1. Haploidentical family member previously identified as eligible donor by donor/recipient cross-matching including HLA-typing.
Note: In case of positive cross-match results for donor-reactive anti HLA antibodies an alternative donor with negative cross-match results should be preferred, if available. If no alternative donor with negative cross-match results is available, removal of anti HLA antibodies is highly recommended to prevent graft rejection.

2. Donor age >=16 years
Note: Positive evaluation for allogeneic hematopoietic cell donation has to have been performed at the collection center according to local standard practice. Also informed consent for mobilization and collection of peripheral blood stem cells according to local institutional guidelines has to have been given in this context independently of the present clinical study. Stem cell mobilization and collection procedures are not part of this study and will be performed at the collection center according to local standard procedures.

3. Study specific informed consent given.

Patients eligible for inclusion in this study must meet all of the following criteria:

1. Signed informed consent must be obtained prior to participation in the study.

2. Patients must be >= 18 years of age.

3. Target disease characteristics:

Dose escalation part:
Patients with advanced unresectable or metastatic MSI^hi or dMMR* solid tumors who have progressed after or are intolerant to prior standard therapy.Patients must have progressed on the most recent therapy for advanced disease.

3a ArmA HRO761 s.a.
- Patient should have received all available lines of standard of care therapy, including chemotherapy and/or targeted therapy, and prior immune checkpoint inhibitor therapy.

3b ArmB HRO781 in combination with tislelizumab
- Patient should have received standard of care therapy, i.e., chemotherapy and/or targeted therapy. Patient should have received checkpoint inhibitor therapy for advanced disease as prior treatment or should be expected to benefit from anti-PD1 checkpoint inhibitor therapy as part of the HRO761 in combination with tislelizumab.
- Prior adjuvant therapy is allowed

3c Arm C HRO761 in combination with irinotecan
- Patient should have received at least one prior line of chemotherapy or targeted therapy, and prior checkpoint inhibitor therapy. Patient should not have previously received irinotecan for advanced disease but should be expected to benefit from irinotecan therapy


Dose optimization (Arm A) and Dose expansion (Arms A, B and C) parts:

3d Arm A - Optimizazion and Expansion Group A1 HRO761 s.a.
- Patients with advanced unresectable or metastatic MSI^hi or dMMR* colorectal cancer (CRC) who have progressed after or are intolerant to prior standard therapy including at least one line of immune checkpoint inhibitor. Patient must have received prior therapy that included fluoropyrimidine and oxaliplatin or irinotecan.
- No more than total 3 prior lines of therapy for advanced disease (prior adjuvant therapy is allowed)

3e Arm A - Optimization and Expansion Group A2 HRO761 s.a.
- Patients with advanced unresectable or metastatic MSI^hi or dMMR* solid tumors (with the exception of CRC) who have progressed after or are intolerant to prior standard therapy. Patient should have received at least one prior line of chemotherapy or targeted therapy, and one prior line of checkpoint inhibitor therapy.
- No more than total 3 prior lines of therapy for advanced disease (prior adjuvant therapy is allowed).

3f Arm B - Group B1 HRO761 in combination with tislelizumab
- patients with advanced unresectable or metastatic MSI^hi or dMMR* colorectal cancer (CRC) who have not received any prior checkpoint inhibitor therapy and no more than one prior line of chemotherapy for advanced disease. Patients should be expected to benefit from anti-PD1 checkpoint inhibitor therapy.
- Prior adjuvant therapy is allowed if completed > 12 months prior to study start.

3g Arm B - Group B2 HRO761 in combination with tislelizumab
- Patients with advanced unresectable or metastatic MSI^hi or dMMR* solid tumors (with the exception of CRC) who have not received any prior checkpoint inhibitor therapy and no more than one prior line of systemic therapy (chemotherapy and/or targeted therapy) for advanced disease. Patients should be expected to benefit from anti-PD1 checkpoint inhibitor therapy.
- Prior adjuvant therapy is allowed if completed > 12 months prior to study start

3h Arm C - Group C1 HRO761 in combination with irinotecan
- Patients with advanced unresectable or metastatic MSI^hi or dMMR* solid tumors who have progressed after or are intolerant to prior standard therapy. Patient should have received at least one prior line of chemotherapy or targeted therapy, and one prior line of checkpoint inhibitor therapy. Patient should not have previously received irinotecan for advanced disease, but should be expected to benefit from irinotecan therapy.

For patients who have received prior definitive chemoradiation, adjuvant or neoadjuvant therapy: if disease progression occurred within = 6 months after completion of last therapy, this will be considered as one line of treatment for advanced disease.

* For dose escalation, dose optimization and dose expansion parts:
MMR deficient (dMMR) or MSIhi status based on local testing will be determined using a test such as:
- For dMMR status: Immunohistochemistry (IHC) including four core MMR proteins (MSH2, MSH6, MLH1 and PMS2).
- For MSI status: PCR analysis including five tumor microsatellite loci (BAT25, BAT26, NR21, NR24, Mono27), or Next Generation Sequencing (NGS).

4. Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) = 1

5. Measurable disease as determined by RECIST version 1.1 (refer to Section 10.3 Appendix 3). Tumor lesions previously irradiated or subjected to other loco-regional therapy will only be considered measurable if there is documented disease progression at the treated site after completion of therapy.

6. Dose escalation and optimization (Arm A only): Patients must have a site of disease amenable to biopsy and be a candidate for tumor biopsy according to the treating institution’s guidelines. Patients must be willing to undergo a new tumor biopsy at screening and during therapy on the study (Please refer to Table 8-8 for details). A biopsy from the same lesion is preferred if safe and medically feasible. Exceptions may be considered after documented discussion with Novartis.

7. Patients will have available archival tumor tissue obtained prior to study treatment initiation (in addition to newly obtained tumor biopsy at screening), to allow retrospective MSIhi/dMMR status confirmation (If an archival tumor sample is not available at screening, a newly obtained tumor sample is to be collected, please refer to Table 8-8 for details)

EXCLUSION CRITERIA APPLICABLE FOR ALL TREATMENT ARMS
Patients meeting any of the following criteria are not eligible for inclusion in this study:

1. Impaired cardiac function or clinically significant cardiac disease, including any of the following:
- Clinically significant and/or uncontrolled heart disease such as congestive heart failure requiring treatment (NYHA Grade = 2), uncontrolled hypertension or clinically significant arrhythmia
- History of cardiac imaging evidence of cardiac fibrosis or structural remodeling/thickening (heart wall thickness = 15 mm). Patient with mild thickening with preserved ejection fraction (> 50%) can be enrolled after a cardiology consultation which would have assessed the overall benefit/risk of participating to the study.
- QTcF > 470 msec on screening ECG or congenital long QT syndrome

2. History of acute myocardial infarction or unstable angina pectoris

3. Clinically significant eye impairment including any of the following:
- History of acute or chronic glaucoma, anterior chamber defect
- Retinal pathology or retinal vessel impairment
- Clinically relevant high intraocular pressure at screening as per ophthalmologist assessment (e.g., CTCAE Grade = 2 glaucoma criteria)

4. Patients with a primary CNS tumor. Patients with brain metastases may participate in this study if at the time of first study treatment the patient is:
- 2 weeks or more from prior CNS-directed therapy completion (including radiation and/or surgery).
- Clinically stable with respect to the CNS tumor.
- Not receiving steroid therapy or, if receiving glucocorticoid therapy, the patient must have been maintained on a stable dose for at least 4 weeks.
- Not receiving anti-convulsive medications (that were started for brain metastases).

5. (Inclusion criteria not applicable as per protocol amendment v.04, revised and included in Inclusion criteria 5a). Treatment with any of the following anti-cancer therapies prior to the first dose of study treatment within the stated timeframes:
- <= 4 weeks for radiation therapy. Limited field radiation for palliation is allowed within :S 2 weeks prior to the first <lose of study treatment.
- <= 4 weeks or :S 5 half-lives (whichever is shorter) for chemotherapy or biological therapy (including monoclonal antibodies) or continuous or intermittent small molecule therapeutics or any other investigational agent.
- <= 6 weeks for cytotoxic agents with major delayed toxicities, such as nitrosoureas and mitomycin C.
- Patients who have undergone major surgery :S 4 weeks prior to first dose of study treatment or who have not recovered from the surgical procedure.

5a. Treatment with any ofthe following anti-cancer therapies prior to the first dose of study treatment within the stated timeframes:
- <= 4 weeks for radiation therapy. Limited field radiation for palliation is allowed within <= 2 weeks prior to the first <lose of study treatment.
- <= 4 weeks or <= 5 half-lives (whichever is shorter) for chemotherapy or biological therapy (including monoclonal antibodies) or continuous or intermittent small molecule therapeutics or any other investigational agent.
- <= 6 weeks for cytotoxic agents with major delayed toxicities, such as nitrosoureas and mitomycin C.
- Patients who have undergone major surgery <= 4 weeks prior to first dose of study treatment or who have not recovered from the surgical procedure.

6. Known additional malignancy that is progressing or requires active treatment. Exceptions include basal cell carcinoma of the skin or squamous cell carcinoma of the skin that has undergone potentially curative therapy or in situ cervical cancer or other tumors that will not affect life expectancy.

7. HIV infection with viral load values consistently greater than 50 copies/mL or CD4+ cell count less than 200/mm^3

8. Active HBV or HCV infection not controlled by antiviral therapy. (Controlled disease is defined as positive anti-HBc and negative HBsAg for HBV and undetectable viral load by real-time PCR for HCV) (Please refer to Table 8-3).

9. Patient with untreated active or latent tuberculosis.

10. Infection requiring systemic antibacterial, antifungal or antiviral therapy within 14 days prior to first dose of study drugs

11. Having out of range laboratory values defined as:
- Creatinine clearance (calculated using Cockcroft-Gault formula, or measured) < 60 mL/min
- Total bilirubin > 1.5 x ULN, except for patients with Gilbert’s syndrome who are excluded if total bilirubin > 3.0 x ULN or direct bilirubin > 1.5 x ULN
- Alanine aminotransferase (ALT) > 3 x ULN
- Aspartate aminotransferase (AST) > 3 x ULN
- Absolute neutrophil count (ANC) < 1.0 x 10^9/L
- Platelet count < 75 x 10^9/L
- Hemoglobin < 9 g/dL
- Clinically significant serum/plasma electrolyte concentration abnormalities (e.g., sodium, chloride, potassium)

12. History of severe hypersensitivity reactions to any ingredient of study drug(s)

13. Use of any live or attenuated vaccines against infectious diseases within 4 weeks of study treatment initiation.

14. Impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of study drugs, (e.g., severe ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection), presence of intestinal obstruction. Prior gastrectomy is not an exclusion criterion.

15. History of or current drug induced interstitial lung disease or non-infectious pneumonitis grade = 2. Non-drug induced interstitial lung disease or non-infectious pneumonitis grade = 2 within 6 months prior to study treatment.

16. Use of hematopoietic growth factors or transfusion support = 2 weeks prior to start of study treatment. For arms A and B only: If growth factors were initiated more than 2 weeks prior to the first dose of study treatment and the patient is on a stable dose, they can be maintained.

17. Unable or unwilling to swallow the oral drug as per dosing schedule

18. Presence of Grade = 2 toxicity according to National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE version 5), with the exception of neuropathy (inclusion of patients with neuropathy of Grade 2 or less is permitted) and alopecia

19. Major surgery treatment (except for surgical treatment of cancer, see exclusion criteria 3) within 4 weeks prior to enrollment (mediastinoscopy, insertion of a central venous access device and insertion of a feeding tube are not considered major surgery)

20. Participation in an interventional, investigational study within 2 weeks prior to the first dose of study treatment

21. Patients who are taking a prohibited medication that cannot be discontinued at least seven days prior to the first dose of study treatment and for the duration of the study (see Section 6.8.2)

22. Pregnant or breast-feeding (lactating) women, where pregnancy is defined as the state of a female after conception and until the termination of gestation, confirmed by a positive human chorionic gonadotropin (hCG) laboratory test

23. Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using highly effective methods of contraception while taking study treatment and for 7 days (patients assigned to HRO761 s.a. Arm) based on estimated half-life of 9 hours (Please refer to HRO761 investigator Brochure) – 120 days patients assigned to HRO761 in combination with tislelizumab) – 6 months or as per the local approved label (patients assigned to HRO761 in combination with irinotecan) after stopping medication. Highly effective contraception methods include:
- Total abstinence (when this is in line with the preferred and usual lifestyle of the patient). Periodic abstinence (e.g., calendar, ovulation, symptothermal, post ovulation methods) and withdrawal are not acceptable methods of contraception.
- Female sterilization (have had surgical bilateral oophorectomy with or without hysterectomy), total hysterectomy, or bilateral tubal ligation at least six weeks before taking study treatment. In case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow-up hormone level assessment.
- Male sterilization (at least 6 months prior to screening). For female patients on the study, the vasectomized male partner should be the sole partner for that patient.
- Use of oral, (estrogen and progesterone), injected, or implanted hormonal methods of contraception or placement of an intrauterine device (IUD) or intrauterine system (IUS), or other forms of hormonal contraception that have comparable efficacy (failure rate < 1%), for example hormone vaginal ring or transdermal hormone contraception.

In case of use of oral contraception, women should have been stable on the same pill for a minimum of 3 months before taking study treatment.

Women are considered post-menopausal and not of childbearing potential if they have had over 12 months of natural (spontaneous) amenorrhea with an appropriate clinical profile (e.g., age appropriate [generally age from 40 to 59 years], history of vasomotor symptoms [e.g., hot flush]) in the absence of other medical justification or have had surgical bilateral oophorectomy (with or without hysterectomy), total hysterectomy or bilateral tubal ligation at least six weeks prior to enrollment on study. In the case of oophorectomy alone, only when the reproductive status of the woman has been confirmed by follow-up hormone level assessment is she considered to be not of child bearing potential.

24. Sexually active males unwilling to use a condom during intercourse while taking study treatment and for 7 days (patients assigned to HRO761 s.a. Arm and in combination with
tislelizumab) – 3 months or as per the local approved label (patients assigned to HRO761 in combination with irinotecan) after stopping study treatment. A condom is required for all sexually active male patients to prevent them from fathering a child AND to prevent delivery of study treatment via seminal fluid to their partner. In addition, male patients must not donate sperm for the time period specified above.

If local regulations deviate from the contraception methods listed above to prevent pregnancy, local regulations apply and will be described in the ICF.

25. Any medical condition that would, in the investigator’s judgement, prevent the patient’s participation in the clinical study due to safety concerns or compliance with clinical study procedures. Any severe, acute or chronic medical or psychiatric condition or laboratory abnormality that may increase the risk associated with study participation or study treatment administration or that may interfere with the interpretation of study results and, in the judgement of the investigator, would make the patient inappropriate for the study.

EXCLUSION CRITERIA SPECIFIC TO TREATMENT ARM B CONTAINING TISLELIZUMAB

101. Groups B1 and B2: prior treatment with immune checkpoint inhibitors

102. History of severe hypersensitivity reactions to other monoclonal antibodies, which in the opinion of the investigator may pose an increased risk of serious infusion reaction

103. Active, known or suspected autoimmune disease. Patients with vitiligo, type I diabetes, residual hypothyroidism only requiring hormone replacement, psoriasis not requiring systemic treatment or conditions not expected to recur may be considered. Patients previously exposed to anti-PD-1/PD-L1 treatment who are adequately treated for skin rash or with replacement therapy for endocrinopathies should not be excluded.

104. Patients who discontinued prior anti-PD-1 therapy due to an anti-PD-1-related toxicity

105. Systemic chronic steroid therapy (> 10mg/day prednisone or equivalent) or any other immunosuppressive therapy within 7 days of the first dose of study treatment. Topical, inhaled, nasal and ophthalmic steroids are allowed.

106. Uncontrollable pleural effusion, pericardial effusion, or ascites requiring frequent drainage (recurrence within 2 weeks of intervention)

EXCLUSION CRITERIA SPECIFIC TO TREATMENT ARM C CONTAINING IRINOTECAN

108. UGT1A1*28 TA7/7, TA7/8, TA8/8 genetic polymorphisms; known history or clinical evidence of reduced UGT1A1 activity, known Gilbert's syndrome, known Crigler-Najjar syndrome, (testing for UGT1A1 status is not mandatory unless required by local regulations and can be conducted at a local laboratory)

109. Use of hematopoietic growth factors or transfusion support = 2 weeks prior to start of study treatment.

110. Patients requiring treatment with strong inhibitors or strong inducers of CYP3A4 for whom treatment cannot be changed to another appropriate medication

111. History of severe diarrhea or colitis

112. Absolute neutrophil count (ANC) < 1.5 x 10^9/L

113. Platelet count < 100 x 10^9/L

114. Prior pelvic / abdominal radiotherapy

115. Known hypersensitivity to irinotecan or components of the drug

Subjects eligible for inclusion in this study must meet all of the following criteria:

1. Signed informed consent must be obtained prior to participation in the study.

2. Subject is currently enrolled in a pre-defined Novartis-sponsored study and is receiving spartalizumab as single agent or in combination with other study treatment.

3. Subject is currently deriving clinical benefit from the study treatment, as determined by the investigator.

4. Subject has demonstrated compliance, as assessed by the investigator, with the parent protocol requirements.

5. Subject is willing and able to comply with the scheduled visits and treatment plans.

Subjects meeting any of the following criteria are not eligible for inclusion in this study.
- Subject has been permanently discontinued from spartalizumab in the parent protocol for any reason other than enrollment in the CPDR001X2X01B study.
- Subject does not meet the criteria specified in the parent protocol criteria for continued study treatment.
- Subject not willing to comply with the contraception requirements outlined in the exclusion criteria of the parent protocol.

Patients must meet all of the following inclusion criteria to be eligible to enroll in this study:

1. Written informed consent in accordance with federal, local, and institutional guidelines. The patient must provide informed consent prior to the first screening procedure

2. Age >= 18 years

3. Eastern Cooperative Oncology Group (ECOG) performance status of <= 2

4. Availability of patient-specific molecular MRD markers of immunoglobulin/T-cell receptor gene rearrangements as assessed with a sensitivity of at least 10E-04

5. Diagnosis of Ph-negative, CD19-positive B-precursor acute lymphoblastic leukemia according to WHO classification:

- Refractory BCP-ALL to primary induction therapy, including at least three cycles of standard chemotherapy
- Untreated first relapse of BCP-ALL with first remission duration < 12 months or
- Second or greater relapse of BCP-ALL or refractory relapse or
- Relapse of BCP-ALL any time after allogeneic HSCT or

6. Positivity of MRD marker of immunoglobulin/T-cell receptor gene rearrangements of greater than 0.01 % if in first or second remission of BCP-ALL

7. Negative pregnancy test < 7 days before first study drug in women of childbearing potential, defined as all women physiologically capable of becoming pregnant, unless they fulfil at least one of the following criteria:

- Post-menopausal (i.e. 12 months of natural amenorrhea or 6 months of amenorrhea with Serum FSH > 40 U/ml
- Post-operative after bilateral ovariectomy with or without hysterectomy
- Continuous and correct application of a contraception method with a Pearl index of < 1 % (e.g. implants, depots, oral contraceptives, intrauterine device) from initial study drug administration until at least 3 months after the last dose of study drug. A hormonal contraception method must always be combined with a barrier method (e.g. condom)
- Sexual abstinence
- Vasectomy of the sexual partner

8. Ability to understand and willingness to sign a written informed consent

9. Willingness to participate in the registry of the German Multicenter Study Group for Adult ALL (GMALL)

Patients meeting any of the following exclusion criteria are not eligible to enroll in this study:

1. Patients with diagnosis of Philadelphia positive BCP-ALL according to WHO classification

2. Patients with diagnosis of Burkitt´s Leukemia according to WHO classification

3. Patients with extramedullary relapse; non-bulky lymph node (< 7.5 cm diameter) involvement will be accepted

4. Patients with CNS involvement at relapse (as determined by CSF analysis)

5. Patients with suspected or histologically confirmed testicular involvement at relapse

6. Current autoimmune disease of any kind or history of autoimmune disease with potential CNS involvement

7. Patients with Philadelphia-positive BCP-ALL still receiving TKI

8. Prior or concomitant therapy with BH3 mimetics

9. Prior therapy with anti CD19 therapy, unless administered in MRD-positive setting (i.e. with bone marrow blasts <= 5 %)

10. Treatment with any of the following within 7 days prior to the first dose of study drug: strong cytochrome P450 3A (CYP3A) inhibitors, moderate or strong CYP3A inducers

11. Intake of any of the following within 3 days prior to the first dose of study drug: grapefruit, grapefruit products, Seville oranges or star fruit

12. Presence of Graft-versus-Host Disease (GvHD) and/or on immunosuppressant medication
within 2 weeks before start of protocol-specified therapy

13. Radiation, chemotherapy (with the exception of prephase therapy), or immunotherapy or any other anticancer therapy <= 2 weeks prior to Cycle 1 Day 1 or radio-immunotherapy 4 weeks prior to Cycle 1 Day 1.

14. Major surgery within 2 weeks of first dose of study drug

15. Patients who are pregnant or lactating

16. Any life-threatening illness, medical condition or organ system dysfunction which, in the investigator's opinion, could compromise the patient’s safety

17. Unstable cardiovascular function:

- Symptomatic ischemia, or
- Uncontrolled clinically significant conduction abnormalities (1st degree AV block or asymptomatic LAFB/RBBB will not be excluded), or
- Congestive heart failure (CHF) of NYHA Class >= 3, or
- Myocardial infarction (MI) within 3 months

18. Evidence of clinically significant uncontrolled condition(s) including, but not limited to:
Uncontrolled and/or active systemic infection (viral, bacterial or fungal), chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) requiring treatment. Note: subjects with serologic evidence of prior vaccination to HBV (i.e. hepatitis B surface (HBs) antigen negative-, anti HBs antibody (anti-HBs) positive and anti-hepatitis B core (HBc) antibody negative) or positive anti-HBc antibody from intravenous immunoglobulins (IVIG) or blood transfusions may participate.

19. Known human immunodeficiency virus (HIV) infection (HIV testing is not required)

20. Patients unable to swallow tablets, patients with malabsorption syndrome, or any other GI disease or GI dysfunction that could interfere with absorption of study treatment

21. Adequate hepatic function per local laboratory reference range as follows: Aspartate transaminase (AST) and alanine transaminase (ALT) < 3.0 x ULN, Bilirubin <= 1.5 x ULN (unless bilirubin rise is due to Gilbert’s syndrome or of non-hepatic origin)

22. Severe renal dysfunction: estimated creatinine clearance of < 20 mL/min, measured in 24 hour urine or calculated using the formula of Cockroft and Gault

23. History or presence of clinically relevant CNS pathology such as epilepsy, childhood or adult seizure, paresis, aphasia, stroke, severe brain injuries, dementia, Parkinson’s disease, cerebellar disease, organic brain syndrome, or psychosis. History of CNS leukemia that is controlled at relapse may be enrolled in this study.

24. History of malignancy other than ALL within 5 years prior to start of protocol-specified therapy with the exception of:

- Malignancy treated with curative intent and with no known active disease present for 2 years before enrollment and felt to be at low risk for recurrence by the treating physician including

- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease

- Adequately treated cervical carcinoma in situ without evidence of disease

- Adequately treated breast ductal carcinoma in situ without evidence of disease

- Prostatic intraepithelial neoplasia without evidence of prostate cancer.

25. Current autoimmune disease or history of autoimmune disease with potential CNS involvement

26. Live vaccination within 2 weeks before the start of study treatment

27. Known hypersensitivity to immunoglobulins or to any other component of the study drug formulation

28. Subject has known sensitivity to immunoglobulins or any of the products or components to be administered during dosing.

29. Currently receiving treatment in another investigational device or drug study or less than 30 days since ending treatment on another investigational device or drug study(s). Thirty days is calculated from day 1 of protocol-specified therapy

30. Subject likely to not be available to complete all protocol-required study visits or procedures, including follow-up visits, and/or to comply with all required study procedures to the best of the subject’s and Investigator’s knowledge.

31. History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.

32. Woman of childbearing potential, defined as all women physiologically capable of becoming pregnant, unless they fulfil at least one of the following criteria:

- Post-menopausal (i.e. 12 months of natural amenorrhea or 6 months of amenorrhea with Serum FSH > 40 U/ml
- Post-operative after bilateral ovariectomy with or without hysterectomy
- Continuous and correct application of a contraception method with a Pearl index of < 1 % (e.g. implants, depots, oral contraceptives, intrauterine device) from initial study drug administration
until at least 3 months after the last dose of study drug. A hormonal contraception method must always be combined with a barrier method (e.g. condom)
- Sexual abstinence
- Vasectomy of the sexual partner

33. Male who has a female partner of childbearing potential, and is not willing to use 2 highly effective forms of contraception while receiving protocol-specified therapy and for at least an additional 3 months after the last dose of protocol-specified therapy

Inclusion Criteria; HLA (S1), and Tumor Target Screening (S2) and Treatment Eligibility Assessment (VA)

1. Patients must have voluntarily signed a written ICF, be able to understand and comply with clinical trial procedures. S1: ICF1, VA: ICF2

2. Patients >= 18 years old. S1

3. Patients must have pathologically confirmed and documented advanced and/or metastatic solid tumor.

Among the range of solid tumor indications, sarcoma (e.g., synovial, myxoid liposarcoma or angiosarcoma), squamous non-small cell lung cancer (sqNSCLC), small-cell lung cancer (SCLC), head & neck squamous cell carcinoma (HNSCC), bladder urothelial carcinoma, uterine carcinosarcoma, esophageal squamous carcinoma, testicular germ cell tumor, triple-negative breast cancer (TNBC), ovarian serous cystadenocarcinoma, cervical squamous cell carcinoma and adenocarcinoma, and cutaneous melanoma should be screened primarily. Other solid tumor indications may be considered only after consultation with the sponsor.

NOTE: There is no limitation on type and number of prior anti-tumor treatments. S1: x

4. Patients must have a lesion considered accessible for a biopsy unless adequate archival FFPE tumor tissue samples for target determination is available or adequate tissue was obtained during a medically indicated procedure conducted at any time during the tumor disease (e.g., resection, debulking surgery, etc.), and obtained tissue was stored under appropriate storage conditions. S1: x S2: x

5. Patients must have measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1). VA: x^2


6. HLA genotype: HLA-A*02:01 positive and at the same time not positive for another HLA-A*02:XX sub allele (repeat assessment allowed).

NOTES: Suitable HLA genotype has to be assessed by an SBT and/or NGS-based assay. The NGS result will be used as decisive result.

For any patient previously HLA typed for participation in other Immatics-sponsored clinical trials or an Immatics-supported IIT using a central laboratory selected by Immatics for HLA-genotyping and confirmed as being HLA-A*02:01 positive via an SBT-based assay, the additional NGS-based HLA typing assay must be performed to confirm the appropriate HLA-A genotype.

In case the patient is known to be HLA-A*02:01 positive as tested routinely or as a trial-specific procedure by a local hospital laboratory or central laboratory with appropriate accreditation (e.g., CLIA, CAP, EFI, ASHI, DakkS) using a PCR-based or sequencing based method, S1 and S2 visit assessments may be conducted on the same day. For these patients, HLA genotyping by NGS must be repeated at Immatics designated CLIA/CAP-certified laboratory. The NGS result will be used as decisive result. S1: x^3 (SBT/NGS) Va: x (NGS)


7. Patients’ tumor must express MAG-003 based on the following:

a. assessment by IMADetect RT-qPCR using a fresh tumor biopsy specimen either from this clinical trial, another Immatics-sponsored clinical trial, or an Immatics-supported IIT

OR

b. assessment by IMADetect RT-qPCR based on fresh tumor material stored in RNAlater/RNAprotect or (for fresh frozen tissues, after consultation with sponsor) RNALater ICE from any medically indicated procedure collected at any time during the tumor disease.

OR

c. assessment by IMADetect RT-qPCR based on archival FFPE tumor tissue samples (freshly cut [<=3 weeks] sections from blocks <= 2 years of age; older blocks or sections may be possible after consultation with sponsor).

NOTE: If acquired tissue was inadequate to determine the presence of MAG-003 antigen, patients may undergo a repeat biopsy at the discretion of the investigator. S2: x

8. Life expectancy > 2 months. VA: x

9. ECOG Performance Status of 0 to 1. S1: x, S2: x, VA: x^1

10. Absolute neutrophil count (ANC) >= 1.0 x 10^9/L (without granulocyte colony-stimulating factor [G CSF] support); platelets >= 75,000/µL; hemoglobin >= 8 g/dL; absolute lymphocyte count (ALC) >= 0.5 x 10^9/L (repeat assessment allowed). S2: x^4 VA: x^1

11. Adequate hepatic function, as defined by a total bilirubin level <= 1.5 x upper limit of normal unless the patient is a hepatocellular carcinoma patient or has known Gilbert’s syndrome (total bilirubin level of <= 2.5 x ULN), and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) <= 2.5 x ULN or <= 5 x ULN for patients with liver metastases (repeat assessment allowed). S2: x^4 VA: x^1

12. Adequate renal function defined by creatinine clearance = 30 mL/min (as estimated by Cockcroft Gault or other medically acceptable formulars such as MDRD (Modification of Diet in Renal Disease) or CKD-EPI (the Chronic Kidney Disease Epidemiology Collaboration) (repeat assessment allowed). S2: x^4 VA: x^1

13. Acceptable coagulation status defined by an international normalized ratio (INR) of prothrombin time (PT) of blood coagulation <= 2.0 x ULN and partial thromboplastin time (PTT) or activated PTT (aPTT) <= 2.0 x ULN (repeat assessment allowed) unless patient is on stable dose of anticoagulants, the interruption of which for the purpose of obtaining the biopsy is medically feasible. S2: x^4 VA: x^1

14. Patients must have recurrent and/or refractory solid tumors and must have received or not be eligible for all available indicated standard-of-care treatments (e.g., radiation, surgery, chemotherapy, immunotherapy or targeted therapy). There is no limitation on type and number of prior anti-tumor treatments patients may have received. VA: x

15. The patient must have recovered from any side effects of prior therapy to Grade 1 or lower (except for non-clinically significant toxicities; e.g., alopecia, vitiligo) prior to treatment start. As determined by the investigator, the patient may still be eligible if not fully recovered from Grade >= 2 toxicities, in case these toxicities are not anticipated to further improve (e.g., chronic peripheral neuropathy) and such toxicities are not anticipated to worsen with the IMA401 therapy. VA: x

16. Male patients must agree to use highly effective contraception or be abstinent while on treatment and for 1 month after the last infusion of IMA401. VA: x

17. Female patients of childbearing potential must use highly effective contraception or be abstinent during screening, while on treatment and until 1 month after the last infusion of IMA401. S1: x S2: x VA: x

^1 Assessment to be performed 7 days prior to start of IMA401 treatment
^2 Imaging to be performed as close as possible to baseline, and not later than 3 weeks prior to start of IMA401 treatment.
^3 Eligibility verification of HLA status (NGS) at VA at the latest.
^4 Eligibility verification for laboratory values at VA.

Exclusion Criteria; HLA (S1), and Tumor Target Screening (S2) and Treatment Eligibility Assessment (VA)

1. Other active malignancies that require treatment or that might interfere with the trial endpoints (ongoing adjuvant anti-hormonal treatment is allowed). S1: x, VA: x

2. The patient is pregnant (confirmed by serum or urine pregnancy test) or is breastfeeding. S1: x^1, S2: x, VA: x

3. History of hypersensitivity to components of IMA401 or rescue medications, if no alternative treatment option is available. S1: x, VA: x

4. Patients with prior allogeneic stem cell transplantation or organ transplantation. S1: x, VA: x

5. Patients with autoimmune diseases needing disease-directed treatment such as clinically relevant inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), rheumatoid arthritis, multiple sclerosis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus, vasculitis, hepatitis, nephritis, dermatitis. S1: x, VA: x

6. The patient is known to have any of the following clinically relevant cardiac conditions: uncontrolled hypertension despite optimal therapy, uncontrolled angina, clinically relevant ventricular arrhythmias, congestive heart disease (New York Heart Association Class II or above), baseline left ventricular ejection fraction <= 50%, prior or current clinically relevant cardiomyopathy, uncontrolled atrial fibrillation, unstable ischemic heart disease (myocardial infarction within the last 6 months or angina requiring use of nitrates), coronary heart disease with coronary intervention in the last 6 months or known clinically relevant stenosis upon coronary angiography/CT, an implanted cardiac pacemaker, or with QTcF interval prolongation >480 msec (corrected for heart rate using Fridericia’s formula [QTcF]) or congenital long QT syndrome. S1: x^1, S2: x, VA: x

7. Clinically significant pulmonary dysfunction, that, in the investigator’s judgement, would compromise the patient’s ability to tolerate protocol therapy or significantly increase the risk for complications. VA: x

8. The patient has concurrent severe and/or uncontrolled medical disease that could compromise participation in the trial (e.g., uncontrolled diabetes, severe malnutrition). S1: x, VA: x

9. History of, or current, immunodeficiency disease or prior treatment relevantly compromising immune function, at the discretion of the investigator. S1: x, VA: x

10. Any other condition that would, in the investigator’s judgement, contraindicate the patient’s participation in the clinical trial because of safety concerns (e.g., potential intolerance to IMA401) or compliance with clinical trial procedures (e.g., psychiatric disorders or substance dependence, neurological impairment). S1: x, VA: x

11. Positive for HIV or with active hepatitis B or C infection. S1: x^1 VA:x

12. Patients with active infection (e.g., COVID-19, influenza, Severe Acute Respiratory Syndrome [SARS], Middle East Respiratory Syndrome [MERS]and other) or sepsis within the last 4 weeks^2. S1: x, S2: x, VA: x

13. The patient has received prior to start of IMA401 therapy systemic corticosteroids (= 10 mg/day prednisone or equivalent), major surgery, any vaccines, therapeutic radiotherapy, cytotoxic agents, or small molecule treatments within 2 weeks, monoclonal antibodies within 3 weeks or 5 half-lives, or cell therapies within 3 months. No wash-out period is required for hormonal therapy.

NOTE: Use of inhaled or topical steroids is permitted. VA: x

14. Treatment in another clinical trial or a device study that could interfere with the IMA401 treatment 3 weeks or 5 half-lives prior to start withIM401 therapy. . VA: x

15. Patients with active brain metastases.

NOTE: Patients with a history of brain metastases are eligible if imaging studies performed >=4 weeks following treatment indicate stable disease of brain metastasis, the patient is asymptomatic, and steroid therapy has been discontinued for >= 2 weeks. VA: x

16. Rapid clinical deterioration (e.g., worsening of performance status, worsening of clinical symptoms likely associated with rapid disease progression) within 3 weeks. VA: x

17. Patients with LDH > 2.0-fold ULN (repeat assessment allowed) S2: x VA: x

^1 Based on medical history
^2 Applicable for VA only

Inclusion Criteria; HLA (S1), and Tumor Tissue Collection (S2) and Treatment Eligibility Assessment (VA)

1. Patients must have voluntarily signed a written ICF, be able to understand and comply with clinical trial procedures - S1: ICF1, VA: ICF2

2. Patients >= 18 years old - S1

3. Patients must have pathologically confirmed and documented advanced and/or metastatic cutaneous melanoma, uveal melanoma, endometrial carcinoma including uterine carcinosarcoma, epithelial ovarian, fallopian tube or primary peritoneal cancer restricted to serous, clear cell, and endometrioid subtypes, synovial sarcoma, or sqNSCLC.
Phase IIa: Patients must have pathologically confirmed and documented advanced and/or metastatic cutaneous melanoma.
Note: Depending on trial progress, the patient's tumor indication should be considered to meet the requirements of the planned treatment cohort (i.e., basket population for dose Phase Ia escalation/de-escalation and in Phase Ib extension cohorts; indicationspecific extension cohorts in Phase IIa (see Section 2.2.2)- S1

4. Patients must have measurable disease according to Response Evaluation Criteria in Solid Tumors (RECIST 1.1).
Exception: Measurable disease according to RECIST 1.1 is not required for patients dosed with up to 0.5 mg IMA402 - VA ^2

5. HLA genotype: HLA-A*02:01 positive (repeat assessment allowed; refer to Section 8.2.1).
Note: In case the patient is known to be HLA-A*02:01 positive as tested routinely, or in another Immatics-sponsored clinical trial, or an Immatics-supported IIT, or as a trial-specific procedure by a local hospital laboratory or central laboratory with appropriate accreditation (e.g., CLIA, CAP, EFI, ASHI, ISO15189) using a PCR-based or sequencing-based method, S1, S2 and/or VA visits may be conducted on the same day, and treatment can be started. In any case , for these patients, HLA genotyping will be reconfirmed at Immatics’ designated ASHI and/or EFI-certified laboratory - S1^4, VA

6. ECOG Performance Status of 0 to 1 - S1, S2, VA ^1

7. Absolute neutrophil count (ANC) >= 1.0 x 10^9/L (without granulocyte colony-stimulating factor [G CSF] support); platelets >= 75,000/µL; hemoglobin >= 8 g/dL; absolute lymphocyte count (ALC) >= 0.5 x 10^9/L (repeat assessment allowed) - S2 ^5, VA ^1

8. Adequate hepatic function, as defined by a total bilirubin level <= 1.5 x upper limit of normal unless the patient is a hepatocellular carcinoma patient or has known Gilbert’s syndrome (total bilirubin level of <= 2.5 x ULN), and alanine aminotransferase (ALT)/aspartate aminotransferase (AST) <= 2.5 x ULN or <= 5 x ULN for patients with liver metastases (repeat assessment allowed) - VA ^1

9. Adequate renal function defined by creatinine clearance = 30 mL/min (as estimated by Cockcroft Gault or other medically acceptable formulars such as MDRD (Modification of Diet in Renal Disease) or CKD-EPI (the Chronic Kidney Disease Epidemiology Collaboration) (repeat assessment allowed) - VA ^1

10. Acceptable coagulation status defined by an international normalized ratio (INR) of prothrombin time (PT) of blood coagulation <= 2.0 x ULN and partial thromboplastin time (PTT) or activated PTT (aPTT) <= 2.0 x ULN (repeat assessment allowed) unless patient is on stable dose of anticoagulants, the interruption of which for the purpose of obtaining the biopsy is medically feasible - S2 ^3 ^5 , VA ^1

11. Patients must have recurrent and/or refractory solid tumors and must have received or not be eligible for all available indicated standard-of-care treatments (e.g., radiation, surgery, chemotherapy, immunotherapy or targeted therapy) - VA

12. The patient must have recovered from any side effects of prior therapy to Grade 1 or lower (except for nonclinically significant toxicities; e.g., alopecia, vitiligo) prior to treatment start. As determined by the investigator, the patient may still be eligible if not fully recovered from Grade >= 2 toxicities, in case these toxicities are not anticipated to further improve (e.g., chronic peripheral neuropathy) and such toxicities are not anticipated to worsen with the IMA402 therapy - VA

13. Male patients must agree to use highly effective contraception or be abstinent while on treatment and for 1 month after the last infusion of IMA402 - VA

14. Female patients of childbearing potential must use highly effective contraception or be abstinent during screening, while on treatment and until 1 month after the last infusion of IMA402 - S1, S2, VA

^1 Assessment to be performed 7 days prior to start of IMA402 treatment
^2 Imaging to be performed as close as possible to baseline, and not later than 3 weeks prior to start of IMA402 treatment
^3 Only to be taken in case a biopsy is performed at S2.
^4 Eligibility verification of HLA status at VA at the latest.
^5 Eligibility verification for laboratory values at VA.

Exclusion Criteria; HLA (S1), and Tumor Sample Collection (S2) and Treatment Eligibility Assessment (VA)

1. Other active malignancies that require treatment or that might interfere with the trial endpoints (ongoing adjuvant anti-hormonal treatment is allowed) - S1, VA

2. The patient is pregnant (confirmed by serum or urine pregnancy test) or is breastfeeding - S1 ^1, S2, VA

3. History of hypersensitivity to components of IMA402 or rescue medications, if no alternative treatment option is available - S1, VA

4. Patients with prior allogeneic stem cell transplantation or organ transplantation - S1, VA

5. Patients with autoimmune diseases needing disease-directed treatment such as clinically relevant inflammatory bowel disease (including Crohn’s disease and ulcerative colitis), rheumatoid arthritis, multiple sclerosis, systemic progressive sclerosis (scleroderma), systemic lupus erythematosus, vasculitis, hepatitis, nephritis, dermatitis - S1, VA

6. The patient is known to have any of the following clinically relevant cardiac conditions: uncontrolled hypertension despite optimal therapy, uncontrolled angina, clinically relevant ventricular arrhythmias, congestive heart disease (New York Heart Association Class II or above), baseline left ventricular ejection fraction <= 50%, prior or current clinically relevant cardiomyopathy, uncontrolled atrial fibrillation,reoccurrence of pericardial effusion within previous 4 weeks, unstable ischemic heart disease (myocardial infarction within the last 6 months or angina requiring use of nitrates), coronary heart disease with coronary intervention in the last 6 months or known clinically relevant stenosis upon coronary angiography/CT, an implanted cardiac pacemaker, or with QTcF interval prolongation >480 msec (corrected for heart rate using Fridericia’s formula [QTcF]) or congenital long QT syndrome - S1 ^1, VA

7. Clinically significant pulmonary dysfunction, that, in the investigator’s judgement, would compromise the patient’s ability to tolerate protocol therapy or significantly increase the risk for complications - VA

8. The patient has concurrent severe and/or uncontrolled medical disease that could compromise participation in the trial (e.g., uncontrolled diabetes, severe malnutrition) - S1, VA

9. History of, or current, immunodeficiency disease or prior treatment relevantly compromising immune function, at the discretion of the investigator - S1, VA

10. Any other condition that would, in the investigator’s judgement, contraindicate the patient’s participation in the clinical trial because of safety concerns (e.g., potential intolerance to IMA402) or compliance with clinical trial procedures (e.g., psychiatric disorders or substance dependence, neurological impairment) - S1, VA

11. Positive for HIV or with active hepatitis B or C infection - S1 ^1, VA

12. The patient has received prior to start of IMA402 therapy systemic corticosteroids (>= 10 mg/day prednisone or equivalent), major surgery,any vaccines, therapeutic radiotherapy, cytotoxic agents, small molecule treatments or treatments with investigational agents within 2weeks, monoclonal antibodies within 3 weeks or 5 half-lives, or cell therapies within 3 months. No wash-out period is required for hormonal therapy - VA

Note: Use of inhaled or topical steroids is permitted.

13. Concurrent treatment in another clinical trial or a device study that could interfere with the IMA402 treatment after signature of ICF2 - VA

14. Patients with active brain metastases.
Note: Patients with a history of brain metastases are eligible if imaging studies performed = 4 weeks following treatment indicate stable disease of brain metastasis, the patient is asymptomatic, and steroid therapy has been discontinued for >= 2 weeks - VA

15. Patients who have received more than 4 prior systemic treatment lines for treatment of advanced and/or metastatic disease. Systemic adjuvant and neo-adjuvant treatment lines with curative intend are not considered. The evaluation should be conducted at S2 (if applicable, before a biopsy is taken) - S2
Note: Additionally applied systemic anti-tumor treatment lines after S2 are allowed.

16. Patients with LDH > 2.0-fold ULN - S2, VA

17. Known presence of leptomeningeal metastases. S1, VA

18. Any active infection or ongoing reactivation of infection (e.g., HSV, EBV, CMV) within the last 3 weeks, sepsis within the last 4 weeks - VA

19. apid clinical deterioration (e.g., worsening of performance status, worsening of clinical symptoms likely associated with rapid disease progression) within 3 weeks - VA

^1 Based on medical history

1. Histologically confirmed locally advanced (not manageable with curative intent) or metastatic solid tumor

Specification for Stratum C: Only patients with NSCLC adenocarcinomas, (squamous or adenosquamous not permitted) who are scheduled to receive platin + pembrolizumab + pemetrexed standard treatment (only for Stratum C)

Specification for Stratum E: Including only metastatic or irresectable locally advanced urothelial carcinomas – also refer to IC 15 below (only for Stratum E)

2. Tumor is accessible for repeated injections and biopsies (only for Stratum A)

3. Peritoneal carcinomatosis (only for Stratum B)

4. Patient failed standard therapy or refused standard therapy or is intolerable towards standard therapy (Strata A, B, and D) or who receives Standard-of-Care first line treatment comprising platin + pembrolizumab + pemetrexed (only for Stratum C)

5. Patient has not received more than 4 prior lines of therapy.
Neoadjuvant/adjuvant treatment is not counted unless progression occurs < 6 months after completion of the treatment. In these cases, neoadjuvant/adjuvant treatment is counted as one prior line (only for Stratum D).

Specification for Stratum C: Only patients receiving first line Standard-of-Care therapy (platin + pembrolizumab + pemetrexed; only for Stratum C)

Specification for Stratum E: Refer to IC 15 below with regards to previous lines of therapy; only for Stratum E)

Note exclusion criterion 7 on exclusion of defined previous cancer immunotherapy (only for Strata D and E)

6. Patients >= 18 years. Patients in reproductive age must be willing to use highly effective contraception during the study and 4 months after the end of the study (appropriate contraception is defined as combined (estrogen and progestogen containing) hormonal contraception associated with inhibition of ovulation, progestogen-only hormonal contraception associated with inhibition of ovulation, intrauterine device (IUD), intrauterine hormone-releasing system (IUS), vasectomized partner, bilateral tubal occlusion, sexual abstinence. If an oral contraception is used, a barrier method of contraception (e.g. male condom, female condom, cervical cap, diaphragm, contraceptive sponge) has to be applied additionally.). Female patients with childbearing potential need to have a negative pregnancy test within 7 days before study start.

7. ECOG 0 or 1

8. Adequate hematological, hepatic and renal function parameters:
- ANC (absolute neutrophil count) >= 1.500/MikroL
- Leukocytes >= 3.000/MikroL
- Platelets >= 75.000/MikroL (for Stratum D: >= 100.000/MikroL)
- Serum creatinine <= 1.5 x upper limit of normal, or GFR >= 50 ml/min
- Bilirubin <= 1.5 - 3 x upper limit of normal (for Stratum D: <= 1.5 x ULN)
- AST and ALT <= 3 x upper limit of normal (<= 5 x if liver metastases are present) (for Stratum D: AST and ALT <= 2.5 x ULN; <= 5 x if liver metastases are present)
- Alkaline phosphatase <= 6 x upper limit of normal
- Hemoglobin >= 9g/dL

9. Adequate coagulation functions as defined by International Normalized Ratio (INR) <= 1.5, and a partial thromboplastin time (PTT) <= 5 seconds above the ULN (unless receiving anticoagulation therapy). Patients receiving warfarin/phenprocoumon must be switched to low molecular weight heparin and have achieved stable coagulation profile.

10. Patient able and willing to provide written informed consent and to comply with the study protocol and with the planned surgical procedures

11. Evidence of measurable disease as defined by RECIST v1.1 (only for Strata C, D and E) or assessable disease as defined by RECIST v1.1 (only for Stratum C)

12. Expected survival > 3 months

13. Resolution of toxicity associated with prior or current therapy to grade < 2 (except for alopecia and transaminases in case of liver metastases)

14. Patient is eligible if one of the following settings applies (only for Stratum E):
- did not receive any prior systemic therapy for metastatic disease AND would be eligible for platinum-based therapy AND has a PD-L1 CPS >= 10
or
- did not receive any prior systemic therapy for metastatic disease AND is not eligible for platinum-based therapy, independent from PD-L1 CPS status or
- did suffer disease progression during/directly after a platinum-based chemotherapy for metastatic disease AND did not receive avelumab maintenance therapy after platinum-based chemotherapy, independent from PD-L1 CPS status

1. Inability to understand the aims of the study and/or protocol procedures

2. Bleeding ulcerative tumors or tumors requiring intratumoral injections of study drug into parenchymatous organs such as, but limited to liver, spleen or pancreas (only for Stratum A)

3. Patients with contraindication versus a laparoscopy or refusing a laparoscopy (only for Stratum B)

4. Hypersensitivity towards eftilagimod alpha, avelumab (only for Strata D and E) or any ingredient of the injection/infusion solutions

5. History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins

6. Currently receiving any other antineoplastic treatment including irradiation, or targeted small molecule therapy, or biological cancer therapy, or less than 4 weeks since completion of these therapies and first dose of study treatment (only Strata A, B, D and E)

7. Prior PD-1/PD-L1 targeted therapy (only for Strata D and E). NOTE: For stratum E only, patients can be enrolled if they received prior PD-1/PD-L1 targeted therapy during neoadjuvant treatment. HOWEVER, enrollment is allowed only after a disease free interval of at least 12 months after neoadjuvant PD-1/PD-L1 addressed- therapy.

8. Cirrhosis of the liver (Child > Grade A), pronounced alcohol abuse with anticipated detoxification, severe pulmonary infection with considerable reduction of pulmonary function

9. Clinically significant active coronary heart disease, cardiomyopathy or congestive heart failure, NYHA III-IV (for Stratum D: >= NYHA II) within 6 months prior to first dose of study treatment including: myocardial infarction, severe/unstable angina, ongoing cardiac dysrhythmias of current NCI CTCAE version Grade > 2, atrial fibrillation of any grade, coronary/peripheral artery
bypass graft, symptomatic congestive heart failure, cerebrovascular accident including transient ischemic attack, ventricular arrhythmias requiring medication or symptomatic pulmonary embolism

10. Cerebral or leptomeningeal metastases
Note: Subjects with previously treated brain metastases may participate if they meet the following criteria: 1) are stable for at least 28 days prior to the first dose of study treatment and if all neurologic symptoms returned to baseline; 2) have no evidence of new or enlarging brain metastases; and 3) have not been using steroids for at least 7 days prior to first dose of study treatment. This exception does not include carcinomatous meningitis which is excluded regardless of clinical stability.

11. Chronic inflammatory bowel disease

12. Active infection requiring systemic therapy at the start of study treatment or chronic infection or serious intercurrent infection within 4 weeks prior to first dose of study treatment

13. QTcF > 480 ms, family or personal history of long or short QT syndrome, Brugada syndrome or known history of QTc prolongation, or Torsade de Pointes (TdP)

14. Uncontrolled electrolyte disorders that can worsen the effects of a QTc prolonging drug (e.g., hypocalcaemia, hypokalaemia, hypomagnesemia)

15. Positive test for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome. Testing is not required in the absence of history.

Participants with known human immunodeficiency virus (HIV) infections are eligible if the following criteria are met:
a. If clinically indicated participants must be stable on antiretroviral therapy (ART) for at least 4 weeks and agree to adhere to ART. If not clinically indicated, consult Principal Investigator (LKP).
b. Participants with HIV infection should have no evidence of documented multidrug resistance that would prevent effective ART.
c. Have an HIV viral load of < 400 copies/mL at Screening.
d. If prophylactic antimicrobial drugs are indicated, patient may still be considered eligible upon agreement with the Principal Investigator (LKP)

16. Active hepatitis B (defined as having a positive hepatitis B surface antigen [HBsAg] test) or hepatitis C Note: Patients with past hepatitis B virus (HBV) infection or resolved HBV infection (defined as having a negative HBsAg test and a positive antibody to hepatitis B core antigen antibody test) are eligible.

Note: Patients positive for hepatitis C virus (HCV) antibody are eligible only if polymerase chain reaction testing is negative for HCV ribonucleic acid (RNA).
Testing is not required in the absence of history.

17. History or evidence of interstitial lung disease, active non-infectious pneumonitis or active tuberculosis

18. Active or prior autoimmune disease requiring immunosuppressive therapy that might deteriorate when receiving an immunostimulatory agent. Patients with diabetes type I, vitiligo, psoriasis, or hypo- or hyperthyroid disease not requiring immunosuppressive treatment are eligible.

19. Known history of immune-mediated colitis, pneumonitis, pulmonary fibrosis (only for Strata D and E).

20. Administration of a live, attenuated vaccine (including Covid-19 vaccination with live, attenuated vaccine) within four weeks prior to start of treatment or anticipation that such a live attenuated vaccine will be required during the remainder of the study.

21. Any condition requiring continuous systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 4 weeks prior to first dose of study treatment. Intranasal, inhaled or topical steroids, eye drops or local steroid injection (eg, intra-articular injection), steroids as premedication for hypersensitivity reactions (eg, computed tomography [CT] scan premedication) and physiological replacement doses of up to 10 mg daily prednisone equivalent are permitted in the absence of active autoimmune disease.

22. Treatment with systemic immunostimulatory agents (including but not limited to interferons or interleukin-2) within four weeks or five half-lives of the drug,
whichever is shorter, prior to start of study treatment

23. Any previous venous thromboembolism > National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) Grade 3 within the last 6 months

24. Past history of severe allergic episodes and/ or Quincke’s oedema

25. Prior organ transplantation or stem cell transplantation

26. On-treatment participation in another clinical study in the period 30 days prior to start of study treatment and during the study

27. Patients in a closed institution according to an authority or court decision (AMG § 40, Abs. 1 No. 4)

28. Pregnancy or lactation

29. Planned intratumoral injections in parenchymatous organs (e.g. liver, spleen, adrenal gland, pancreas)

30. Life-threatening illness unrelated to cancer

31. History of irAEs of CTCAE Grade 4 requiring steroid treatment (only for Strata C, D and E)

32. Persisting toxicity related to prior therapy (NCI CTCAE current version Grade > 1); however, alopecia, sensory neuropathy Grade <= 2, or other Grade <= 2 AEs not constituting a safety risk based on investigator's judgment are acceptable (only for Strata D and E)

33. Other severe acute or chronic medical conditions, psychiatric conditions including recent (within the past year) or active suicidal ideation or behavior; or laboratory abnormalities that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results and, in the judgment of the investigator, would make the patient inappropriate for entry into this study.

Participants are eligible to be included in the study only if all of the following criteria apply:

1. Ability to comprehend and willingness to sign a written ICF for the study.

2. Aged 18 years or older at the time of signing the ICF.

3. ECOG performance status score of the following:

- 0 or 1

- For Parts 1b and 1c only: enrollment of participants with ECOG performance status score of 2 will commence only after the Agency's approval. An interim report (including but not limited to safety, PK, pharmacodynamics, and preliminary efficacy data and the foreseen RDE[s]) will be submitted for review before dose expansion parts are initiated in one treatment group.

4. Life expectancy is greater than 6 months.

5. Willingness to undergo a pretreatment and regular on-study BM biopsies and aspirates (as appropriate to disease). If a biopsy and aspirate are not possible or contraindicated, or
the tissue requirement cannot be satisfied, this requirement may be waived with approval from the sponsor's medical monitor.

6. Willingness to avoid pregnancy or fathering children based on the criteria below:

a. Male participants with reproductive potential must agree to take appropriate precautions to avoid fathering children from screening through 90 days (a spermatogenesis cycle) after the last dose of study treatment and must refrain from donating sperm during this period. Permitted methods in preventing pregnancy (see Appendix A) should be communicated to the participants and their understanding confirmed.

b. Female participants who are WOCBP must have a negative serum pregnancy test at screening and a negative urine pregnancy test before the first dose on Day 1 and must agree to take appropriate precautions to avoid pregnancy from screening through the safety follow-up visit and must refrain from donating oocytes during this period. Highly effective contraception methods (failure rate of < 1% per year) must be used (see Appendix A) and should be communicated to the participants and their understanding confirmed.

c. Female participants not considered to be of childbearing potential as defined in Appendix A are eligible.

7. Existing documentation from a qualified local laboratory of CALR exon-9 mutation (preferably obtained by next-generation targeted deep sequencing or PCR).

For participants with MF:

8. Histologically confirmed diagnosis of PMF or post-ET MF according to the 2022 WHO criteria (see Appendix B).

9. Bone marrow and peripheral blood myeloblast count < 5%.

10. Evidence of evaluable residual burden of disease:

- Radiologic confirmation of splenomegaly (spleen volume = 450 mL per MRI or CT).
or
- Palpable spleen of > 10 cm below the left subcostal margin on physical examination at the screening visit.
or
- Palpable splenomegaly of 5 to 10 cm below left subcostal margin on physical examination.
and
- Active symptoms of MF at the screening visit as demonstrated by the presence of 1 symptom score = 5 or 2 symptom scores = 3 as determined by MPN-SAF TSS (see Appendix F).

11. As applicable:

a. TGA-MF: Participants with MF who have been previously treated with JAK inhibitors for = 12 weeks and are resistant, refractory, or intolerant to, lost response to, or are ineligible for JAK inhibitor treatment.

b. TGB-MF SubOpt R:

- Intermediate- or high-risk DIPSS MF (according to IWG-MRT criteria, Passamonti et al 2010).
- Must have been on a therapeutic regimen of ruxolitinib (ie, dose and dose regimen of ruxolitinib between 5 and 25 mg BID to treat MF) for at least 12 weeks and at least 8 consecutive weeks on a stable dose (1 dose reduction due to toxicities allowed) immediately preceding the first dose of study treatment (see Section 6.1).
- Unlikely to benefit from further ruxolitinib monotherapy in the opinion of the investigator, and meet the criteria for evidence of evaluable residual burden of disease as defined in Inclusion Criterion 10.

c. TGA-MF TxN and TGB-MF TxN:
- Intermediate-2 or high-risk DIPSS MF (according to IWG-MRT criteria, Passamonti et al 2010).
- Must be JAK inhibitor–naive (TxN) and have an indication for initiation of ruxolitinib treatment.

For participants with ET:

12. Confirmed diagnosis of ET according to the 2022 WHO criteria (see Appendix B).

13. Revised IPSET-thrombosis high-risk (Barbui et al 2015; see Appendix D).

14. Documented resistance/intolerance to at least 1 line of prior cytoreductive therapy (including but not limited to hydroxyurea, interferon, thalidomide, busulfan, lenalidomide, or anagrelide) according to ELN criteria (Barosi et al 2007; see Appendix C).

15. Platelet counts > 600 x 10^9/L.

Participants are excluded from the study if any of the following criteria apply:

1. Presence of any hematological malignancy other than ET, PMF, or post-ET MF.

2. History or presence of an abnormal ECG that, in the investigator's opinion, is clinically meaningful. If screening QTcF interval is > 450 milliseconds for male participants or > 470 milliseconds for female participants, the ECG should be repeated twice and the mean QTcF of the 3 ECGs should be = 450 milliseconds for male participants or = 470 milliseconds for female participants; if QTcF > 450 milliseconds for male participants or 470 milliseconds for female participants, the participant is excluded. For participants with an intraventricular conduction delay (QRS interval > 120 milliseconds), the JTc interval may be used in place of the QTcF with sponsor approval. The JTc must be = 340 milliseconds if JTc is used in place of the QTcF. Participants with left bundle branch block are excluded. Participants with QTcF prolongation due to a pacemaker may be enrolled with prior approval from the sponsor's medical monitor.

3. Prior history of major bleeding, or thrombosis within the last 3 months prior to study enrollment.

4. Participants with laboratory values at screening as defined in Table 7.

Exclusionary Laboratory Values

Laboratory Parameter: Exclusion Criterion

Hematology

a - Platelets: TGA-ET: < 600 x 10^9/L
TGA-MF: < 50 x 10^9/L
TGBs: < 75 x 10^9/L
without the assistance of growth factors, thrombopoietic factors, or platelet transfusions.

b - ANC: < 1.0 x 10^9/L

Hepatic

c - ALT: = 2.5 x ULN

d - AST: = 2.5 x ULN

e - Total/direct bilirubin: = 2.0 ULN, unless conjugated (direct) bilirubin = 1.5 ULN.
If there is no institutional ULN, then direct bilirubin must be < 40% of total bilirubin.

Note: In no case can the total bilirubin exceed 3 x ULN (except participants with Gilbert syndrome may have total bilirubin > 3.0 mg/dL).

Renal

f - Creatinine clearance/eGFR: < 30 mL/min according to Cockcroft-Gault formula
< 30 mL/min/1.73 m^2 according to CDK-EPI 2021

5. Unwillingness to be transfused with blood components including RBC packs and platelet transfusions.

6. Has undergone any prior allogenic or autologous stem-cell transplantation or such transplantation is planned.

7. Active invasive malignancy over the previous 2 years.

Note: Participants with the following may be eligible to participate at the investigator's discretion:

- Early-stage basal cell or squamous cell skin cancer

- Completely resected intraepithelial carcinoma of the cervix

- Completely resected papillary thyroid and follicular thyroid cancers

Participants with malignancies with indolent behavior, such as prostate cancer treated with radiation or surgery, may be enrolled as long as they have a reasonable expectation to have been cured with the treatment modality received.

8. History of clinically significant or uncontrolled cardiac disease, including recent (within the last 12 months) unstable angina or acute myocardial infarction, or New York Heart Association Class III or IV congestive heart failure, or clinically significant arrhythmias not controlled by medication. Participants with a pacemaker and well-controlled rhythm for at least 1 month before the first dose of study treatment will be allowed.

9. Any major surgery within 28 days before the first dose of study treatment.

10. Active HBV (or at risk of reactivation), defined as follows: positive HBsAg result (laboratory test required at screening), and/or positive total anti-HBc result (laboratory test required at screening), and/or quantitative HBV-DNA test result greater than the lower limits of detection of the assay (if known; laboratory test not required for eligibility purpose, but can be done as part of screening if available locally).

Note: Participants with no prior history of HBV infection who have been vaccinated against HBV and who have a positive anti-HBs as the only evidence of prior exposure may participate in the study.

11. Active HCV, defined as follows: positive anti-HCV result (laboratory test required at screening) and quantitative HCV-RNA test result greater than the lower limits of detection of the assay (laboratory test only required if anti-HCV–positive, can be done as part of screening if available locally).
Note: Anti-HCV–positive participants who received and completed treatment for HCV that was intended to eradicate the virus may participate if HCV-RNA levels are undetectable at least 12 weeks after the last dose of therapy. Anti-HCV–positive participants with no available confirmatory negative HCV-RNA test results will be excluded.

12. Any condition or circumstance that would, in the investigator's judgment, interfere with full participation in the study (eg, unable, unlikely, or unwilling to comply with the dose schedule and study evaluations, active alcohol or drug addiction), including administration of study treatment and attending required study visits; pose a significant risk to the participant; or interfere with interpretation of study data.

13. Women who are pregnant (including women who may possibly be pregnant based on medical interview by investigators in Japan) or breastfeeding. Women must also refrain from breastfeeding during the course of study and for 60 days after the last dose of study treatment. For Japan, women who are breastfeeding and wish to enroll must discontinue breastfeeding at least 30 days before receiving study treatment.

14. Presence of chronic or current active infectious disease requiring systemic antibiotic, antifungal, or antiviral treatment. Participants with acute infection requiring antibiotic, antifungal, or antiviral treatment use should delay screening/enrollment until the course of antibiotic antifungal, or antiviral therapy has been completed and the infection is not active anymore.

Note: If a participant has a positive screening test result for SARS-CoV-2 infection, they should be excluded until test normalization and clinical recovery.

15. Any prior chemotherapy, immunomodulatory drug therapy, immunosuppressive therapy, biological therapy, endocrine therapy, targeted therapy, antibody, or hypomethylating agent used to treat the participant's disease (see Section 6.8), with the exception of ruxolitinib for TGBs only, within 5 half-lives or 28 days (whichever is shorter) before the first dose of study treatment.

16. Any prior radiation therapy within 28 days before the first dose of study treatment. Palliative radiation therapy to single sites or small fields is allowed with at least a 1-week washout period before the first dose of study treatment.

17. Known hypersensitivity, severe reaction, or any known contraindications to the use of any of the active substances or excipients in INCA033989 drug product or ruxolitinib as appropriate to the relevant treatment group.

18. Has any unresolved toxicity = Grade 2 from previous therapy except for stable chronic toxicities (Grade 2) not expected to resolve, such as stable Grade 2 peripheral neuropathy.

19. Undergoing treatment with another investigational medication or has been treated with an investigational medication within 28 days before the first dose of study treatment.

20. For TGBs only: Undergoing treatment with a potent/strong inhibitor or inducer of CYP 3A4/5 (see Appendix H) within 14 days or 5 half-lives (whichever is longer) before the first dose of study treatment, or expected to receive such treatment during the study.

21. Current use of prohibited medication described in Section 6.8.3.

22. Participants undergoing treatment with G-CSF or GM-CSF, romiplostim, or eltrombopag at any time within 4 weeks before the first dose of study treatment.

23. The following participants are excluded in France: vulnerable populations according to article L.1121-6 of the French Public Health Code and adults under legal protection, or who are unable to express their consent per article L.1121-8 of the French Public Health Code, not affiliated to a social security per article L.1121-8-1 of the French Public Health Code.

24. Known history of HIV (1/2 antibodies).

Subjects must meet all of the following criteria in order to be included in the study. Anything other than a positive response to the questions below will result in exclusion from study participation.

CONSENT

1. Subjects or their legally authorized representative, if permitted, must voluntarily sign and date an informed consent, approved by an independent ethics committee (IEC)/institutional review board (IRB), prior to the initiation of any screening or study-specific procedures.

Subjects must not be incarcerated and must be freely willing and able to provide informed consent (e.g., adults under legal protection measure [e.g., under guardianship/curatorship] or unable to express their consent and select adults under psychiatric care). Investigator's discretion should be applied.

DEMOGRAPHIC AND LABORATORY ASSESSMENTS

2. Adult male or female, at least 18 years old.

3. Laboratory values meeting the following criteria within the screening period prior to the first dose of study drug:
- Absolute neutrophil count (ANC) = 1.5 x 10^9/L (growth factor use is allowed if evidence of bone marrow involvement, but subject must not have received growth factor within 14 days prior to screening labs)
- Hemoglobin = 8.0 g/dL (red blood cell transfusions permitted, but subject must not have received blood transfusions within 7 days prior to screening labs)
- Platelet count = 75 x 10^9/L, or = 50 x 10^9/L if bone marrow infiltration or hypersplenism (platelet transfusions permitted, but subject must not have received blood transfusions within 7 days prior to screening labs)
- Serum aspartate transaminase (AST) AND alanine transaminase (ALT) level = 3 x upper limit of normal (ULN)
- Direct bilirubin must be = 2 x ULN
- Estimated Creatinine Clearance (CrCl) (as calculated by Cockcroft-Gault Formula, modified as needed for factors such as body weight) or eGFR (as calculated by MDRD equation) = 50 mL/min
- Prothrombin time (PT) or International normalized ratio (INR), and Activated partial thromboplastin time (aPTT) = 1.5 x ULN, unless receiving anticoagulation (although INR should not be > 4.0)

4. Subject is willing and able to comply with procedures required in this protocol.

5. Subject must be able to tolerate subcutaneous injections.

6. Subject must have available adequate fresh or paraffin-embedded tissue at Screening.

DISEASE/CONDITION ACTIVITY

7. Diagnosis of:
- (Arms 1, 2, 3, and 4) DLBCL (de novo or histologically transformed from follicular lymphoma or nodal marginal zone lymphoma) with histologically confirmed CD20+ disease at most recent representative tumor biopsy pathology report, inclusive of the following according to WHO 2016 classification and documented in pathology report:
- DLBCL, NOS
- High-grade B cell lymphoma with MYC and BCL-2 and/or BCL-6 translocations per WHO 2016 ("double-hit" or "triple-hit")
Note: High-grade B-cell lymphomas NOS or other double-/triple-hit lymphomas (with histologies not consistent with DLBCL) are not eligible
- Follicular lymphoma Grade 3B
Or
- (Arm 5) FL with histologically confirmed CD20+ Grade 1 to 3a FL and no evidence of histologic transformation to an aggressive lymphoma at most recent representative tumor biopsy pathology report according to WHO 2016 classification
Or
- (Arms 6 and 7 and 8) MCL with histologically confirmed CD20+ disease at most recent representative tumor biopsy pathology report according to the WHO 2016 classification with evidence of overexpression of cyclin D1 in association with relevant markers by IHC or evidence of t(11;14) assessed by flow cytometry, FISH, or PCR
- A report from the local laboratory is acceptable if available, however, a tumor block or slides must be sent to the central pathology laboratory for confirmation

8. Subject must have no prior treatment with epcoritamab or any other bispecific antibody targeting CD3 and CD20

9. Subject must have 1 or more measurable disease sites:
- A PET-CT scan demonstrating PET-positive lesion(s)
AND
- At least 1 measurable nodal lesion (long axis > 1.5 cm) or = 1 measurable extra-nodal lesion (long axis > 1.0 cm) on CT scan or MRI

10. Subject must be eligible to receive and have a need for treatment initiation based on symptoms and/or disease burden as per investigator assessment.

11. Subject must have ECOG performance status 0-2, except for Arms 6, 7 and 8 where ECOG performance status must be 0-1.

SUBJECT HISTORY

12. Subject has no toxicities from prior anticancer therapy that have not resolved to Common Terminology Criteria for Adverse Events (CTCAE, v 5.0), Grade 2 or below, with the exception of alopecia. Other eligibility criteria (e.g., laboratory, cardiac criteria) must also be met.

13. Subject has no current evidence of primary central nervous system (CNS) tumor or known CNS involvement, including leptomeningeal disease, at screening.

14. Subject has no history of severe allergic or anaphylactic reactions to anti-CD20 mAb therapy or known significant allergy or intolerance or contraindications to any component or excipient of epcoritamab or components of study drug combination agents (e.g., lenalidomide, rituximab, etc.)

15. Subject must not have had autologous stem cell transplantation (ASCT) within 3 months prior to screening, and no previous allogeneic hematopoietic stem cell transplant.

16. Subject must not have had any chemotherapy or non-investigational anti-neoplastic agents (except CD20 mAbs) within 4 weeks or 5 half-lives (whichever is shorter) prior to the first dose of epcoritamab (except for Arms 6, 7 and 8, where bridging therapy for MCL is allowed, see Section 5.4)

17. Subject has no clinically significant cardiovascular disease, including:
- Myocardial infarction or stroke within 6 months prior to enrollment,
OR
- The following conditions within 6 months prior to enrollment: unstable or uncontrolled disease/condition related to or affecting cardiac function (e.g., unstable angina, congestive heart failure, New York Heart Association Class III-IV), uncontrolled cardiac arrhythmia, and uncontrolled hypertension
OR
- Other clinically significant ECG abnormalities within 6 months prior to enrollment unless deemed stable and appropriately treated.
OR
- Left ventricular ejection fraction < 45%

In case of any history of cardiovascular disease, a cardiology consult is required within 60 days prior to enrollment.

18. Subject has no clinically significant liver disease, including hepatitis, current alcohol abuse, or cirrhosis.

19. Subject does not have active Hepatitis B Virus or Hepatitis C Virus infection. Subjects who are positive for hepatitis B core antibody, hepatitis B surface antigen, or hepatitis C antibody must have a negative polymerase chain reaction (PCR) result before enrollment. Those who are PCR positive will be excluded.

20. Subject has no known history of Human Immunodeficiency Virus infection. Note: Human immunodeficiency virus testing does not need to be conducted at screening unless it is required per local guidelines or institutional standards.

21. Subject has no known active bacterial, viral, fungal, mycobacterial, parasitic, or other infection (excluding fungal infections of the nail beds) requiring intravenous (IV) therapy within 2 weeks prior to enrollment.

22. Subject has no evidence of significant, uncontrolled concomitant diseases that could affect compliance with the protocol or interpretation of results.

23. Subject has no history of other prior malignancies, except for the following:
- Malignancy treated with curative intent and with no known active disease present for = 3 years before the first dose of study drug and felt to be at low risk for recurrence by the treating physician
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
- Adequately treated carcinoma in situ without evidence of disease
- Localized prostate cancer, post-radical prostatectomy or with no known active disease present, with stable (non-rising) prostate-specific antigen levels < 0.1 ng/mL

24. Subject has not had radiation therapy, except for palliative radiation therapy to non-target lesions and must have at least 1 target lesion that has not received radiation therapy within 6 weeks prior to enrollment.

25. Subject has no Grade > 1 neuropathy with the exception of neuropathy related directly to lymphoma (e.g., nerve compression from tumor).

26.Subject must not have active tuberculosis (TB) or history of completed treatment for active TB within the past 12 months.
Note: Interferon gamma release assay (IGRA) testing does not need to be performed at screening unless active or latent TB is suspected. For subjects with positive IGRA, active pulmonary TB must be excluded with clinical evaluation and radiologic imaging. Subjects with positive IGRA and no evidence of active disease may be enrolled after treatment for latent tuberculosis infection (recommendation isoniazid monotherapy for total of 6 months) has been initiated.

27. Subject does not have active (symptomatic) cytomegalovirus (CMV) disease.

28. Subject has no current autoimmune disease requiring immunosuppressive therapy except for up to 20 mg prednisone daily (or equivalent).

29. Subject has no life-threatening illness, medical condition, or organ system dysfunction that, in the Investigator's opinion, could compromise the subject's safety or put the study outcomes at undue risk.

30. Subject has no current seizure disorder requiring therapy.

31. Subject has no known active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. If a subject has signs/symptoms suggestive of SARS-CoV-2 infection or have recent known exposure to someone with SARS-CoV infection, they should undergo molecular (e.g., PCR) or 2 negative antigen test results at least 24 hours apart to rule out SARS-CoV-2 infection.
Note: SARS-CoV-2 diagnostic tests should be applied following local requirements/regulations.

32. Subjects who do not meet SARS-CoV-2 infection eligibility criteria and/or cannot complete all screening required activities within the 28 day screening window once SARS-CoV-2 criteria ave
been met, must be screen failed and may only rescreen after they meet the following SARS-CoV 2 infection viral clearance criteria:
- At least 10 days since first positive test result have passed in asymptomatic subjects or at least 10 days since recovery, defined as resolution of fever without use of antipyretics and improvement in symptoms.

33. Subject must not have had major surgery within 4 weeks prior to the first dose of study drug.

34. Subject has a life expectancy of > 3 months from standard of care treatment from time of enrollment

35. Subject has no known history of Progressive Multifocal Leukoencephalopathy (PML).

CONTRACEPTION

36. For all females of child-bearing potential; a negative serum pregnancy test (beta human chorionic gonadotropin [hCG]) at the Screening Visit and a negative urine pregnancy test at baseline prior to the first dose of study drug

37. Female subjects of childbearing potential must practice at least 1 protocol-specified method of birth control that is effective from 30 days prior to enrollment through at least 12 months after the last dose of study drug. Female subjects of non-childbearing potential do not need to use birth control

38. Female subject who is not pregnant, breastfeeding, donating eggs (ova, oocytes), or considering becoming pregnant during the study or for 12 months after the last dose of study drug.

39. If male, and subject is sexually active with female partner(s) of childbearing potential, he must agree, from 30 days prior to enrollment through 12 months after the last dose of study drug, to practice the protocol-specified contraception.

40. Male subject who is not considering fathering a child or donating sperm during the study or for 12 months after the last dose of study drug.

CONCOMITANT MEDICATIONS

41. Subject has no active medication use known to decrease T-cell numbers or activity or other concurrent immunosuppressive medication except for up to 20 mg prednisone daily or equivalent, or for control of lymphoma related symptoms. during screening.

42. Subject must not have been treated with any investigational drug within 30 days or 5 half lives of the drug (whichever is longer) prior to the first dose of study drug or is currently enrolled
in another interventional clinical study or was previously enrolled in this study (agents that have been approved under emergency authorization, e.g., anti-SARS-CoV-2 mAbs, are allowed)

43. Subject has not received vaccination with live-attenuated vaccines within 28 days prior to screening or is expected to need any live-attenuated vaccination during study participation including at least 3 months following the last dose of study treatment. Coronavirus mRNA and adenovirus-based vaccines, which are not live-attenuated vaccines, are permitted.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 1

44. Subject must have R/R DLBCL
Note: Relapsed disease is defined as disease that previously responded to therapy but progressed = 6 months after completion of therapy. Refractory disease is defined as disease that either progressed during therapy, failed to achieve an objective response to prior therapy, or progressed within 6 months after completion of therapy (including maintenance therapy).

45. Subject must have R/R disease to at least one prior systemic anti-lymphoma therapy (radiotherapy is not considered a systemic therapy) which contains an anti-CD20 monoclonal antibody. Subject who received only prior anti-CD20 monoclonal antibody monotherapy is not eligible.

46. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

47. Subjects must have either failed prior ASCT, not be considered eligible for ASCT due to age, performance status, comorbidities and/or insufficient response, or have refused ASCT.

48. Subject must not have documented refractoriness to lenalidomide and must be suitable for treatment with lenalidomide in the opinion of the investigator.
Note: Refractoriness is defined as:
- Best response to prior regimen(s) of SD or PD, OR
- Progressive disease within 6 months of completion of prior regimen(s)

49. Subject must be willing to take aspirin prophylaxis or prophylactic anticoagulation for thromboembolic event (or per local guidelines for lenalidomide administration).

50. Female subjects of childbearing potential must practice at least 2 protocol-specified methods of birth control that are effective from 30 days prior to enrollment through at least 12 months after the last dose of study drug. Female subjects of non-childbearing potential do not need to use birth control.

51. Subject is willing to adhere to the pregnancy risk minimization plan associated with lenalidomide treatment.

52. Subject must not have had lenalidomide exposure within 12 months prior to screening.

53. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

54. Subjects must agree not to donate blood while receiving, during dose interruptions, and for at least 28 days following the last dose of lenalidomide.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 2

55. Subject must have R/R (as defined in Criterion 44) DLBCL.

56. Subject must have received at least 1 prior treatment for which must include an anti-CD20 monoclonal antibody in combination with another systemic therapy (radiotherapy is not considered a systemic therapy).

57. Subject must have received prior CAR-T cell therapy, but for those who achieved a response to prior CAR-T, not less than 90 days prior to first dose of epcoritamab, or for those who were refractory to CAR-T, not less than 30 days prior to first dose of epcoritamab.
Note: Refractoriness is defined as:
- Best response to prior regimen(s) of SD or PD, OR
- Progressive disease within 6 months of completion of prior regimen(s)

58. Subjects must have either failed prior ASCT, not be considered eligible for ASCT due to age, performance status, comorbidities and/or insufficient response, or have refused ASCT.

59. Subject must not have documented refractoriness to lenalidomide and must be suitable for treatment with lenalidomide in the opinion of the investigator.

60. Subject must not have had prior treatment with ibrutinib and must be suitable for treatment with ibrutinib in the opinion of the investigator.

61. Subject must not have had lenalidomide exposure within 12 months prior to screening.

62. Subject must not have known bleeding diathesis (e.g., von Willebrand's disease) or hemophilia.

63. Subject must not require treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

64. Subject must not have consumed grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to Cycle 1 Day 1.

65. Subject must be willing to take aspirin prophylaxis or prophylactic anticoagulation for thromboembolic event (or per local guidelines for lenalidomide administration).

66. Female subjects of childbearing potential must practice at least 2 protocol-specified methods of birth control that are effective from 30 days prior to enrollment through at least 12 months after the last dose of study drug. Female subjects of non-childbearing potential do not need to use birth control.

67. Subject is willing to adhere to the pregnancy risk minimization plan associated with lenalidomide treatment.

68. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

69. Subjects must agree not to donate blood while receiving, during dose interruptions, and for at least 28 days following the last dose of ibrutinib or lenalidomide.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 3

70. Subject must have newly diagnosed, treatment-naive (not including prior treatments for indolent lymphoma that has transformed) DLBCL.

71. Subject must be suitable for treatment with polatuzumab, rituximab, cyclophosphamide, doxorubicin, and prednisone in the opinion of the investigator.

72. Subject must have International Prognostic Index score of 2 - 5.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 4

73. Subject must have R/R (as defined in Criterion 44) DLBCL.

74. Subject must have R/R disease to at least one prior systemic anti-lymphoma therapy (radiotherapy is not considered a systemic therapy) which contains an anti-CD20 monoclonal antibody. Subject who received only prior anti-CD20 monoclonal antibody monotherapy is not eligible.

75. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

76. Subjects must have either failed prior ASCT, not be considered eligible for ASCT due to age, performance status, comorbidities and/or insufficient response, or have refused ASCT.

77. Female subjects of childbearing potential must practice at least 2 protocol-specified methods of birth control (at least one highly effective method and one effective method) at the same time from 30 days prior to enrollment through at least 12 months after the last dose of epcoritamab.

78. Subject must be willing to adhere to the pregnancy risk minimization plan associated with CC-99282 treatment.

79. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

80. Subject must not have received prior treatment with CC-99282 or CC-220 (iberdomide).

81. Subjects must agree not to donate blood while receiving CC-99282, during dose interruptions and for at least 28 days following the last dose of CC-99282.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 5

82. Subject must have R/R (as defined in Criterion 44) FL.

83. Subject must have Stage II-IV disease.

84. Subject must have a need for treatment initiation per investigator determination based on symptoms and/or disease burden.

85. Subject must have R/R disease to at least one prior systemic anti-lymphoma therapy for the indication of follicular lymphoma (radiotherapy is not considered a systemic therapy) which contains an anti-CD20 monoclonal antibody. Subjects who received only prior anti-CD20 monoclonal antibody monotherapy are not eligible.

86. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

87. Female subjects of childbearing potential must practice at least 2 protocol-specified methods of birth control (at least one highly effective method and one effective method) at the same time from 30 days prior to enrollment through at least 12 months after the last dose of epcoritamab.

88. Subject must be willing to adhere to the pregnancy risk minimization plan associated with CC-99282 treatment.

89. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

90. Subject must not have received prior treatment with CC-99282 or CC-220 (iberdomide).

91. Subjects must agree not to donate blood while receiving CC-99282, during dose interruptions and for at least 28 days following the last dose of CC-99282.

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 6A

92. Subject must have R/R (as defined in Criterion 44) MCL.

93. Subject must have an absolute lymphocyte count < 50 x 10^9/L during screening and < 10 x 10^9/L by Cycle 1 Day 1 (bridging therapy may be needed and is allowed).

94. Subject must have received at least 1 prior treatment for MCL which must include an anti CD20 monoclonal antibody in combination with another systemic therapy (radiotherapy is not considered a systemic therapy).

95. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

96. Subject must be suitable for treatment with ibrutinib in the opinion of the investigator.

97. Subject must not have received prior BTKi therapy.

98. Subject must not have known bleeding diathesis (e.g., von Willebrand's disease) or hemophilia.

99. Subject must not require treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

100. Subject must agree to not consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to Cycle 1 Day 1.

101. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 6B

102. Subject must have R/R (as defined in Criterion 44) MCL.

103. Subject must have an absolute lymphocyte count < 50 x 10^9/L during screening and < 10 x 10^9/L by Cycle 1 Day 1 (bridging therapy may be needed and is allowed).

104. Subject must have received at least 1 prior treatment for MCL which must include an anti CD20 monoclonal antibody in combination with another systemic therapy (radiotherapy is not
considered a systemic therapy).

105. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

106. Subject must be suitable for treatment with ibrutinib and venetoclax in the opinion of the investigator.

107. Subject must not have received prior BTKi therapy.

108. Subject must not have known bleeding diathesis (e.g., von Willebrand's disease) or hemophilia.

109. Subject must not require treatment with a strong cytochrome P450 (CYP) 3A inhibitor and must not have received a strong CYP3A inhibitor for at least 7 days prior to Cycle 1 Day 1.

110. Subject must agree to not consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to Cycle 1 Day 1.

111. Subject must not have received prior BCL-2 inhibitor therapy.

112. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 7

113. Subject must have treatment-naive MCL disease.

114. Subject must have an absolute lymphocyte count < 50 x 10^9/L during screening and < 10 x 10^9/L by Cycle 1 Day 1 (bridging therapy may be needed and is allowed).

115. Subject must have refused ASCT, not be Transplant for ASCT (due to age, performance status, comorbidities), OR have high-risk disease characteristics (e.g., TP53 alterations [deletion/mutation], Ki-67 > 30%, blastoid/pleomorphic variant).

116. Subject must be suitable for treatment with ibrutinib and venetoclax in the opinion of the investigator.

117. Subject must not have known bleeding diathesis (e.g., von Willebrand's disease) or hemophilia.

118. Subject must not require treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

119. Subject must agree to not consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to Cycle 1 Day 1.

120. Subject must be able to swallow capsules and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

ADDITIONAL ELIGIBILITY CRITERIA SPECIFIC TO ARM 8

121. Subject must have R/R (as defined in Criterion 44) MCL.

122. Subject must have an absolute lymphocyte count (or MCL cell count) < 50 x 10^9/L during screening and < 10 x 10^9/L by Cycle 1 Day 1 (bridging therapy may be needed and is allowed).

123. Subject must have received at least 1 prior treatment for MCL which must include an anti CD20 monoclonal antibody in combination with another systemic therapy (radiotherapy is not
considered a systemic therapy).

124. Subject must not be refractory (defined as best response of stable disease [SD] or progressive disease [PD]) to prior CAR-T therapy. Subject should not have received any treatment with CAR-T therapy within 90 days prior to enrollment; any CAR-T related toxicity should have been resolved for at least 30 days.

125. Subject must be suitable for treatment with pirtobrutinib in the opinion of the investigator.

126. Subject must not have known bleeding diathesis (e.g., von Willebrand's disease) or hemophilia.

127. Subject must not require treatment with a strong cytochrome P450 (CYP) 3A inhibitor.

128. Subject must agree to not consume grapefruit, grapefruit products, Seville oranges (including marmalade containing Seville oranges), or starfruit for at least 3 days prior to Cycle 1 Day 1.

129. Subject must be able to swallow tablets and must not have any disease significantly affecting gastrointestinal function (e.g., resection of the stomach or small bowel, symptomatic inflammatory bowel disease, or partial or complete bowel obstruction).

1. For Dose Escalation (Part 1) only*: Participants with documented diagnosis for one of the following third line or later treatment of B-cell malignancies, from one of the following WHO-defined histologies (Swerdlow et al 2016):

a) CLL

b) SLL

c) CAR-T/HCT R/R or ineligible DLBCL from the following histologies: DLBCL not otherwise specified (NOS) (GCB and non-GCB DLBCL), T-cell/histiocyte-rich large B-cell lymphoma, primary mediastinal (thymic) large B-cell lymphoma, intravascular large B-cell lymphoma, anaplastic lymphoma kinase positive (ALK+) large B-cell lymphoma, high-grade B-cell lymphoma with MYC and BCL2 and/or BCL6 rearrangements, and high-grade B-cell lymphoma NOS

d) MCL

e) FL (grades 1-3b)

f) MZL (splenic, extranodal, and nodal)

g) LPL including WM

h) Transformed iNHL

2. For Dose Expansion (Part 2) only*+: Participants with documented diagnosis of CLL/SLL who are in their third line or later treatment including those with BTK mutations or CAR-T/HCT R/R or ineligible non-GCB DLBCL who are in their third line or later treatment with histology based on criteria established by the WHO.
*Participants with CLL/SLL should have either received both a BTK inhibitor and venetoclax therapy, been evaluated for and determined to be ineligible for either or both of these therapies, and/or been offered and declined treatment with either or both of these therapies.+Participants with CLL and transformed iNHL must meet relevant disease-specific requirements for systemic treatment (e.g., iwCLL or Groupe d'Etude des Lymphomes Folliculaires [GELF] for FL, respectively).

3. Participant must be at least 18 years old.

4. Participant has an ECOG PS of 0 or 1.

5. Participant has a life expectancy >= 12 weeks.

6. Prior BTKi is allowed.

7. Adequate hematologic function independent of growth factor or transfusion support within 14 days prior to enrollment, defined as:
- Hemoglobin > 8 g/dL.
- ANC > 1 x 10^9/L.
- Platelet count > 50 x 10^9/L.

8. Adequate renal and hepatic function, defined as:
- ALT <= 2.5 x upper limit of normal (ULN).
- AST <= 2.5 x ULN.
- Total bilirubin <= 1.5 x ULN (unless bilirubin rise is due to cases of documented Gilbert's syndrome or of non-hepatic origin, a total bilirubin <= 3 x ULN may be allowed).
- Estimated glomerular filtration rate (by Modification of Diet in Renal Disease [MDRD] or Chronic Kidney Disease Epidemiology [CKD-EPI]) >= 40 mL/min.

9. Adequate coagulation factor levels:
- PT <= 1.5 x ULN.
- INR <= 1.5 x ULN.
- aPTT <= 1.5 x ULN.

10. Participant (excluding CLL subtype) must have archival or freshly collected tumor tissue for correlative studies before study enrollment.

11. A female who is not pregnant, breastfeeding, donating eggs (ova, oocytes), or considering becoming pregnant, breastfeeding, or donating eggs (ova, oocytes) during the study or for 180 days after the last dose of study treatment can be enrolled. For men or women of childbearing potential, willing to use adequate contraception for the duration of study and 90 days (men) or 180 days (women) after last dose of study treatment.
Note: For guidance on the use of contraceptives and barriers, see Appendix 4 (Section 10.4).

12. Women of childbearing potential must have negative serum pregnancy test within 14 days prior to first dose of study treatment and a negative confirmational urine (or serum per local guidelines) pregnancy test prior to study drug dosing on Cycle 1 Day 1 (C1D1).

13. Must voluntarily sign and date an informed consent, approved by an IEC/ IRB, before the initiation of any screening or study-specific procedures.

14. Echocardiogram with ejection fraction >= 50%.

15. Able to swallow tablets and no conditions that could interfere with drug absorption including but not limited to short bowel syndrome or malabsorption syndrome.

16. Must be willing and able to comply with procedures required in this protocol.

17. Ability to tolerate uric acid reducing medications (note: participants with known glucose-6-phosphate dehydrogenase [G6PD] deficiency will be excluded).

18. No known history of other malignancy, with the following exceptions:
- No known active disease present for >= 3 years before first dose of study treatment and considered to be at risk of low recurrence by the Investigator.
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
- Adequately treated carcinoma in situ without evidence of disease.

1. Previously treated with a BTK degrader.

2. Known active central nervous system (CNS) disease, or primary CNS lymphoma. Participants with prior CNS disease that have been effectively treated may be eligible.

3. Known bleeding disorders (e.g., von Willebrand's disease or hemophilia).

4. Therapeutic need for anticoagulation therapy with warfarin or Low Molecular Weight Heparin (LMWH).

5. Known history of stroke or intracranial hemorrhage within 12 months prior to first dose of study treatment.

6. Uncontrolled active systemic infection, or active cytomegalovirus infection.

7. Active hepatitis B or C infection or less than 12 weeks since achieving undetectable viral load in cases of prior active hepatitis C.

8. Known history of human immunodeficiency virus (HIV).

9. Known active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Participant must not have signs/symptoms associated with SARS-CoV-2 infection or known exposure to a confirmed case of SARS-CoV-2 infection during screening. If a participant has signs/symptoms suggestive of SARS-CoV-2 infection, the participant must have a negative molecular (e.g., polymerase chain reaction) test or 2 negative antigen test results at least 24 hours apart. Participants with resolved SARS-CoV-2 infection are eligible.

10. Anticancer therapy including chemotherapy, radiotherapy, small molecule and investigational agents, or monoclonal antibody therapy within 28 days (or at least 5 half--lives, whichever is shorter) prior to first dose of study treatment, and/or corticosteroids at doses exceeding 20 mg/day of prednisone or equivalent given with anti-neoplastic intent within 7 days prior to first dose of study treatment.

11. The participant must not require urgent cytoreductive therapy.

12. Stem cell transplant (SCT) within 90 days prior to the first dose of study treatment and recovery from SCT-related complications is required.

13. Evidence of active graft versus host disease (GVHD) or requirement for immunosuppressants within 28 days prior to first dose of study treatment.

14. Active or uncontrolled autoimmune cytopenias (for 14 or more days) including autoimmune hemolytic anemia (AIHA) and idiopathic thrombocytopenic purpura (ITP).

15. Ongoing history of clinically significant medical and/or psychiatric conditions or any other reason that, in the Investigator's opinion, could impact the participant's safety or put the study outcomes at risk.

16. History or evidence of current interstitial lung disease or pneumonitis.

17. Currently active, clinically significant cardiovascular abnormalities (unless pacemaker was installed with no subsequent abnormalities) including symptomatic congestive heart failure (New York Heart Association [NYHA] Class III or IV heart failure), unstable angina pectoris, cardiac arrhythmia, or cardiac infarction within 6 months prior to first dose of study treatment.

18. Corrected QT interval > 450 msec (males) or > 470 msec (females) based on Fridericia's formula or other significant electrocardiographic abnormalities including second degree atrioventricular block type II, third degree atrioventricular block, or bradycardia (ventricular rate less than 50 beats/min).

19. Has received any live vaccine within 28 days prior to the first dose of study treatment or has an expected need for a live vaccination during study participation, including at least 28 days after the last dose of study treatment. The first dose of study treatment, when possible, is preferred to be given at least 7 days after SARS-CoV-2 vaccine administration.

20. Major surgery within 28 days of first dose of study treatment.

21. Unresolved toxicity of = Grade 2 from prior anticancer therapy, except for alopecia.

22. Known hypersensitivity or an allergic reaction to the active ingredient or other components of the study drug and/or other products in the same class.

23. Participant has systemically used proton-pump inhibitors within 7 days prior to the first dose of study treatment.

24. Participant has systemically used known moderate/strong inhibitors of cytochrome P450 3A(CYP)3A enzyme isoform subfamily, or p-glycoprotein (P-gp), within 14 days or 5 half-lives of the drug (whichever is shorter) prior to the first dose of study treatment.

25. Participant has systemically used known moderate/strong inducers of CYP3A within 14 days prior to the first dose of study treatment.

26. Participant requires treatment with known moderate or strong inhibitors or inducers of CYP3A, P-gp inhibitors, or proton-pump inhibitors form the first dose of study treatment and for the duration of the study.

27. Administration or consumption of any of the following within 3 days prior to first dose of study treatment and while on study treatment: grapefruit or grapefruit products, Seville oranges (including marmalade-containing Seville oranges), and star fruit.

Consent

1. Subjects must voluntarily sign and date an informed consent, approved by an independent ethics committee (IEC)/institutional review board (IRB), prior to the initiation of any screening or
study-specific procedures.

Demographic and Laboratory Assessments

2. Individuals age = 18 years old at the time of screening.

3. Subjects with Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2 at screening and baseline (last assessment prior to first dose of study drug).

4. Laboratory values meeting the following criteria within the screening period prior to the first dose of study drug:

a. Alanine transaminase (ALT) and aspartate transaminase (AST) = 2.5 x the upper limit of normal (ULN)

b. Total bilirubin = 1.5 x ULN (unless secondary to Gilbert's syndrome*, hemolysis, or leukemia)
i. If suspected to be secondary to leukemia or hemolysis, retesting allowed; subjects eligible if repeat values meet criteria.
*For patients with Gilbert's Syndrome: Total bilirubin = 3 x ULN.

c. Estimated Glomerular Filtration Rate (by MDRD or CKD-Epi) or measured creatinine clearance by 24-hour urine collection = 50 mL/min.

d. Prothrombin time (PT)/International normalized ratio (INR) and activated partial thromboplastin time (PTT [aPPT]) = 1.5 x ULN (unless abnormalities are unrelated to coagulopathy or bleeding disorder).

e. Subject must have adequate hematologic function independent of growth factor support (within 7 days prior to first dose of study drug) or transfusion support (as specified below).
Adequate hematologic function is defined as:
i. Absolute neutrophil count = 1,500/mm^3 (independent of growth factor support within 7 days),
ii. Platelet count = 50,000/µL (with no platelet transfusion in the last 7 days),
iii. Hemoglobin = 8 g/dL (with no red blood cell transfusion in the past 7 days).

5. Subject is willing and able to comply with procedures required in this protocol.

6. Subjects must not be incarcerated and must be freely willing and able to provide informed consent (e.g., adults under legal protection measure [e.g., under guardianship/curatorship] or
unable to express their consent and select adults under psychiatric care). Investigator's discretion should be applied.

Disease Activity

7. Documented diagnosis of CLL/SLL, per 2018 iwCLL criteria.36

8. R/R CLL/SLL that has received at least 2 prior systemic therapies and have no available (or established) therapies known to provide clinical benefit and to which the patient would consent
to receiving.

9. All subjects must consent to collection of bone marrow aspirate and biopsy during screening and collection of bone marrow aspirate (and biopsies per standard of care) at specified response
assessments.

Subject History

10. No history of other malignancies, with the following exceptions:

f. No known active disease present within 3 years prior to first dose of study treatment, and felt to be at low risk of recurrence by the treating investigator.

g. Adequately treated in situ carcinoma without evidence of disease.

h. Basal cell carcinoma of the skin or localized squamous cell carcinoma of the skin without evidence of disease.

Contraception

11. Pregnancy testing in female subjects of childbearing potential:

i. Subjects must have a negative serum pregnancy test at the Screening Visit and a negative urine pregnancy test at baseline prior to the first dose of study drug.

j. Subjects with a borderline serum pregnancy test at screening must have absence of clinical suspicion of pregnancy or other pathological causes of borderline results and a serum
pregnancy test = 3 days later to document continued lack of a positive result (unless prohibited by local requirements).

k. Subjects with a urine pregnancy test at baseline that is borderline or ambiguous must have a serum pregnancy test. In such cases, the subject must be excluded from participation if the serum pregnancy result is positive.

12. Female subjects of childbearing potential must practice at least 1 protocol-specified method of birth control, from Study Day 1 through at least 185 days after the last dose of ABBV-453 and 18 months after the last dose of obinutuzumab, whichever is longer. Female subjects of non childbearing potential do not need to use birth control.

13. Female subject who is not pregnant or breastfeeding and is not considering becoming pregnant or donating eggs during the study and for 185 days after the last dose of ABBV-453 and 18 months after the last dose of obinutuzumab, whichever is longer.

14. Male subject who is sexually active with female partner(s) of childbearing potential, must agree, from Study Day 1 through 95 days after the last dose of study drug, to practice the protocol-specified contraception.

15. Male subject who is not considering fathering a child or donating sperm during the study or for 95 days after the last dose of study drug.

Cardiac and Pulmonary Assessments

1. QT interval corrected for heart rate (QTc) using Fridericia's correction of > 470 msec (females) or > 450 msec (males), Grade 3 arrythmia, and/or other clinically significant cardiac abnormalities.

2. Only if clinically indicated or per local/country requirement (e.g., France, Japan): PaO2 < 60 mmHg by arterial blood gas analysis or SpO2 < 93% by percutaneous oxygen saturation.

3. Only if clinically indicated or per local/country requirement (e.g., Japan, France, Germany): acute diffuse infiltrative pulmonary disease including interstitial pneumonitis, pulmonary fibrosis, or abnormal (e.g., ground glass opacity or linear) interstitial shadow bilaterally by a chest computed tomography (CT) scan (high resolution) regardless of symptom, or high values of Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A) or surfactant protein D (SP-D).
Clinical significance can be determined through consultation with a pulmonary expert as necessary.

Disease Activity

4. Evidence of progressive multifocal leukoencephalopathy (PML).

5. Evidence of ongoing graft-versus-host disease (GVHD).

Subject History

6. Subject known to be BCL-2i refractory or has received a BCL-2i-containing regimen within (6 months) of starting study drug (e.g., venetoclax, lisaftoclax, BGB-11417).

7. Subject has known B-cell prolymphocytic leukemia.

8. Subject has history of histologic transformation of previously indolent disease (e.g., Richter's transformation).

9. Subject has known central nervous system manifestations of malignancy.

10. Subject has major surgery within 4 weeks of study treatment or planned during study participation.

11. Subject has active human immunodeficiency virus (HIV) infection.
a. HIV testing is not required unless required locally.

12. Subject has known active infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2).

13. Subject has active Hepatitis B (HbsAg positive) infection based on screening blood testing:
a. Subjects with resolved infection (HbsAg negative, but antiHBc or antiHBs positive) must be screened using real-time polymerase chain reaction (PCR) of HBV DNA. Those with positive PCR will be excluded;
b. Exception: Subjects with serologic findings suggestive of HBV vaccination (antiHBs antibody positivity as the only serologic marker) AND a known history of prior HBV vaccination, do not need to be tested for HBV DNA by PCR;

14. Subject is not known to be seropositive for Hepatitis C or positive HCV antibody at screening.
Subjects with an undetectable HCV viral load at least 12 weeks following completion of antiviral therapy are eligible.

15. Subject has clinically significant liver disease, including cirrhosis or other hepatitis (including autoimmune).

16. Subject has active viral infections.

17. Subject has a recent infection requiring systemic treatment that was completed = 7 days before first dose of study treatment and/or uncontrolled active systemic infection.

18. Subject has unresolved toxicity of Grade = 2 from prior anti-cancer therapy, or to levels dictated in the eligibility criteria, with the exception of alopecia.

19. Subject has history of an allergic reaction or significant sensitivity to constituents of the study drug (and its excipients) and/or other products in the same class.

20. Subject has history of allergic reaction or significant sensitivity to oral uric acid reducing agents (e.g., xanthine oxidase inhibitors and rasburicase). Note: Subjects with known glucose-6-phosphate dehydrogenase (G6PD) deficiency will be excluded.

21. Subject has a history of hypersensitivity reactions to obinutuzumab.

22. Subject is unable to swallow capsules or tablets or have malabsorption syndrome or other condition that prevents enteral route of administration.

23. Subject has known gastrointestinal disease, gastrointestinal procedure or medical condition that could interfere with the oral absorption or tolerance of the study drug.

24.Subject has recent history (within 6 months) of:
a. congestive heart failure (defined as New York Heart Association, Class 2 or higher),
b. ischemic cardiovascular event,
c. cardiac arrhythmia requiring pharmacological or surgical intervention,
d. pericardial effusion, or
e. pericarditis.

25. Subject has history of clinically significant medical conditions, life expectancy < 6 months, or any other reason that the Investigator determines would interfere with the subject's participation in this study or would make the subject an unsuitable candidate to receive study treatment. This criterion includes any medical condition of any grade rendering the patient at risk of suffering a dose-limiting toxicity as defined in Section 4.3.

Concomitant Medications & Food

26. Subject has received anti-cancer therapy including chemotherapy, radiation therapy, immunotherapy, biologic, small molecule inhibitor or any investigational therapy within 28 days or 5 half-lives of the drug (whichever is shorter) prior to the first dose of study drug.

27. Subject has received any live vaccine within 28 days or other vaccine within 7 days prior to first dose of study drug.

28. Subject consumes known moderate or strong inhibitors of cytochrome P450 3A isoform subfamily (CYP3A) within 14 days or 5 half-lives of the drug (whichever is shorter) days before the first dose of ABBV-453.

29. Subject consumes known moderate or strong inducers of CYP3A within 14 days before the first dose of ABBV-453.

30. Subject requires concurrent or expected treatment with known moderate or strong inhibitors or moderate or strong inducers of CYP3A from screening through the last dose of ABBV-453.

31. Subject doesn't agree to refrain from consuming grapefruit, grapefruit products, Seville oranges (including marmalade-containing Seville oranges), or star fruit from 3 days before anticipated first dose of ABBV-453 through the last dose of ABBV-453.

Patients eligible for inclusion in this study have to meet all of the following criteria:

1. Age = 18 years.

2. Patients with diagnosis of relapsed or refractory AML (= 5% bone marrow blasts, and/or = 1% peripheral blood blasts, and/or histologically proven extramedullary disease) defined according to 2022 ICC criteria1 after at least one prior line of treatment who are ineli gible for intensive salvage chemotherapy and/or allogeneic hematopoietic cell transplantation or who decline standard treatment.
OR
Patients with diagnosis of relapsed/refractory MDS/AML with 10 - 19% bone marrow blasts at initial diagnosis and = 5%bone marrow blasts, and/or = 1% peripheral blood blasts at screening defined according to 2022 ICC criteria1 after at least one prior line of treatment who are ineligible for intensive salvage chemotherapy and/or allogeneic hematopoietic cell transplantation or who decline standard treatment.

3. IDH1-mutated as determined by a validated assay at a specific site (IDH1 R132).

4. ECOG 0-2.

5. Adequate hepatic function as evidenced by:
- Serum total bilirubin = 3 x upper limit of normal (ULN) unless considered due to Gilbert’s syndrome, or leukemic involvement of the liver – following written approval by the coordinating investigator.
- Aspartate aminotransferase (AST) and alanine ami notransferase (ALT), = 3.0 x ULN, unless considered due to leukemic involvement of the liver - following written approval by the coordinating investigator.

6. Adequate renal function as evidenced by creatinine clearance = 30 mL/min based on the CKD-EPI for mula for glomerular filtration rate (GFR).

7. Able to understand and willing to sign an informed consent form (ICF).

8. Written informed consent.

9. Female patient must either:
- Be of non-childbearing potential:
- Postmenopausal prior to screening defined as:
- Age = 50 years and in postmeno pausal state > 1 year or
- Age < 50 years and in postmenopausal state > 1 year with serum FSH > 40 IU/l and serum estrogen < 30 ng/l or a negative estrogen test, both at screening
or
- Patient is documented surgically sterile by bilateral tubal ligation or bilateral oophorectomy or status post-hysterectomy or uterine agenesis (at least 1 month prior to screening).
- If of childbearing potential:
- Agree not to try to become pregnant during the study and for 6 months after the final study drug administration
- And have a negative serum pregnancy test at screening
And, if heterosexually active, agree to consist ently use highly effective* contraception per locally accepted standards in addition to a barrier method starting at screening and
throughout the study period and for 6 months after the final study drug administration.

* Highly effective forms of birth control include:
i. Established intrauterine device (IUD) or intrauterine system (IUS).
ii. Bilateral tubal occlusion.
iii. Vasectomy (a vasectomy is a highly effective contraception method pro vided the absence of sperm has been confirmed. If not, an additional highly effective method of contraception should be used).
iv. Male is sterile due to a bilateral orchiectomy.
v. Sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual activity during the entire period of risk as sociated with the study drug. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical study and the preferred and usual lifestyle of the patient.

* List is not all inclusive. Prior to enrollment, the investigator is responsible for confirming patient will utilize highly effective forms of birth control per the requirements of the CTFG Guidance document Recommendations related to contraception and pregnancy testing in clinical trials’, September 2020 (and any updates thereof) during the protocol defined period. Since ivosidenib
may decrease the concentrations of hormonal contraceptives, it is recom mended to use alternative methods of contraception as mentioned above (see section 5.5).

- Female patient must agree not to breastfeed starting at screening and throughout the study period, and for 2 months after the final study drug administration.
- Female patient must not donate ova starting at screening and throughout the study period, and for 6 months after the final study drug administration.

10. Male patient and their female partners who are of childbearing potential must use highly effective contraception per locally accepted standards (see above *highly effective forms of birth control) in addition to a barrier method starting at screening and continue throughout the study period and for 4 months and 1 week after the final study drug administration.

11. Male patient must not donate sperm starting at screening and throughout the study period and for 4 months and 1 week after the final study drug administration.

12. Patient agrees not to participate in another interven tional study while on treatment.

13. Ability to swallow and retain oral medication, no known malabsorption syndrome, adequate organ function for the study treatment in the opinion of the investigator.

Patients eligible for inclusion in this study must not meet any of the following criteria:

1. Acute promyelocytic leukemia (APL) with t(15;17)(q22;q12); PML-RARA, or other transloca tions associated with APL.

2. AML with BCR-ABL translocation.

3. MDS with bone marrow blasts < 10% at initial diagnosis (if patients progress from MDS to MDS/AML they should be treated with a hypomethylating agent first).

4. MDS with bone marrow blasts < 5% at screening.

5. Prior treatment with ivosidenib, olutasidenib or a PHD inhibitor (e.g. roxadustat) within the last 10 months prior to screening.

6. Persistence of toxicity of prior chemotherapy above grade 1.

7. Treatment with any investigational agent within two weeks before day one of study treatment or less than 5 half-lives of the compound.

8. CNS disease or other severe acute or chronic medical or psychiatric condition, or laboratory abnormality that may increase the risk associated with study participation or study drug administration, or may interfere with the interpretation of study results, and in the judgment of the investigator would make the patient inappropriate for entry into this study.

9. Known allergy or suspected hypersensitivity to molidustat and/or ivosidenib and/or any excipients.

10. Taking medications with narrow therapeutic windows with potential interaction with investigational medication (see Appendix I), unless the patient can be transferred to other medications prior to enrolling or unless the medications can be properly monitored during the study.

11. Taking P-glycoprotein (P-gp) or breast cancer resistance protein (BCRP) transporter- sensitive substrate medications (see Appendix J) unless the pa tient can be transferred to other medications within = 5 half-lives prior to administration of molidustat and ivosidenib, or unless the medications can be properly monitored during the study.

12. Breast feeding at the start of study treatment.

13. Active infection, including hepatitis B or C or HIV infection that is uncontrolled at screening. An infection controlled with an approved or closely monitored an tibiotic/antiviral/antifungal treatment is allowed.

14. Patients with a currently active second malignancy.
Patients are not considered to have a currently active malignancy if they have completed therapy and are considered by their physician to be at < 30% risk of relapse within one year. However, patients with the following history/concurrent conditions are allowed:
- Basal or squamous cell carcinoma of the skin
- Carcinoma in situ of the cervix
- Carcinoma in situ of the breast
- Incidental histologic finding of prostate cancer

15. Significant active cardiac disease within 6 months prior to the start of study treatment, including New York Heart Association (NYHA) class III or IV congestive heart failure (Appendix H); myocardial infarction, unstable angina and/or stroke; or left ventricular ejec tion fraction (LVEF) < 40% by ultrasound obtained within 28 days prior to the start of study treatment.

16. Liver cirrhosis Child Pugh B or Child Pugh C or disorders of bilirubin metabolism, e.g. in patients with Crigler-Najjar syndrome or Rotor syndrome, with exception of Gilbert’s syndrome (see section 4.1 and 5.5).

17. QTc interval using Fridericia’s formula (QTcF) = 480 msec or other factors that increase the risk of QT prolongation or arrhythmic events (e.g., heart failure, family history of long QT interval syndrome). Prolonged QTc interval associated with bundle branch block or pacemaking is permitted with written approval of the coordinating investigator.

18. Taking medications that are known to prolong the QT interval (see Appendix K), unless deemed critical and without a suitable alternative. In those cases, they may be administered with proper monitoring.

19. Dysphagia, short-gut syndrome, gastroparesis, or other conditions that limit the ingestion or gastrointestinal absorption of orally administered drugs.

20. Clinical symptoms suggestive of active central nervous system (CNS) leukemia or known CNS leukemia.
Evaluation of cerebrospinal fluid (CSF) during screening is only required if there is a clinical suspicion of CNS involvement by leukemia during screening.

21. A known medical history of progressive multifocal leukoencephalopathy (PML).

22. Immediately life-threatening, severe complications of leukemia such as uncontrolled bleeding, pneumonia with hypoxia or shock, and/or severe disseminated in travascular coagulation.

23. Any other medical condition deemed by the Investigator to be likely to interfere with a patient’s ability to give informed consent or participate in the study.

24. Any psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule.

Subjects meeting all of the following criteria will be considered for admission to the trial:

1. Must be = 18 years at the time of signing the informed consent.

2. Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures.

3. Patients with a “good risk status as defined by the NCCN guidelines (version 1.2021)

4. Tumor board protocol confirming:
- a clinical recommendation for intrathecal therapy and evaluation of trial enrollment
- a statement on the potential necessity of additional systemic treatment of metastatic tumor outside the CNS

5. Able to adhere to the study visit schedule and other protocol requirements.

6. All subjects must agree to refrain from donating blood while on study drug and for 28 days after discontinuation from this study treatment.

7. Patients with Karnofsky performance score > 50%

8. Diagnosis of LMD by CSF and/or MRI

a. A thorough CSF evaluation must be performed in every patient prior to the inclusion in this trial. The reason is that a positive CSF cytology is considered the gold standard for LMD diagnosis. Furthermore, a thorough CSF evaluation will allow the thorough assessment of potential differential diagnoses (for example viral meningitis, bacterial meningitis, aseptic meningitis, sarcoidosis etc.)

b. Presence of malignant cells on CSF cytology. The frequency of CSF evaluation is based on guideline of the German Society of Neurology: Please note that the first lumbar puncture is only 50-60% sensitive. Repeat collection increases sensitivity up to approximately 80%. Thus, a negative first CSF evaluation should at least be repeated once. According to guidelines from the German Society for Neurology each CSF collection should draw enough, i.e. at least 5-10 ml CSF and should be processed within one hour of collection.

c. MRI diagnosis of LMD: pial enhancement, pial nodular manifestations (as defined per LANO criteria, see appendix).

d. A positive CSF cytology and an MRI evidence is enough to determine the LMD diagnosis.

e. Please note that approximately 20% of patients with symptomatic LMD might lack positive CSF cytology even upon repeated puncture. In these cases, the LMD diagnosis can also be performed based on cerebral/spinal MRI manifestations and by exclusion of differential diagnosis.

f. In the absence of diagnostic findings for LMD in the CSF: patients must present with typical clinical and MRI signs of LMD (Le Rhun et al., 2017). If the CSF has signs of pleocytosis (BUT NOT any malignant, atypical or suspicious cells) the differential diagnosis for CSF pleocytosis (aseptic meningitis, viral meningitis, bacterial meningitis) must be excluded.

g. Some centers perform biopsies of leptomeninges for obtaining a LMD diagnosis. The LMD diagnosis will be based on histology and should be documented accordingly. Yet, a histological diagnosis of LMD is NOT required for the inclusion in this trial.

9. If radiation therapy had occurred: Please make sure that a documentation of the past radiation therapy is available (including applied dosage and radiation therapy fields):

a. Participants eligible for IT-PD1 should have completed their radiation therapy due to clinical indication > 2 weeks prior to enrollment into the trial.

b. All LMD patients without an indication for radiation therapy (per investigator s choice) can be enrolled immediately

10. Neurological examination (NANO scale) (Nayak et al., 2017).

11. MRI: the assessment at baseline and for subsequent time points should be based on the LANO scorecard (see appendix) according to (Le Rhun et al., 2019).

12. Ability to undergo intrathecal therapy via an intraventricular catheter (e.g. Ommaya reservoir).

13. Primary tumor tissue for the assessment of PD-1 and PD-L1 is optional at the timepoint of inclusion and enrollment but does need to be shipped before end of the trial.

14. Female Patient of childbearing potential^1 and male patients with female partner of childbearing potential1 is willing to use highly effective contraceptive methods during treatment and for 150 days (male or female, see SmPC) after the last dose. Recommendations highly effective contraceptive methods are:

a. combined hormonal contraception associated with inhibition of ovulation (oral-, intravaginal, -transdermal)

b. progestogen-only hormonal contraception associated with inhibition of ovulation (pral injectable, implantable),

c. intrauterine device (IUD),

d. intrauterine hormone - releasing system (IUS),

e. bilateral tubal occlusion,

f. vasectomized partner2

g. sexual abstinence3

^1
For the purpose of this document, a female is considered of childbearing potential (FCBP), i.e. fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilisation methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause. A high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. However, in the absence of 12 months of amenorrhea, a single FSH measurement is insufficient. For the purpose of this document, aman is considered fertile after puberty unless permanently sterile by bilateral orchidectomy.

^2
Vasectomized partner is a highly effective birth control method provided that partner is the sole sexual partner of the WOCBP trial participant and that the vasectomized partner has received medical assessment of the surgical success

^2
In the context of this guidance sexual abstinence is considered a highly effective method only if defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments. The reliability of sexual abstinence needs to be evaluated in relation to the duration of the clinical trial and the preferred and usual lifestyle of the
subject.

Subjects presenting with any of the following criteria will not be included in the trial:

1. Women during pregnancy and lactation.

2. Previous intrathecal Nivolumab application.

3. Patient at “poor risk (NCCN guidelines version 1.2021).

4. The following differential diagnoses to LMD are exclusion criteria:
a. Aseptic meningitis
b. Viral meningitis
c. Bacterial meningitis

5. History of hypersensitivity to monoclonal antibodies.

6. Participation in other clinical AMG or MDR trials or observation period of competing trials or if there is otherwise a high risk of insurance law issues intervening between two studies and if the participation affects the primary endpoint of the IT-PD1 study. In case of uncertainty, competing insurances must be contacted prior to participation

7. A clinical condition that in the opinion of the investigator would interfere with the evaluation or interpretation of patient safety or trial results or that would prohibit the understanding of informed consent and compliance with the requirements of the protocol.

8. Any treatment-related toxicities from prior systemic anti-tumor or immune therapy not having resolved to CTCAE version 5.0 grade 1, with the exception of alopecia.

9. Patient with confirmed hisory of current autoimmune disease.

10. Patients with any disease resulting in permanent immunosuppression or requiring permanent immunosuppressive therapy.

11. Clinically significant active infection, for example:
a. Presence of human immunodeficiency virus
b. Active hepatitis B virus/hepatitis C virus. HIV infection or active Hepatitis B or C infectionor active infections requiring oral or intravenous antibiotics or that can cause a severe disease and pose a severe danger to lab personnel working on patients’ blood or tissue (e.g. rabies) *.

12. Inability to undergo MRI with contrast agent.

13. The underlying primary tumor has not a registered and authorized indication in the European Union for intravenous treatment with Nivolumab, Pembrolizumab or Atezolizumab. The solide tumor registered are, i.e. melanoma, non-small cell lung cancer (NSCLC), Malignant pleural mesothelioma (MPM),renal cell carcinoma (RCC), Classical Hodgkin lymphoma (cHL), squamous cell cancer of the head and neck (SCCHN), urrothelial carcinoma, muscle invasive urothelial carcinoma (MIUC), colorectal cancer (CRC) with Mismatch repair deficient (dMMR) or microsatellite instability-high (MSI-H), esophageal squamous cell carcinoma (ESCC), Adjuvant treatment of esophageal cancer (EC) or gastro-oesophageal junction cancer (GEJC), Gastric gastro oesophageal junction (GEJ) or oesophageal adenocarcinoma, triple negative breast carcinoma. In addition, leptomeningeal disease of solid tumors with a high tumor mutational burden is also eligible.

14. Abnormal laboratory values for the following values in haematology, coagulation parameters, liver and renal function:
a. Haemoglobin < 8 g/dl
b. White blood cell count < 2.0 x 10^9/L)
c. Platelet count decrease < 50 x 10^9/L
d. Bilirubin > 2.5 x upper limit of normal (ULN) according to the performing laboratory s reference range. Note that benign hereditary hyperbilirubinemia e.g. Gilbert s syndrome is permitted.
e. Alanine aminotransferase > 3 x ULN
f. Aspartate aminotransferase > 3 x ULN
g. Serum creatinine increase > 1.5 x ULN

15. Patients who have received live or attenuated vaccine therapy used for prevention of infectious disease within 4 weeks of the first IT application of Nivolumab.

16. Patients requiring chronic systemic corticosteroid therapy (> 10 mg prednisone or equivalent per day) or any other immunosuppressive therapies (including anti-TNF-a therapies).

*) These parameters are necessary in immunotherapy studies, as they in turn may have an impact on immune parameters (independent of study treatment)

Participants are eligible to be included in the study only if all of the following criteria apply. The below are the core inclusion criteria for all modules of the study; all participants must
also meet the criteria described in the relevant module in addition to those described below. Where module-specific criteria are more stringent than core study criteria, the module-specific criteria take precedence.

Age

1 Participant must be 18 or the legal age of consent in the jurisdiction in which the study is taking place, or older, at the time of signing the informed consent.

Type of Participant and Disease Characteristics

2 Eastern Cooperative Oncology Group performance status of < 2.

3 Able to provide a tumor biopsy sample collected before treatment with AZD5492 (except for participants with CLL, for whom a bone marrow sample should be provided).
Note: Receipt of tumor samples does not have to occur prior to study enrolment.

4 Adequate organ and bone marrow function as detailed in Table 5.

Table 5 Criteria for Adequate Organ and Bone Marrow Function at Screening

HEMATOLOGICALl^a
Hemoglobin = 8 g/dL (4.96 mmol/L)
Absolute neutrophil count = 1 x 10^9/L (1000 per mm^3)^b
If BM involvement, = 0.75 x 10^9/L
Platelet count = 50 x 10^9/L (50000 per mm^3)
Absolute lymphocyte count = 25 x 10^9/L (25000 per mm^3)

HEPATIC
TBL = 1.5 x ULN in the absence of Gilbert’s syndrome (or = 3.0 x ULN in presence of Gilbert’s syndrome)
AST and ALT = 3 x ULN (or = 5 x ULN if elevated values are primarily due to the significant liver involvement of the disease)

RENAL
CrCl by Cockcroft and Gault method = 50 mL/minute

COAGULATION
INR < 1.5 x ULN

PANCREATIC
Lipase = 1.5 x ULN
Amylase = 1.5 x ULN and no active pancreatitis

CARDIAC
LVEF as measured by echocardiography, MUGA, or MRI > 45%

^a Hematological criteria cannot be met with ongoing or recent blood transfusions (within 7 days prior to the date of the screening laboratory assessment)
^b Short acting myeloid growth factors (eg, G-CSF) are permitted up to 72 hours prior to the date of the screening laboratory assessment. Long-acting myeloid growth factors (eg, Peg-G-CSF) are permitted up to 21 days prior to the date of the screening laboratory assessment.

Sex and Contraceptive/Barrier Requirements

5 Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies. Refer to Appendix L for definitions of women of childbearing potential and highly effective methods of contraception.

(a) Male participants:
(i) Condom use is required throughout the study and for 75 days (ie, 5 half-lives and 2 weeks to clear exposed sperm) following last dose.
(ii) Male participants must not donate or bank sperm during the same time period.

(b) Female sexual partners of male study participants:
(i) One form of highly effective contraception (see Appendix L) for the sexual partners of male trial participants throughout the study and for 75 days (ie, 5 half-lives and 2 weeks) following last dose.

(c) Female participants of childbearing potential:
(i) All women of childbearing potential must have a negative serum pregnancy test result at the Screening Visit (Note: In Japan, even if the pregnancy test result is negative, a participant could be excluded where it is judged that there is a possibility of pregnancy based on the investigator’s interview, etc.).
(ii) All women of childbearing potential who are sexually active with a non-sterilized male partner must use a highly effective form of contraception (see Appendix L) throughout the study and for 60 days (ie, 5 half-lives) following last dose. Male partners of female participants of childbearing potential shall use a condom during the same period. Cessation of contraception after this point should be discussed with a responsible physician.
(iii) Female condom and male condom should not be used together.

It should be noted that interaction between hormonal contraception and AZD5492 has not been studied. Therefore, it is unknown whether AZD5492 may reduce the efficacy of the contraceptive method.

INFORMED CONSENT

6 Capable of giving signed informed consent as described in Appendix A which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.

7 Provision of signed and dated written Optional Genetic Research Information informed consent prior to collection of samples for optional genetic research that supports the Genomic Initiative (see Appendix D 2).

Participants are excluded from the study if any of the below criteria apply. The below are the core exclusion criteria for all modules of the study; all participants must also meet the criteria described in the relevant module in addition to those described below. Where module-specific criteria are more stringent than core study criteria, the module-specific criteria take precedence

MEDICAL CONDITIONS

1 Active CNS involvement by lymphoma, leptomeningeal disease or spinal cord compression. Participants with a prior history of CNS localization of lymphoma who received treatment are eligible provided that there is no evidence of CNS involvement at study entry as documented by CSF cytology and/or brain MRI.

2 CNS pathology including:
- History of CNS disease which was symptomatic or required treatment in the past year such as CNS vasculitis, severe brain injury, dementia, Parkinson’s disease, neurodegenerative diseases, cerebellar disease, severe uncontrolled mental illness, psychosis, CNS involvement of autoimmune diseases.
- Paresis, aphasia, or stroke within 3 months prior to consent.
- History of seizure disorder/epilepsy. Participants with stable dose of antiepileptics or without antiepileptics may be included if no seizure activity in the past year.
- History of progressive multifocal leukoencephalopathy (PML).

3 History of Grade = 3 CRS or Grade = 3 ICANS (see Appendix I).

4 Participants with previous history of hemophagocytic lymphohistiocytosis/macrophage activation syndrome.

5 Positive anti-HCV Ab, unless HCV PCR is undetectable at screening. Participants treated with antivirals require sustained negativity for 12-24 weeks following end of antiviral treatment.

6 Serologic status reflecting active hepatitis B:
- Participants HBsAg positive, will be excluded.
- Participants anti-HBc IgG Ab positive, will be excluded if HBV PCR is positive. If HBV PCR is negative, they can enroll with repeat (or serial) HBV PCR during the study (refer to relevant SoA).

7 Active HIV infection. HIV-infected participants on effective anti-retroviral therapy with sustained undetectable viral load for longer than 6 months prior to enrollment are eligible for this study after confirmation from the sponsor.

8 Participant has any medical or psychiatric condition which, in the opinion of the investigator or Medical Monitor, places the participant at an unacceptably high risk for toxicities, could interfere with successful or safe delivery of therapy, or could interfere with evaluation of the investigational product or interpretation of participant safety or study results. Examples include major psychiatric illness and drug or alcohol abuse.

9 History of QT prolongation associated with other medications, that required discontinuation of that medication.

10 Congenital long QT syndrome.

11 History of arrhythmia (multifocal premature ventricular contractions, bigeminy, trigeminy, ventricular tachycardia) which is symptomatic or requires treatment, symptomatic or uncontrolled atrial fibrillation, or asymptomatic sustained ventricular tachycardia. Participants with atrial fibrillation controlled by medication are permitted.

12 Major cardiac abnormalities, including but not limited to the following: uncontrolled angina (or unstable life-threatening arrhythmias), history of myocardial infarction = 12 weeks before screening, Class = 3 New York Heart Association congestive heart failure, severe cardiac insufficiency, or persistent QTc prolongation (= 480 msec, QTcF).

13 Unresolved non-hematological AEs Grade = 2 (NCI CTCAE v5.0) due to prior anticancer therapy except for:
- Alopecia
- Fatigue
- Grade 2 peripheral neuropathy
- Endocrine disorders that are controlled with replacement hormone therapy
- Stable vitiligo

14 Other invasive malignancy within 2 years prior to screening with the exception of:

(a) Malignancy treated with curative intent and with no evidence of active disease present for more than 2 years before screening and considered to be at low risk of recurrence by the treating physician.
(b) Adequately treated lentigo malignant melanoma without current evidence of disease or adequately controlled non-melanomatous skin cancer.

15 Any severe and uncontrolled medical condition (eg, uncontrolled hypertension, bleeding diathesis, hepatic failure, clinically significant liver disease including cirrhosis or hepatitis, unstable respiratory or cardiac conditions, active infection [bacterial, viral, fungal or other infection], any major infection that required hospitalization or treatment with IV or oral antimicrobials within 14 days of Day 1, evidence of clinically active ILD or active pneumonitis, or history of pneumonitis/ILD) requiring treatment which in the investigator's opinion makes it undesirable or poses a safety risk for the participant to participate in the study. Note that chronic active EBV infection (known or suspected) must be excluded and that a past COVID-19 infection may be a risk factor, but if resolved and the participant is vaccinated, it may be allowable to enroll the participant.

16 Active or prior documented autoimmune or inflammatory disorders including, but not limited to, inflammatory bowel disease (eg, colitis or Crohn’s disease), myasthenia gravis, myositis, autoimmune hepatitis, diverticulitis, systemic lupus erythematosus, Sarcoidosis syndrome, or Wegener syndrome (granulomatosis with polyangiitis), Graves’ disease, rheumatoid arthritis, hypophysitis, uveitis, vascular thrombosis associated with antiphospholipid syndrome, Sjogren syndrome, Guillain-Barre syndrome, vasculitis, glomerulonephritis, etc. The following are exceptions to this criterion:
(a) Vitiligo or alopecia
(b) Hypothyroidism (eg, following Hashimoto syndrome) stable on hormone replacement.
(c) Controlled Type 1 diabetes mellitus on insulin.
(d) Any chronic skin condition that does not require systemic therapy.
(e) Participants without active disease in the last 5 years may be included but only after consultation with the Study Physician.
(f) Celiac disease, controlled by diet alone.

PRIOR/CONCOMITANT THERAPY

17 Treatment with any of the following:
(a) Received adoptive cellular therapy such as autologous or donor NK cell or T lymphocyte infusions [eg, CAR-T cells]), or T-cell engager therapy, within 90 days prior to the first dose of study treatment.
(b) Received any anti-CD20 monoclonal antibody within 28 days prior to the first dose of study treatment.
(c) Received any investigational drug within 21 days (or 5 half-lives, whichever is shorter) prior to the first dose of study treatment.
(d) Received any other chemotherapy, immunotherapy, immunosuppressant medication (other than low dose of corticosteroids, ie, = 10 mg prednisone or equivalent) or anticancer agents within 21 days or 5 half-lives (whichever is shorter) prior to the first dose of study treatment.
(e) Received radiation therapy with curative intent within 14 days prior to the first dose of study treatment (localized palliative radiotherapy is permitted).
(f) Received prior allogeneic HSCT, unless the transplant occurred > 180 days prior to the first scheduled dose and the participant has no active graft-versus-host disease requiring treatment and has been stable off immunosuppression for at least 2 months.
(g) Received prior autologous HSCT unless the transplant occurred > 90 days prior to the first scheduled dose and transplant-related toxicities are resolved to at least a Grade 1.
(h) Received major surgery within 28 days prior to the first dose of study treatment.

18 Receipt of live, attenuated vaccine within 28 days before the first dose of study treatment(s).

PRIOR/CONCURRENT CLINICAL STUDY EXPERIENCE

19 Participants with a known hypersensitivity to AZD5492 or any of the excipients of the product.

OTHER EXCLUSIONS

20 Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site).

21 Judgment by the investigator that the participant should not participate in the study if the participant is unlikely to comply with study procedures, restrictions, and requirements.

22 Previous dosing with AZD5492 in the present study.

23 Currently pregnant (confirmed with positive pregnancy test) or breast feeding or intention of becoming pregnant (female) or having child (male) during the study or within 75 days (male)/60 days (female) after the last dose of AZD5492.