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Tagraxofusp (Elzonris) is a CD123-directed cytotoxin composed of recombinant human interleukin-3 (IL-3) fused to a truncated diphtheria toxin (DT388). It is being investigated by M.D. Anderson Cancer Center in a Phase Ib/II clinical trial (NCT05032183) in combination with a low-intensity chemotherapy regimen for the treatment of relapsed or refractory CD123-positive acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma. The mechanism of action involves the IL-3 domain binding to the CD123 receptor (IL-3 receptor alpha) on the surface of malignant cells, followed by internalization and the subsequent inhibition of protein synthesis by the diphtheria toxin moiety, leading to apoptosis. The low-intensity chemotherapy backbone typically includes agents such as vincristine, dexamethasone, and cyclophosphamide, designed to provide synergistic anti-tumor effects with reduced toxicity compared to standard intensive induction regimens.
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