Efficacy and safety of tisagenlecleucel in adult patients with refractory or relapsed follicular lymphoma

Prior treatment

• Presence of active or prior hepatitis B or C as indicated by serology. Serology must be repeated, if the interval between testing prior to lymphodepletion and tisagenlecleucel infusion exceeds 8 weeks
• Presence of HIV antibody. Serology must be repeated, if the interval between testing prior to lymphodepletion and tisagenlecleucel infusion exceeds 8 weeks
• Uncontrolled acute life threatening bacterial, viral or fungal infection (e.g. blood culture positive ≤ 72 hours prior to tisagenlecleucel infusion)
• Previous or concurrent malignancy with the following exceptions: a. Adequately treated basal cell or squamous cell carcinoma (adequate wound healing is required prior to enrollment) b. In situ carcinoma of the cervix or breast, treated curatively and without evidence of recurrence for at least 3 years prior to enrollment c. A primary malignancy which has been completely resected and in complete remission for ≥ 3 years at the time of enrollment
• 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 at least 12 months after the tisagenlecleucel infusion and until CAR T-cells are no longer present by qPCR on two consecutive tests. 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 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.
• Prior anti-CD19 therapy
• Prior gene therapy
• Prior adoptive T cell therapy
• Prior allogeneic hematopoietic stem cell transplant
• Investigational medicinal product within the last 30 days or five half-lives (whichever is longer) prior to screening

Other illness

• Active CNS involvement by malignancy
• Active neurological autoimmune or inflammatory disorders (e.g. Guillain-Barre syndrome, Amyotrophic Lateral Sclerosis)

Lab values

• Cardiac or cardiac repolarization abnormality, including any of the following: • History of myocardial infarction (MI), angina pectoris, or coronary artery bypass graft (CABG) within 6 months prior to starting study treatment • Clinically significant cardiac arrhythmias (e.g., ventricular tachycardia), complete left bundle branch block, high-grade AV block (e.g., bifascicular block, Mobitz type II and third degree AV block) • LVEF <45% as determined by ECHO or MRA or MUGA • NYHA functional class III or IV
• Pregnant or nursing (lactating) women NOTE: female study participants of reproductive potential must have a negative serum or urine pregnancy test performed within 24 hours before leukapheresis, lymphodepletion and prior to tisagenlecleucel infusion.

Other

• Evidence of histologic transformation
• Sexually active males must use a condom during intercourse while taking study treatment and for at least 12 months after the tisagenlecleucel infusion and until CAR T-cells are no longer present by qPCR on two consecutive tests. A condom is required for all sexually active male participants to prevent them from fathering a child AND to prevent delivery of study treatment via seminal fluid to their partner. In addition, male participants must not donate sperm for the time period specified above.
• Intolerance to the excipients of the tisagenlecleucel cell product.
• Follicular Lymphoma Grade 3B

• Written informed consent prior to any screening procedures
• ≥18 years of age at the time of ICF signature
• FL (Grade 1, 2, 3A) confirmed histologically by central pathology review before tisagenlecleucel infusion.
• FL meeting one of the following criteria: • Refractory to a second line or later line of systemic therapy (including an anti-CD20 antibody and an alkylating agent) or relapsed within 6 months after completion of a second line or later line of systemic therapy • Relapsed during anti-CD20 antibody maintenance (following at least two lines of therapies as above) or within 6 months after maintenance completion • Relapsed after autologous HSCT
• Radiographically measurable disease at screening defined as: • At least one nodal lesion greater than 20 mm in the long axis, regardless of the length of the short axis AND/OR • Extranodal lesions (outside lymph node or nodal mass, including liver and spleen) greater than 10 mm in long AND short axis
• ECOG performance status that is either 0 or 1 at screening
• Patients must meet the following laboratory values without transfusion at screening: • Absolute neutrophil count (ANC) ≥ 1,000/mm3 (≥ 1×109/L) • Absolute lymphocyte count (ALC) > 300/mm3 (> 0.3×109/L) • Absolute number of CD3+ T cells > 150/mm3 (> 0.15×109/L) • Platelets ≥ 50 000/mm3 (≥ 50×109/L) • Hemoglobin ≥ 8.0 g/dl (≥ 4.9 mmol/L) • A serum creatinine of ≤1.5 times ULN or eGFR ≥ 60 mL/min/1.73 m2 • Alanine aminotransferase (ALT)/ Aspartate aminotransferase (AST) ≤ 5 times the Upper Limit of Normal (ULN) • Total bilirubin (TBIL) ≤ 1.5 times ULN (with the exception of patients with Gilbert’s syndrome. Patients with Gilbert’s syndrome may be included if their total bilirubin is ≤ 3.0 times ULN and direct bilirubin ≤ 1.5 times ULN
• Adequate pulmonary function defined as: • No or mild dyspnea (≤ Grade 1) • Oxygen saturation measured by pulse oximetry > 90% on room air
• Must have a leukapheresis product of non-mobilized cells accepted for manufacturing