Yescarta - patient leaflet, side effects, dosage

B. PACKAGE LEAFLET

Package leaflet: Information for the patient

Yescarta 0.4 – 2 × 10 8 cells dispersion for infusion axicabtagene ciloleucel (CAR+ viable T cells)

This medicine is subject to additional monitoring. This will allow quick identification of new safety information. You can help by reporting any side effects you may get. See the end of section 4 for how to report side effects.

Read all of this leaflet carefully before you are given this medicine because it contains important information for you.

• – Keep this leaflet. You may need to read it again.

• – Your doctor will give you a Patient Alert Card. Read it carefully and follow the instructions on

it.

• – Always show the Patient Alert Card to the doctor or nurse when you see them or if you go to

hospital.

• – If you have any further questions, ask your doctor or nurse.

• – If you get any side effects, talk to your doctor or nurse. This includes any possible side effects

not listed in this leaflet. See section 4.

What is in this leaflet

• 1. What Yescarta is and what it is used for

• 2. What you need to know before you are given Yescarta

• 3. How Yescarta is given

• 4. Possible side effects

• 5. How to store Yescarta

• 6. Contents of the pack and other information

1. What Yescarta is and what it is used for

Yescarta is a gene therapy medicine used for treating adults with aggressive diffuse large B-cell lymphoma (DLBCL) and primary mediastinal large B-cell lymphoma (PMBCL) affecting your lymph tissue (part of the immune system) that affects a type of white blood cell called B lymphocytes and other organs in your body. Too many of these abnormal white blood cells accumulate in your tissue and this is the cause of the symptoms you may have. It is used to treat these conditions when other available medicines have stopped working for you.

The medicine is made specially for you as a single administration of your own modified white blood cells. It is given by a drip (infusion ) into a vein (intravenously ).

2. What you need to know before you are given Yescarta

You should not be given Yescarta if you are allergic to any of the ingredients of this medicine (listed in section 6). If you think you may be allergic, ask your doctor for advice.

Warnings and precautions

Yescarta is made from your own white blood cells and should only be given to you (autologous use ).

Before you are given Yescarta you should tell your doctor if you:

• – have problems with your nervous system (such as fits, stroke, or memory loss).

• – have kidney problems.

• – have low blood cell levels (blood counts).

• – have had a stem cell transplant in the last 4 months.

• – have any lung, heart or blood pressure (low or raised) problems.

• – have signs or symptoms of graft-versus-host disease. This happens when transplanted cells

attack your body, causing symptoms such as rash, nausea, vomiting, diarrhoea and bloody stools.

• – notice the symptoms of your cancer are getting worse. If you have lymphoma this might

include fever, feeling weak, night sweats, sudden weight loss.

• – have an infection. The infection will be treated before the Yescarta infusion.

• – have had hepatitis B, hepatitis C or human immunodeficiency virus (HIV) infection.

If any of the above apply to you (or you are not sure), talk to your doctor before being given Yescarta.

Tests and checks

Before you are given Yescarta your doctor will:

• Check your lungs, heart and blood pressure.
• Look for signs of infection; any infection will be treated before you are given Yescarta.
• Check if your cancer is getting worse.
• Look for signs of graft-versus-host disease that can happen after a transplant.
• Check your blood for uric acid and for how many cancer cells there are in your blood. This will

show if you are likely to develop a condition called tumour lysis syndrome. You may be given medicines to help prevent the condition.

• Check for hepatitis B, hepatitis C or HIV infection.
• Check if you had a vaccination in the previous 6 weeks or are planning to have one in the next

few months.

After you have been given Yescarta

Tell your doctor or nurse immediately if you have any of the following:

• Chills, extreme tiredness, weakness, dizziness, headache, cough, shortness of breath, or rapid

heartbeat, which may be symptoms of a condition known as cytokine release syndrome. Take your temperature twice a day for 3–4 weeks after treatment with Yescarta. If your temperature is high, see your doctor immediately.

• Fits, shaking, or difficulty speaking or slurred speech, loss of consciousness or decreased level

of consciousness, confusion and disorientation, loss of balance or coordination.

• Fever, which may be a symptom of an infection.
• Extreme tiredness, weakness and shortness of breath, which may be symptoms of a lack of red

blood cells.

• Bleeding or bruising more easily, which may be symptoms of low levels of cells in the blood

known as platelets.

Your doctor will regularly check your blood counts as the number of blood cells and other blood components may decrease.

Do not donate blood, organs, tissues or cells for transplants.

If any of the above apply to you (or you are not sure), talk to your doctor or nurse before you are given Yescarta. Your doctor may need to take special care of you during your treatment with Yescarta.

In some cases, it might not be possible to go ahead with the planned treatment with Yescarta. For example:

• – If Yescarta infusion is delayed for more than 2 weeks after you have received preparatory

chemotherapy you may have to receive more preparative chemotherapy.

Children and adolescents

Yescarta should not be used in children and adolescents below 18 years of age.

Other medicines and Yescarta

Tell your doctor or nurse if you are taking, have recently taken or might take any other medicines.

Before you are given Yescarta tell your doctor or nurse if you are taking any medicines that weaken your immune system such as corticosteroids, since these medicines may interfere with the effect of Yescarta.

In particular, you must not be given certain vaccines called live vaccines:

• In the 6 weeks before you are given the short course of chemotherapy (called lymphodepleting

chemotherapy) to prepare your body for the Yescarta cells.

• During Yescarta treatment.
• After treatment while the immune system is recovering.

Talk to your doctor if you need to have any vaccinations.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before being given this medicine. This is because the effects of Yescarta in pregnant or breast-feeding women are not known, and it may harm your unborn baby or your breast-fed child.

• If you are pregnant or think you may be pregnant after treatment with Yescarta, talk to your

doctor immediately.

• You will be given a pregnancy test before treatment starts. Yescarta should only be given if the

results show you are not pregnant.

Discuss pregnancy with your doctor if you have received Yescarta.

Driving and using machines

Some people may feel tired, dizzy or have some shaking after being given Yescarta. If this happens to you, do not drive or use heavy machines until at least 8 weeks after infusion or until your doctor tells you that you have completely recovered.

Yescarta contains sodium

This medicine contains 300 mg sodium (main component of cooking/table salt) in each infusion bag. This is the equivalent to 15% of the recommended maximum daily dietary intake of sodium for an adult.

• 3. How Yescarta is given

Yescarta will always be given to you by a healthcare professional.

• Since Yescarta is made from your own white blood cells, your cells will be collected from you

to prepare your medicine. Your doctor will take some of your blood using a catheter placed in your vein (a procedure call leukapheresis). Some of your white blood cells are separated from your blood and the rest of your blood is returned to your vein. This can take 3 to 6 hours and may need to be repeated.

• Your white blood cells are frozen and sent away to make Yescarta. It usually takes about 3 to 4

weeks to-receive your Yescarta therapy but the time may vary.

Medicines given before Yescarta treatment

During the 30 to 60 minutes before you are given Yescarta you may be given other medicines. This is to help prevent infusion reactions and fever. These other medicines may include:

• Paracetamol.
• An antihistamine such as diphenhydramine.

Prior to receiving Yescarta, you will be given other medicines such as preparative chemotherapy, which will allow your modified white blood cells in Yescarta to multiply in your body when the medicine is given to you.

Your doctor or nurse will check carefully that this medicine is yours.

How you are given Yescarta

Yescarta will always be given to you by a doctor in a qualified treatment centre.

• Yescarta is given in a single dose.
• Your doctor or nurse will give you a single infusion of Yescarta through a catheter placed into

your vein (intravenous infusion) over about 30 minutes.

• Yescarta is the genetically modified version of your white blood cells. Your healthcare

professional handling the treatment will therefore take appropriate precautions (wearing gloves and glasses) to avoid potential transmission of infectious diseases and will follow local guidelines on handling of waste of human-derived material to clean up or dispose of any material that has been in contact with it.

You must receive Yescarta infusion in a qualified clinical facility and be discharged only when your doctor thinks it is safe for you to go home.

Your doctor may do blood tests to check for side effects.

After you are given Yescarta

• Plan to stay within proximity from the hospital where you were treated for at least 4 weeks after

you have been given Yescarta. Your doctor will recommend that you return to the hospital daily for at least 10 days and will consider whether you need to stay at the hospital as an in-patient for the first 10 days after infusion. This is so your doctor can check if your treatment is working and help you if you have any side effects.

If you miss any appointments, call your doctor or the qualified clinical facility as soon as possible to reschedule your appointment.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Yescarta can cause side effects to your immune system that may be serious or life-threatening, and can lead to death.

The following side effects have been reported with Yescarta.

Very common (may affect more than 1 in 10 people)

• – Fever, chills, reduced blood pressure which may cause symptoms such as dizziness,

lightheadedness, fluid in the lungs, which may be severe and can be fatal (all symptoms of a condition called cytokine release syndrome).

• – Fever or chills.

• – Decrease in the number of red blood cells (cells that carry oxygen) which may cause you to feel

extremely tired with a loss of energy.

• – Low blood pressure, dizziness.

• – Feeling sick, constipation, diarrhoea, pain in the stomach or being sick.

• – Headache, depressed level of consciousness, difficulty in speaking, agitation, shaking.

• – Decrease in the number of white blood cells, which are important for fighting infections.

• – Decreased levels of sodium, phosphate, or potassium which will show up on blood tests.

• – Changes in the rhythm or rate of the heartbeat.

• – Anxiety.

• – Decrease in the number of cells that help clot the blood (thrombocytopenia).

• – Infections in the blood caused by bacteria, viruses or other types of infection.

• – Shortness of breath, cough.

• – Low levels of antibodies called immunoglobulins, which may lead to infections.

• – High blood pressure.

• – Swelling in the limbs, fluid around the lungs (pleural effusion).

• – Muscle and joint pain, back pain.

• – Extreme tiredness.

• – Dehydration.

• – Decreased appetite, weight loss.

• – Confusion.

• – Increased levels of liver enzymes which will show up on blood tests.

• – Dry mouth.

• – Low oxygen level in blood.

• – Pain in the hands or feet.

Common (may affect up to 1 in 10 people)

• – Difficulty understanding numbers, memory loss, fits, loss of control of body movements.

• – Failure of the kidneys causing your body to hold onto fluid which can be serious or life

threatening.

• – Fluid in the lungs.

• – Lung infection.

• – Sudden, unexpected stopping of the heart (cardiac arrest); this is serious and life-threatening.

• – Heart failure.

• – Muscle spasms.

• – Difficulty to swallow.

• – Leakage of fluids from blood vessels into surrounding tissue. This can lead to a weight gain

and difficulty in breathing.

• – Decreased levels of calcium which will show up on blood tests.

• – Infections in the blood caused by fungi.

• – Decreased levels of albumin which will show up on blood tests.

• – Skin rash.

• – Increased levels of bilirubin reporting on how your liver is working, which will show up on

blood tests.

• – Signs and symptoms of blood clots.

• – Difficulty sleeping.

• – Hypersensitivity.

Uncommon (may affect up to 1 in 100 people)

• – Inflammation and swelling of spinal cord which may cause partial or total paralysis of limbs and

torso.

Tell your doctor immediately if you get any of the side effects listed above. Do not try to treat your symptoms with other medicines on your own.

Reporting of side effects

If you get any side effects, talk to your doctor or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the national reporting system listed in By reporting side effects, you can help provide more information on the safety of this medicine.

5. How to store Yescarta

The following information is intented for doctors only.

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the container label and infusion bag.

Store frozen in vapour phase of liquid nitrogen < –150 °C until thawed for use.

Do not refreeze.

This medicine contains genetically modified human blood cells. Local guidelines on handling of waste of human-derived material should be followed for unused medicinal product or waste material. As this medicine will be given by qualified healthcare professionals, they are responsible for the correct disposal of the product. These measures will help protect the environment.

6. Contents of the pack and other information

What Yescarta contains

The active substance is axicabtagene ciloleucel. Each patient-specific single infusion bag contains a dispersion of anti-CD19 CAR T cells in approximately 68 mL for a target dose of 2 × 106 anti-CD19 CAR-positive viable T cells/kg.

The other ingredients (excipients) are: Cryostor CS10, sodium chloride, human albumin. See section 2 “Yescarta contains sodium”.

What Yescarta looks like and contents of the pack

Yescarta is a clear to opaque, white to red dispersion for infusion, supplied in an infusion bag individually packed in a metal cassette. A single infusion bag contains approximately 68 mL of cell dispersion.

Marketing Authorisation Holder and Manufacturer

Kite Pharma EU B.V.

Tufsteen 1

2132 NT Hoofddorp

The Netherlands

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

This leaflet was last revised in

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site: There are also links to other websites about rare diseases and treatments.

This leaflet is available in all EU/EEA languages on the European Medicines Agency website.

The following information is intended for healthcare professionals only:

It is important that you read the entire content of this procedure prior to administering Yescarta.

Precautions to be taken before handling or administering the medicinal product

• Yescarta contains genetically-modified human blood cells. Local guidelines on handling of

waste of human-derived material applicable for such products should be followed.

• Yescarta should be transported within the facility in closed, break-proof, leak-proof containers.
• Yescarta is prepared from autologous blood of the patient collected by leukapheresis. Patient

leukapheresis material and Yescarta may carry a risk of transmitting infectious viruses to healthcare professionals (HCP) handling the product. Accordingly, HCP should employ appropriate precautions (wearing gloves and glasses) when handling leukapheresis material or Yescarta to avoid potential transmission of infectious diseases.

• Work surfaces and materials that have potentially been in contact with Yescarta must be

decontaminated according to local guidelines on the handling of waste of human-derived materials.

Preparation for infusion

• Verify that the patient’s identity (ID) matches the patient identifiers on the Yescarta cassette.
• The Yescarta product bag must not be removed from the metal cassette if the information on the

patient-specific label does not match the intended patient.

• Once the patient’s ID is confirmed, remove the Yescarta product bag from the metal cassette.
• Check that the patient information on the metal cassette label matches that on the bag label.

Inspect the product bag for any breaches of container integrity before thawing. If the bag is compromised, follow the local guidelines for handling of waste of human-derived material (or immediately contact Kite).

• Place the infusion bag inside a second bag.
• Thaw Yescarta at approximately 37 °C using either a water bath or dry thaw method until there

is no visible ice in the infusion bag. Gently mix the contents of the bag to disperse clumps of cellular material. If visible cell clumps remain, continue to gently mix the contents of the bag. Small clumps of cellular material should disperse with gentle manual mixing. Yescarta should not be washed, spun down, and/or re-suspended in new media prior to infusion. Thawing should take approximately 3 to 5 minutes.

• Once thawed, Yescarta is stable at room temperature (20 °C-25 °C) for up to 3 hours.

However, Yescarta infusion should begin within 30 minutes of thaw completion.

Do NOT use a leukodepleting filter.

Administration

• The medicine must be administered in a qualified treatment centre by a physician(s) with

experience in the treatment of haematological malignancies and trained for administration and management of patients treated with Yescarta.

• Ensure that at least 1 dose of tocilizumab per patient and emergency equipment are available

prior to infusion and during the recovery period. Hospitals should have access to an additional dose of tocilizumab within 8 hours of each previous dose.

• The patient’s identity should be matched with the patient identifiers on the infusion bag.
• Yescarta is for autologous use only.
• Yescarta should be administered as an intravenous infusion using latex-free intravenous tubing without a leukocyte depleting filter within 30 minutes by either gravity or a peristaltic pump.
• Gently agitate the bag during Yescarta infusion to prevent cell clumping. All contents of the

infusion bags should be infused.

• Sterile sodium chloride 9 mg/mL (0.9%) (0.154 mmol sodium per mL) solution for injection

should be used to prime the tubing prior to infusion as well as rinse it afterwards. When the full volume of Yescarta has been infused, the infusion bag should be rinsed with 10 to 30 mL sodium chloride 9 mg/mL (0.9%) solution for injection by back priming to ensure as many cells as possible are infused into the patient.

Disposal of Yescarta

• Any unused medicinal product or waste material that has been in contact with Yescarta (solid

and liquid waste) should be handled and disposed in accordance with local guidelines on the handling of waste of human-derived material. Work surfaces and material which have potentially been in contact with Yescarta must be decontaminated with appropriate disinfectant.

Accidental exposure

• Accidental exposure to Yescarta must be avoided. Local guidelines on handling of waste of