Description
Tisagenlecleucel injection is used to treat B-cell acute lymphoblastic leukemia (ALL) that has come back a second or later time or after other medicines did not work well in patients up to 25 years of age. Leukemia is a type of cancer where the body makes abnormal white blood cells.
Tisagenlecleucel injection is also used to treat follicular lymphoma (FL) and large B-cell lymphoma (including diffuse large B-cell lymphoma [DLBCL], high grade B-cell lymphoma, or DLBCL from follicular lymphoma) that has come back or after 2 or more lines of treatment did not work well. Lymphoma is a type of cancer where the body makes abnormal white blood cells.
Tisagenlecleucel injection is an antineoplastic (cancer) medicine that is made from your own white blood cells, which have been modified to recognize and attack your cancer cells. Before you begin treatment, talk to your doctor about the benefits of this medicine as well as the possible risks of receiving it.
This medicine is available only under a restricted distribution program called Kymriah® REMS (Risk Evaluation and Mitigation Strategy) Program.
This product is available in the following dosage forms:
- Suspension
Before Using
In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of tisagenlecleucel injection in children with ALL. Safety and efficacy have been established.
Appropriate studies have not been performed on the relationship of age to the effects of tisagenlecleucel injection in children with DLBCL and FL. Safety and efficacy have not been established.
Geriatric
Appropriate studies have not been performed on the relationship of age to the effects of tisagenlecleucel injection in the elderly. Safety and efficacy have not been established.
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bacillus of Calmette and Guerin Vaccine, Live
- Dengue Tetravalent Vaccine, Live
- Measles Virus Vaccine, Live
- Mumps Virus Vaccine, Live
- Rubella Virus Vaccine, Live
- Smallpox Monkeypox Vaccine
- Typhoid Vaccine
- Varicella Virus Vaccine
- Yellow Fever Vaccine
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Adenovirus Vaccine Type 4, Live
- Adenovirus Vaccine Type 7, Live
- Cholera Vaccine
- Ebola Zaire Vaccine, Live
- Influenza Virus Vaccine, Live
- Rotavirus Vaccine, Live
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:
- Heart problems or
- Hypotension (low blood pressure) or
- Infections (including hepatitis B), active or history of or
- Lung or breathing problems—Use with caution. May cause side effects to become worse.
- Neutropenia (low white blood cells) or
- Weak immune system—Use with caution. May increase risk for infection.
Proper Use
A nurse or other trained health professional will give you this medicine in a hospital or cancer center. It is given through a needle placed into one of your veins. The medicine must be injected slowly, so your IV tube will need to stay in place for less than an hour. It is given 2 to 14 days (for ALL), 2 to 11 days (for DLBCL), or 2 to 6 days (for FL) after completing treatment with other cancer medicines (eg, fludarabine, cyclophosphamide, bendamustine).
You should stay within 2 hours of the office or center to check for unwanted effects for at least 4 weeks receiving this medicine.
It is very important that you understand the requirements of the Kymriah® REMS program, and become familiar with the Kymriah® medication guide. Read and follow these instructions carefully. Ask your doctor if you have any questions. Ask your pharmacist for the medication guide if you do not have one.
Missed Dose
This medicine needs to be given on a fixed schedule. If you miss a dose, call your doctor, home health caregiver, or treatment clinic for instructions.
Precautions
It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.
This medicine may cause cytokine release syndrome (CRS) and infusion reactions. This may be life-threatening and requires immediate attention. Tell your doctor right away if you or your child has a fever, chills, headache, nausea, lightheadedness, dizziness, fainting, skin rash, trouble breathing, or tiredness or weakness.
Check with your doctor right away if you or your child have seizures, loss of balance, loss of consciousness, confusion, disorientation, difficulty with speaking, or slurred speech. These may be symptoms of serious nerve problems.
This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and require immediate medical attention. Talk to your doctor right away if you have very fast or irregular breathing, a very fast or irregular heartbeat, a rash, fainting, hive-like swellings on the skin, or swelling of the eyelids or around the eyes, face, lips, or tongue.
This medicine can temporarily lower the number of white blood cells in your blood, which increases the chance of getting an infection. If you can, avoid people with infections. Check with your doctor immediately if you think you or your child are getting an infection or if you have a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
This medicine may increase your risks for hypogammaglobulinemia (immune system problem) and getting other cancers. Talk to your doctor if you have questions about these risks.
This medicine may cause dizziness, confusion, seizures, or decreased alertness. Do not drive or do anything else that could be dangerous until you know how this medicine affects you, for at least 8 weeks after treatment.
While you are being treated with tisagenlecleucel injection, do not have any immunizations (vaccinations) without your doctor's approval. Live virus vaccinations should not be given for at least 6 weeks before start of treatment, during treatment, and until recovery following the last cycle of this medicine.
Before you have any medical tests, tell the medical doctor in charge that you are taking this medicine. The results of some tests may be affected by this medicine.
Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
- Agitation
- back pain
- bleeding gums
- bloody urine
- blue lips, fingernails, or skin
- blurred vision
- chest pain, discomfort, or tightness
- chills
- confusion as to time, place, or person
- cough
- coughing that sometimes produces a pink frothy sputum
- coughing up blood
- decreased urine output
- depression
- difficult, fast, noisy breathing
- dilated neck veins
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- drowsiness
- dry mouth
- fast, pounding, or irregular heartbeat or pulse
- fever
- general feeling of discomfort or illness
- hallucinations
- headache
- hoarseness
- holding false beliefs that cannot be changed by fact
- hostility
- increase in heart rate
- increased blood pressure
- increased menstrual flow or vaginal bleeding
- increased sweating
- irritability
- loss of appetite
- loss of consciousness
- lower back or side pain
- mood or mental changes
- muscle, joint, or bone pain
- nausea
- nervousness
- nosebleeds
- painful or difficult urination
- pale skin
- pounding in the ears
- problems with speech or speaking
- prolonged bleeding from cuts
- rapid shallow breathing
- rapid weight gain
- red or black, tarry stools
- red or dark brown urine
- seeing, hearing, or feeling things that are not there
- seizures
- shakiness and unsteady walk
- slow or fast heartbeat
- stiff neck
- sunken eyes
- swelling of the face, arms, fingers, feet, or lower legs
- trembling and shaking of hands
- trouble breathing
- unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
- unusual excitement, nervousness, or restlessness
- vomiting
- weight gain
Less common
- Change in the amount of urine
- cloudy urine
- headache, sudden or severe
- stomach pain
- tenderness, pain, swelling, warmth, skin discoloration, and prominent superficial veins over the affected area
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Anxiety
- decreased appetite
- diarrhea
- difficulty in moving
- joint pain
- muscle pain or stiffness
- pain in the arms or legs
- stuffy nose
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
DRG-20406560
