3L+ R/R LBCL

An open-label, single-arm trial (N=269)1

TRANSCEND trial: Largest pivotal trial in 3L+ large B-cell lymphoma, including patients with high-risk disease1

Primary endpoints: ORR and safety2
Secondary endpoints: CR, DOR, and OS2

Bridging therapy prior to receiving Breyanzi® was optional.1
Deep and durable complete response in a one-time infusion1*
Response rates (N=192)1
Graph depicting response rates in TRANSCEND clinical trial for 3L+ LBCL
Graph depicting response rates in TRANSCEND clinical trial for 3L+ LBCL
The IRC-assessed overall response rate in the leukapheresed population (N=287) was 59% (95% CI: 53, 64), with a CR rate of 43% (95% CI: 37, 49) and PR rate of 15% (95% CI: 11, 20).1
Efficacy was established on the basis of CR rate and DOR, as determined by an IRC per the Lugano 2014 criteria.1
DOR rates1
Number of responders (n=141/192) Median months (95% Cl)
DOR 16.7 (5.3, NR),‡ range§: 0.0±23.5+
DOR if best
response is CR		 NR (16.7, NR),‡ range§: 0.7±23.5+
DOR if best
response is PR		 1.4 (1.1, 2.2),‡ range§: 0.0±22.8+
1-month median time to first CR (range: 0.8-12.5 months)1

DOR by best overall response; median DOR: 16.7 months1,3

Graph showing DOR in Breyanzi TRANSCEND trial
Graph showing DOR in Breyanzi TRANSCEND trial

CR TotalTotal
104 141
78 83
68 71
64 67
40 43
35 38
17 18
16 17
0 0
Of the 104 patients who achieved CR, 68 (65%) had remission lasting at least 6 months, and 64 (62%) had remission lasting at least 9 months1
Median DOR for PR: 1.4 months (95% CI: 1.1, 2.2)1
*Treatment process can take approximately 2 to 3 months and includes leukapheresis, manufacturing, administration, and adverse event monitoring.1
†Of the 287 patients who underwent leukapheresis and had radiographically evaluable disease, 27 additional patients achieved a response, apart from the responses noted in graph above. These efficacy results include responses that may have been contributed solely by bridging therapy, product outside of the intended dose range, and out-of-specification.1
‡Kaplan-Meier method was used to obtain 2-sided 95% confidence intervals.1
§A plus sign (+) indicates a censored value.1
3L, third-line; CI, confidence interval; CR, complete response; DOR, duration of response; IRC, Independent Review Committee; NR, not reached; ORR, overall response rate; OS, overall survival; PR, partial response.
Overall survival at 2-year follow-up
mOS: 27.3 months (95% CI: 16.2, 45.6)4*
Median (95% Cl) follow-up: 29.3 months (26.2, 30.4)4
View by response:

CR
PR
NR
Overall survival at 2 year follow up Breyanzi TRANSCEND clinical trial Overall survival at 2 year follow up Breyanzi TRANSCEND clinical trial 2-year follow-up 2-year follow-up Overall survival at 2 year follow up Breyanzi TRANSCEND clinical trial Overall survival at 2 year follow up Breyanzi TRANSCEND clinical trial
Overall survival at 2-year follow-up in Breyanzi TRANSCEND clinical trial.
Overall survival at 2-year follow-up in Breyanzi TRANSCEND clinical trial.
51% of all patients were alive at 2 years4

CR PR NR Total
136 51 70 257
135 46 42 223
128 34 28 190
120 25 17 162
116 16 14 146
112 12 12 136
109 10 11 130
105 8 11 124
88 6 9 103
62 5 5 72
47 4 4 55
40 3 3 46
30 3 2 35
22 0 1 23
17   1 18
12   1 13
8   0 8
3     3
0     0
Analysis limitations:
  • OS data are not in the Prescribing Information and should be interpreted with caution
  • OS was a secondary endpoint in TRANSCEND and was not statistically tested in the setting of a single-arm trial. It is not possible to determine if the observed effect is attributable to Breyanzi or to the natural history of the disease
  • The statistical significance of OS is not known
*95% Cl: 16.2, 45.6.4
†Reverse Kaplan-Meier method was used to calculate median (95% CI) of follow-up.4
3L, third-line; CI, confidence interval; CR, complete response; DOR, duration of response; mOS, median overall survival; NR, not reached; ORR, overall response rate; OS, overall survival.
TRANSCEND trial2
Trial design of Breyanzi TRANSCEND clinical trial
Trial design of Breyanzi TRANSCEND clinical trial
The trial included both patients who had previous stem cell transplants and patients who did not undergo transplant due to ineligibility or other reasons. There was no prespecified threshold for blood counts; patients were eligible to enroll if they were assessed to have adequate bone marrow function to receive LDC.1
  • Primary endpoints: ORR and safety2
  • Select secondary endpoints: CR, DOR, and OS2
TRANSCEND trial design and patient disposition1
Of 299 patients who underwent leukapheresis:
  • 44 (15%) did not receive CAR-positive T cells either due to manufacturing failures (n=2), death (n=29), disease complications (n=6), or other reasons (n=7)
  • 204 (68%) received Breyanzi in the intended dose range, of whom 192 were evaluable for efficacy (main efficacy population); 12 were not evaluable due to absence of PET-positive disease at study baseline or after bridging therapy
  • 51 (17%) either received Breyanzi outside of the intended dose range (n=26) or received CAR‑positive T cells that did not meet the product specifications for Breyanzi (manufacturing failures; n=25)
Patients were allowed to receive bridging therapy prior to receiving Breyanzi. Optional bridging therapy for disease control included intrathecal chemotherapy or radiation therapy for treatment of CNS lymphoma.1
25 patients were treated in an outpatient setting per physicians’ discretion2
Select baseline demographics in the TRANSCEND trial1,2
Characteristics1,2 (N=269)
Median age, years (range) 63 (18-86)
≥65 years/≥75 years 42%/10%
Large B-cell lymphoma subtype, n (%)
DLBCL, NOS 53%
DLBCL transformed from indolent lymphoma 25%
Double-/triple-hit B-cell lymphoma 14%
Primary mediastinal large B-cell lymphoma 7%
Follicular lymphoma, Grade 3B 1%
3L, third-line; CAR, chimeric antigen receptor; CNS, central nervous system; CR, complete response; CY, cyclophosphamide; DLBCL, diffuse large B-cell lymphoma; DOR, duration of response; FLU, fludarabine; LDC, lymphodepleting chemotherapy; NOS, not otherwise specified; ORR, objective response rate; OS, overall survival; PET, positron emission tomography.
Important Safety Information
Less
Indications
BREYANZI is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of:
  • adult patients with large B-cell lymphoma (LBCL), including diffuse large B-cell lymphoma (DLBCL) not otherwise specified (including DLBCL arising from indolent lymphoma), high-grade B cell lymphoma, primary mediastinal large B-cell lymphoma, and follicular lymphoma grade 3B, who have:
    • refractory disease to first-line chemoimmunotherapy or relapse within 12 months of first-line chemoimmunotherapy; or
    • refractory disease to first-line chemoimmunotherapy or relapse after first-line chemoimmunotherapy and are not eligible for hematopoietic stem cell transplantation (HSCT) due to comorbidities or age; or
    • relapsed or refractory disease after two or more lines of systemic therapy.

    • Limitations of Use: BREYANZI is not indicated for the treatment of patients with primary central nervous system lymphoma.

Important Safety Information

WARNING: CYTOKINE RELEASE SYNDROME, NEUROLOGIC TOXICITIES, AND SECONDARY HEMATOLOGICAL MALIGNANCIES

  • Cytokine Release Syndrome (CRS), including fatal or life-threatening reactions, occurred in patients receiving BREYANZI. Do not administer BREYANZI to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab with or without corticosteroids.
  • Neurologic toxicities, including fatal or life-threatening reactions, occurred in patients receiving BREYANZI, including concurrently with CRS, after CRS resolution, or in the absence of CRS. Monitor for neurologic events after treatment with BREYANZI. Provide supportive care and/or corticosteroids as needed.
  • T cell malignancies have occurred following treatment of hematologic malignancies with BCMA- and CD19-directed genetically modified autologous T cell immunotherapies, including BREYANZI.
  • BREYANZI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the BREYANZI REMS.
Cytokine Release Syndrome
Cytokine release syndrome (CRS), including fatal or life-threatening reactions, occurred following treatment with BREYANZI. In clinical trials of BREYANZI, which enrolled a total of 702 patients with non-Hodgkin lymphoma (NHL), CRS occurred in 54% of patients, including ≥ Grade 3 CRS in 3.2% of patients. The median time to onset was 5 days (range: 1 to 63 days). CRS resolved in 98% of patients with a median duration of 5 days (range: 1 to 37 days). One patient had fatal CRS and 5 patients had ongoing CRS at the time of death. The most common manifestations of CRS (≥10%) were fever, hypotension, tachycardia, chills, hypoxia, and headache.
Serious events that may be associated with CRS include cardiac arrhythmias (including atrial fibrillation and ventricular tachycardia), cardiac arrest, cardiac failure, diffuse alveolar damage, renal insufficiency, capillary leak syndrome, hypotension, hypoxia, and hemophagocytic lymphohistiocytosis/macrophage activation syndrome (HLH/MAS).
Ensure that 2 doses of tocilizumab are available prior to infusion of BREYANZI.
Neurologic Toxicities
Neurologic toxicities that were fatal or life-threatening, including immune effector cell-associated neurotoxicity syndrome (ICANS), occurred following treatment with BREYANZI. Serious events including cerebral edema and seizures occurred with BREYANZI. Fatal and serious cases of leukoencephalopathy, some attributable to fludarabine, also occurred.
In clinical trials of BREYANZI, CAR T cell-associated neurologic toxicities occurred in 31% of patients, including ≥ Grade 3 cases in 10% of patients. The median time to onset of neurotoxicity was 8 days (range: 1 to 63 days). Neurologic toxicities resolved in 88% of patients with a median duration of 7 days (range: 1 to 119 days).Of patients developing neurotoxicity, 82% also developed CRS.
The most common neurologic toxicities (≥5%) included encephalopathy, tremor, aphasia, headache, dizziness, and delirium.
CRS and Neurologic Toxicities Monitoring
Monitor patients daily for at least 7 days following BREYANZI infusion at a REMS-certified healthcare facility for signs and symptoms of CRS and neurologic toxicities and assess for other causes of neurological symptoms. Monitor patients for signs and symptoms of CRS and neurologic toxicities for at least 4 weeks after infusion and treat promptly. At the first sign of CRS, institute treatment with supportive care, tocilizumab, or tocilizumab and corticosteroids as indicated. Manage neurologic toxicity with supportive care and/or corticosteroid as needed. Counsel patients to seek immediate medical attention should signs or symptoms of CRS or neurologic toxicity occur at any time.
BREYANZI REMS
Because of the risk of CRS and neurologic toxicities, BREYANZI is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the BREYANZI REMS. The required components of the BREYANZI REMS are:
  • Healthcare facilities that dispense and administer BREYANZI must be enrolled and comply with the REMS requirements.
  • Certified healthcare facilities must have on-site, immediate access to tocilizumab.
  • Ensure that a minimum of 2 doses of tocilizumab are available for each patient for infusion within 2 hours after BREYANZI infusion, if needed for treatment of CRS.
Further information is available at www.BreyanziREMS.com, or contact Bristol-Myers Squibb at 1-866-340-7332.
Hypersensitivity Reactions
Allergic reactions may occur with the infusion of BREYANZI. Serious hypersensitivity reactions, including anaphylaxis, may be due to dimethyl sulfoxide (DMSO).
Serious Infections
Severe infections, including life-threatening or fatal infections, have occurred in patients after BREYANZI infusion. In clinical trials of BREYANZI, infections of any grade occurred in 34% of patients, with Grade 3 or higher infections occurring in 12% of all patients. Grade 3 or higher infections with an unspecified pathogen occurred in 7%, bacterial infections in 3.7%, viral infections in 2%, and fungal infections in 0.7% of patients. One patient who received 4 prior lines of therapy developed a fatal case of John Cunningham (JC) virus progressive multifocal leukoencephalopathy 4 months after treatment with BREYANZI. One patient who received 3 prior lines of therapy developed a fatal case of cryptococcal meningoencephalitis 35 days after treatment with BREYANZI.
Febrile neutropenia developed after BREYANZI infusion in 8% of patients. Febrile neutropenia may be concurrent with CRS. In the event of febrile neutropenia, evaluate for infection and manage with broad-spectrum antibiotics, fluids, and other supportive care as medically indicated.
Monitor patients for signs and symptoms of infection before and after BREYANZI administration and treat appropriately. Administer prophylactic antimicrobials according to standard institutional guidelines. Avoid administration of BREYANZI in patients with clinically significant, active systemic infections.
Viral reactivation: Hepatitis B virus (HBV) reactivation, in some cases resulting in fulminant hepatitis, hepatic failure, and death, can occur in patients treated with drugs directed against B cells. In clinical trials of BREYANZI, 35 of 38 patients with a prior history of HBV were treated with concurrent antiviral suppressive therapy. Perform screening for HBV, HCV, and HIV in accordance with clinical guidelines before collection of cells for manufacturing. In patients with prior history of HBV, consider concurrent antiviral suppressive therapy to prevent HBV reactivation per standard guidelines.
Prolonged Cytopenias
Patients may exhibit cytopenias not resolved for several weeks following lymphodepleting chemotherapy and BREYANZI infusion. In clinical trials of BREYANZI, Grade 3 or higher cytopenias persisted at Day 29 following BREYANZI infusion in 35% of patients, and included thrombocytopenia in 25%, neutropenia in 22%, and anemia in 6% of patients. Monitor complete blood counts prior to and after BREYANZI administration.
Hypogammaglobulinemia
B-cell aplasia and hypogammaglobulinemia can occur in patients receiving BREYANZI. In clinical trials of BREYANZI, hypogammaglobulinemia was reported as an adverse reaction in 10% of patients.
Hypogammaglobulinemia, either as an adverse reaction or laboratory IgG level below 500 mg/dL after infusion, was reported in 30% of patients. Monitor immunoglobulin levels after treatment with BREYANZI and manage using infection precautions, antibiotic prophylaxis, and immunoglobulin replacement as clinically indicated.
Live vaccines: The safety of immunization with live viral vaccines during or following BREYANZI treatment has not been studied. Vaccination with live virus vaccines is not recommended for at least 6 weeks prior to the start of lymphodepleting chemotherapy, during BREYANZI treatment, and until immune recovery following treatment with BREYANZI.
Secondary Malignancies
Patients treated with BREYANZI may develop secondary malignancies. T cell malignancies have occurred following treatment of hematologic malignancies with BCMA- and CD19-directed genetically modified autologous T cell immunotherapies, including BREYANZI. Mature T cell malignancies, including CAR-positive tumors, may present as soon as weeks following infusion, and may include fatal outcomes. Monitor lifelong for secondary malignancies. In the event that a secondary malignancy occurs, contact Bristol-Myers Squibb at 1-888-805-4555 for reporting and to obtain instructions on collection of patient samples for testing.
Effects on Ability to Drive and Use Machines
Due to the potential for neurologic events, including altered mental status or seizures, patients receiving BREYANZI are at risk for developing altered or decreased consciousness or impaired coordination in the 8 weeks following BREYANZI administration. Advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, for at least 8 weeks.
Immune Effector Cell-Associated Hemophagocytic Lymphohistiocytosis-Like Syndrome (IEC-HS)
Immune Effector Cell-Associated Hemophagocytic Lymphohistiocytosis-Like Syndrome (IEC-HS), including fatal or life-threatening reactions, occurred following treatment with BREYANZI. IEC-HS is a life-threatening condition with a high mortality rate if not recognized and treated early. Treatment of IEC-HS should be administered per current practice guidelines.
Adverse Reactions
The most common adverse reaction(s) (incidence ≥30%) in:
  • LBCL are fever, cytokine release syndrome, fatigue, musculoskeletal pain, and nausea. The most common Grade 3-4 laboratory abnormalities include lymphocyte count decrease, neutrophil count decrease, platelet count decrease, and hemoglobin decrease.
Please see full Prescribing Information, including Boxed WARNINGS and Medication Guide.
References
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Kamdar M, Solomon S, Arnason J, et al. Lisocabtagene maraleucel (liso-cel) vs standard of care (SOC) with salvage chemotherapy (CT) followed by autologous stem cell transplantation (ASCT) as second-line (2L) treatment in patients (pts) with R/R large B-cell lymphoma (LBCL): 3-year follow-up (FU) from the randomized, phase 3 TRANSFORM study. Presented at: 66th American Society of Clinical Oncology Annual Meeting; May 21-June 4, 2024; Chicago, IL.
  3. Kamdar M, Solomon S, Arnason J, et al. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet. 2022;399(10343):2294-2308. 
  4. Data on file. BMS-REF-LIS-0072. Princeton, NJ: Bristol-Myers Squibb Company; 2024.
  5. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.3.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed September 26, 2024. To view the most recent and complete version of the guideline, go online to NCCN.org.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Data on file. BMS-REF-LIS-0072. Princeton, NJ: Bristol-Myers Squibb Company; 2024.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Chen AI, Maziarz RT. Can we truly define 'Fitness' for CAR-T therapy in large B cell lymphoma patients? Chin Clin Oncol. 2023. doi:10.21037/cco-23-78
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Kamdar M, Solomon S, Arnason J, et al. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet. 2022;399(10343):2294-2308.
  3. Abramson J, Solomon S, Arnason J, et al. Lisocabtagene maraleucel as second line therapy for large B-cell lymphoma: primary analysis of the phase 3 TRANSFORM study. Blood. 2023;141(4):1675-1684.
  4. Kamdar M, Solomon S, Arnason J, et al. Lisocabtagene maraleucel (liso-cel) vs standard of care (SOC) with salvage chemotherapy (CT) followed by autologous stem cell transplantation (ASCT) as second-line (2L) treatment in patients (pts) with R/R large B-cell lymphoma (LBCL): 3-year follow-up (FU) from the randomized, phase 3 TRANSFORM study. Presented at: American Society of Clinical Oncology Annual Meeting; May 21-June 4, 2024; Chicago, IL.
  5. Data on file. BMS-LIS-0052. Princeton, NJ: Bristol-Myers Squibb Company; 2024.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2023.
  2. Sehgal A, Hoda D, Riedell PA, et al. Lisocabtagene maraleucel as second-line therapy in adults with relapsed or refractory large B-cell lymphoma who were not intended for haematopoietic stem cell transplantation (PILOT): an open-label, phase 2 study. Lancet Oncol. 2022;23(8):1066-1077.
  3. Sehgal A, Hoda D, Riedell PA, et al. Lisocabtagene maraleucel as second-line therapy for R/R large B-cell lymphoma in patients not intended for hematopoietic stem cell transplant: final analysis of the phase 2 PILOT study. ASH 2023.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Crombie J, Nastoupil LJ, Andreadis C, et al. Multicenter, real-world study in patients with R/R large B-cell lymphoma (LBCL) who received lisocabtagene maraleucel (liso-cel) in the United States (US). Presented at: the American Society of Hematology (ASH) Congress 2023; December 9-12, 2023; San Diego, California. Presentation 104.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2023.
  2. Abramson JS, Palomba ML, Gordon LI, et al. Lisocabtagene maraleucel for patients with relapsed or refractory large B-cell lymphomas (TRANSCEND NHL 001): a multicentre seamless design study. Lancet. 2020;396(10254):839-852.
  3. Data on file. TRANSCEND DOR. Princeton, NJ: Bristol-Myers Squibb Company; 2022.
  4. Abramson JS, Palomba ML, Gordon LI, et al. Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001. Blood. 2024;143(5):404-416.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. Data on file. BMS-REF-LIS-0052. Princeton, NJ: Bristol-Myers Squibb Company; 2024.
  3. Kamdar M, et al. Lisocabtagene maraleucel versus standard of care with salvage chemotherapy followed by autologous stem cell transplantation as second-line treatment in patients with relapsed or refractory large B-cell lymphoma (TRANSFORM): results from an interim analysis of an open-label, randomised, phase 3 trial. Lancet. 2022;399(10343):2294-2308.
  4. Kamdar M, Solomon S, Arnason J, et al. Lisocabtagene maraleucel (liso-cel) vs standard of care (SOC) with salvage chemotherapy (CT) followed by autologous stem cell transplantation (ASCT) as second-line (2L) treatment in patients (pts) with R/R large B-cell lymphoma (LBCL): 3-year follow-up (FU) from the randomized, phase 3 TRANSFORM study. [Presented at: The American Society of Clinical Oncology Annual Meeting; May 21-June 4, 2024; Chicago, IL].
  5. Sehgal A, Hoda D, Riedell PA, et al. Lisocabtagene maraleucel as second-line therapy for R/R large B-cell lymphoma in patients not intended for hematopoietic stem cell transplant: final analysis of the phase 2 PILOT study. ASH 2023.
  6. Abramson JS, Palomba ML, Gordon LI, et al. Two-year follow-up of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphoma in TRANSCEND NHL 001. Blood. 2024;153(5):404-416.
  1. Crombie J, Nastoupil LJ, Andreadis C, et al. Multicenter, real-world study in patients with R/R large B-cell lymphoma (LBCL) who received lisocabtagene maraleucel (liso-cel) in the United States (US). Presented at: the American Society of Hematology (ASH) Congress 2023; December 9-12, 2023; San Diego, California. Presentation 104.
  2. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2023.
  3. Lee DW, Santomasso BD, Locke FL, et al. ASTCT consensus grading for cytokine release syndrome and neurologic toxicity associated with immune effector cells. Biol Blood Marrow Transplant. 2019;25(4):625-638.

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