Patient Identification

Breyanzi®: CAR T with the broadest eligibility for 2L LBCL patients1
Patient eligibility in TRANSFORM trial vs PILOT trial Patient eligibility in TRANSFORM trial vs PILOT trial

In the 3L+ TRANSCEND trial, patients were refractory or relapsed after ≥2 prior therapies, ≥18 years old, ECOG PS ≤2, LVEF ≥40%, CrCl ≥30 mL/min, and ALT ≤5 × ULN.1

Identify eligible patients early and connect them
with a CAR T cell therapy treatment center

*Median age was 59 years (range: 20-75 years).1
†Eligible patients for the PILOT trial were required to be ≥18 years. Median age was 74 years (range: 53-84 years).1,3
‡PILOT criteria included ALT/AST.1

2L, second-line; 3L, third-line; ALT, alanine transaminase; AST, aspartate aminotransferase; CAR, chimeric antigen receptor; CrCl, creatinine clearance; DLCO, diffusing capacity for carbon monoxide; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction; R/R, relapsed or refractory; ULN, upper limit of normal.

Choose Breyanzi, a smart option for a broad range of patients with 2L LBCL1
Select a patient profile
transplant-eligible
transplant-ineligible
CAR T cell therapy 2L patient

Charlotte, 60 years old

2L transplant-eligible R/R ≤12 months

Active, fit, and chemo-sensitive4

Charlotte is a married interior designer who is heavily involved in her local community. She wants to avoid high-dose chemotherapy and transplant.

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Response to prior therapy

  • CR to DA-EPOCH-R; relapsed at 11 months
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Additional risk factors

  • Double-hit lymphoma
  • No relevant comorbidities
Fitness of body parts icon

Clinical fitness

  • ECOG PS 0
  • LVEF 55%
  • CrCl 70 mL/min
  • Normal bone marrow reserve
  • ANC: 4 × 103 cells/μL
  • Platelets: 400 × 103/μL

LEARN MORE ABOUT 2L EFFICACY

All patients depicted are hypothetical.

2L, second-line; ANC, absolute neutrophil count; CR, complete response; CrCl, creatinine clearance; DA-EPOCH-R, dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction; R/R, relapsed or refractory.

CAR T cell therapy 2L patient

Laurie, 68 years old

2L transplant-eligible R/R ≤12 months

Fit, with additional risk factors4

Laurie is a former social worker who is enjoying retirement. She is eager to receive treatment that is right for her.

Fitness of body parts icon

Clinical fitness

  • ECOG PS 1
  • LVEF 55%
  • CrCl 60 mL/min
  • Normal bone marrow reserve prior to R-CHOP

LEARN MORE ABOUT 2L EFFICACY

All patients depicted are hypothetical.

2L, second-line; CrCl, creatinine clearance; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine; R/R, relapsed or refractory.

CAR T cell therapy 2L patient

Luke, 52 years old

2L transplant-ineligible regardless of time to relapse

Active

Luke is a published author and motivational speaker. He likes taking his dog out for walks, lives an active life, and does not want to plan around chemotherapy appointments.

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Response to prior therapy

  • Refractory disease to 4 cycles of R-CHOP
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Additional risk factors

  • 1 extranodal site
  • Poor bone marrow reserve
Fitness of body parts icon

Clinical fitness

  • ECOG PS 1
  • LVEF 45%
  • CrCl 55 mL/min

LEARN MORE ABOUT 2L EFFICACY

All patients depicted are hypothetical.

2L, second-line; CrCl, creatinine clearance; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine.

CAR T cell therapy 2L patient

Betty, 72 years old

2L transplant-ineligible regardless of time to relapse

Betty is a widowed retired school teacher who recently moved in with her daughter’s family. She is interested in receiving treatment that will give her a chance for remission.

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Response to prior therapy

  • Relapsed at 18 months
Doctor's folder icon

Additional risk factors

  • Diabetes/impaired renal function
Fitness of body parts icon

Clinical fitness

  • ECOG PS 1
  • LVEF 45%
  • CrCl 45 mL/min
  • Normal bone marrow reserve

LEARN MORE ABOUT 2L EFFICACY

All patients depicted are hypothetical.

2L, second-line; CrCl, creatinine clearance; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction.

Breyanzi for patients with 3L+ LBCL
CAR T cell therapy 3L patient

Robin, 56 years old

Original diagnosis: de novo DLBCL

Robin is a florist in a small city who lives with her spouse. Her 3 adult children live nearby. Robin is knowledgeable about her disease and treatment and is motivated to undergo treatment.

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Response to prior therapy

First-line therapy

  • Underwent chemoimmunotherapy; achieved CR
  • Relapsed at 18 months

Second-line therapy

  • Underwent high-dose chemotherapy and ASCT
  • Relapsed after 6 months
Doctor's folder icon

Additional risk factors

  • One extranodal site
  • Renal impairment
Fitness of body parts icon

Clinical fitness at second line

  • ECOG PS 1
  • LVEF 56%
  • CrCl 52 mL/min

LEARN MORE ABOUT 3L+ EFFICACY

All patients depicted are hypothetical.

3L, third-line; ASCT, autologous stem cell transplantation; CR, complete response; CrCl, creatinine clearance; DLBCL, diffuse large B-cell lymphoma; ECOG PS, Eastern Cooperative Oncology Group performance status; LBCL, large B-cell lymphoma; LVEF, left ventricular ejection fraction.

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. National Cancer Institute. CD19-targeted CAR T2 cells. NCI Drug Dictionary. https://www.cancer.gov/publications/dictionaries/cancer-drug/def/cd19-targeted-car-t2-cells?redirect=true. Accessed May 22, 2024.
  2. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  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. 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.
  5. Data on file. BMS-REF-LIS-0049. Princeton, NJ: Bristol-Myers Squibb Company; 2024.
  6. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for B-Cell Lymphomas V.2.2024. © National Comprehensive Cancer Network, Inc. 2024. All rights reserved. Accessed April 30, 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.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2024.
  2. 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.
  3. 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.
  4. 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. 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.
  2. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2023.
  3. Data on file. BMS-REF-LIS-0019. Princeton, NJ: Bristol-Myers Squibb Company; 2022.
  1. Breyanzi [package insert]. Summit, NJ: Bristol-Myers Squibb Company; 2023.
  2. Data on file. TRANSCEND DOR. Princeton, NJ: Bristol-Myers Squibb Company; 2022.
  3. Abramson J, Palomba M, Gordon L, et al. Two-year follow-up of TRANSCEND NHL 001, a multicenter phase 1 study of lisocabtagene maraleucel in relapsed or refractory large B-cell lymphomas. Presented at the 63rd American Society of Hematology Annual Meeting & Exposition; December 11-14, 2021; Atlanta, GA.
  4. 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.
  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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