l pain includes oral pain and oropharyngeal pain.
jPulmonary edema includes acute pulmonary edema and pulmonary edema.
kThrombosis includes deep vein thrombosis, embolism, pulmonary embolism, thrombosis, vena cava thrombosis, and venous thrombosis.
lRash includes rash, rash maculo-papular, rash papular and rash pruritic.
mDermatitis includes dermatitis, dermatitis acneiform and dermatitis contact.
nVisual impairment includes vision blurred and visual impairment.
Additional important adverse reactions that did not meet the threshold criteria for inclusion in Table 5 were:
Blood and lymphatic system disorders: disseminated intravascular coagulation (3%), pancytopenia (2%), histiocytosis hematophagic (1%)
Cardiac Disorders: arrhythmiaa (6%)
Gastrointestinal disorders: vomiting (9%), abdominal painb (9%), anal incontinence (1%)
General disorders and administration site conditions: asthenia (7%), multiple organ dysfunction syndrome (3%)
Infections and infestations: fungal infectious disorders (9%), viral infectious disorders (9%), bacterial infectious disorders (9%)
Musculoskeletal and connective tissue disorders: myalgia (7%), back pain (6%)
Nervous System: peripheral neuropathyc (8%), motor dysfunctiond (6%), speech disordere (3%), seizuref (3%), ischemic cerebral infarction (1%), tremor (7%), ataxia (2%)
Psychiatric disorders: anxiety (9%), deliriumg (6%), sleep disordersh (9%)
Respiratory, thoracic, and mediastinal disorders: hypoxia (8%), oropharyngeal paini (8%), pleural effusion (5%) pulmonary edemaj (3%)
Metabolism and nutrition disorders: fluid overload (3%), tumor lysis syndrome (1%)
Vascular disorders: thrombosisk (7%), hypertension (2%), capillary leak syndrome (1%)
Skin and subcutaneous tissue disorders: rashl (8%), dermatitism (4%)
Eye disorders: visual impairmentn (7%)
Laboratory Abnormalities
Selected laboratory abnormalities worsening from baseline Grade 0-2 to Grade 3-4 are shown in Table 6.
Table 6. Grade 3 or 4 Laboratory Abnormalities occurring in > 10% of Patients Following KYMRIAH Infusion in Adult r/r DLBCL Patients Based on CTCAEa N = 106
aCTCAE = Common Terminology Criteria for Adverse Events version 4.03
Laboratory Parameter Grade 3 or 4 (%)
Hematology
Lymphopenia 94
Neutropenia 81
Leukopenia 77
Anemia 58
Thrombocytopenia 54
Biochemistry
Hypophosphatemia 24
Hypokalemia 12
Hyponatremia 11
6.2 Immunogenicity
In clinical studies, humoral immunogenicity of KYMRIAH was measured by determination of anti-murine CAR19 antibodies (anti-mCAR19) in serum pre- and post-administration. The majority of patients, 86% in ELIANA (Study 1) and 91.4% in JULIET (Study 2) tested positive for pre-dose anti-mCAR19 antibodies prior to KYMRIAH infusion; Treatment induced anti-mCAR19 antibodies were detected in 5% of the patients in JULIET. However, the preexisting and treatment-induced antibodies were not assoc