Legend Biotech to Highlight Continued Progress in the Treatment of Multiple Myeloma With Updated Data From BCMA CAR-T Studies at 2022 ASCO and EHA
May 18, 2022- Longer term follow-up data will be presented from the pivotal CARTITUDE-1 study in patients with relapsed or refractory multiple myeloma, which supported the recent U.S. FDA approval of CARVYKTI™ (ciltacabtagene autoleucel; cilta-cel)
- Updated data from Cohorts A and B of the CARTITUDE-2 study evaluating cilta-cel in earlier lines of multiple myeloma treatment will also be featured
SOMERSET, N.J.–(BUSINESS WIRE)–$LEGN–Legend Biotech Corporation (NASDAQ: LEGN) (Legend Biotech), a global biotechnology company developing, manufacturing and commercializing novel therapies to treat life-threatening diseases, today announced that eight company-sponsored abstracts were accepted at the 2022 American Society of Clinical Oncology (ASCO) Annual Meeting and the European Hematology Association’s (EHA) 2022 Hybrid Congress.
The presentations will provide updates from the CARTITUDE clinical development program, which evaluates ciltacabtagene autoleucel (cilta-cel), a B-cell maturation antigen (BCMA)-directed chimeric antigen receptor T-cell (CAR-T) therapy, for multiple myeloma.
Longer-term results from CARTITUDE-1, two years following the last patient in, will be presented as posters at ASCO and EHA. CARTITUDE-1 is a Phase 1b/2 study in heavily pretreated patients with relapsed or refractory multiple myeloma (RRMM), which supported the recent approval of CARVYKTI™ by the U.S. Food and Drug Administration (FDA).
Updated data from Cohorts A and B of the CARTITUDE-2 study will also be presented. The multicohort study evaluates the safety and efficacy of cilta-cel in various multiple myeloma settings including earlier lines. Data from Cohort A, which includes patients who had progressive multiple myeloma after 1-3 prior lines of therapy and were lenalidomide-refractory, will be presented as a poster discussion at ASCO and as a poster at EHA. Data from Cohort B, which includes patients who experienced early relapse after initial therapy including a proteasome inhibitor and an immunomodulatory drug, will be presented as a poster at ASCO and an oral presentation at EHA. Additional data will also be presented at both meetings including analyses from the real-world LocoMMotion study, a prospective multinational study of real-life standard of care treatments in routine clinical practice for patients with RRMM.
“Legend Biotech, together with our partner Janssen, look forward to presenting longer term data from our CARTITUDE clinical development program of cilta-cel in multiple myeloma,” said Ying Huang, Ph.D., Chief Executive Officer of Legend Biotech. “Results from the CARTITUDE-1 study underscore the potential of CARVYKTI™ to provide early, deep and durable responses in patients with relapsed or refractory multiple myeloma. We are also excited to share updated data from the CARTITUDE-2 study, which demonstrates the promise of cilta-cel in earlier lines of treatment.”
A select list of abstracts from the meetings can be found below.
ASCO Presentations (June 3-7, 2022)
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Abstract No. |
Title |
Information |
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Abstract #8028 Poster |
Phase 1b/2 study of ciltacabtagene autoleucel, a BCMA-directed CAR-T cell therapy, in patients with relapsed/refractory multiple myeloma (CARTITUDE-1): Two years post-LPI. |
Session Title: Hematologic Malignancies—Plasma Cell Dyscrasia Date/Time: June 4, 2022, 9:00 am – 12:00 pm EDT Location: Hall A & On Demand |
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Abstract #8020 Poster Discussion |
Biological correlative analyses and updated clinical data of ciltacabtagene autoleucel (cilta-cel), a BCMA-directed CAR-T cell therapy, in lenalidomide (len)-refractory patients (pts) with progressive multiple myeloma (MM) after 1–3 prior lines of therapy (LOT): CARTITUDE-2, cohort A.
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Session Title: Hematologic Malignancies—Plasma Cell Dyscrasia Date/Time: June 4, 2022, 5:30-7:00 pm EDT Location: Hall A, E451 & On Demand |
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Abstract #8029 Poster |
Biological correlative analyses and updated clinical data of ciltacabtagene autoleucel (cilta-cel), a BCMA-directed CAR-T cell therapy, in patients with multiple myeloma (MM) and early relapse after initial therapy: CARTITUDE-2, cohort B. |
Session Title: Hematologic Malignancies—Plasma Cell Dyscrasia Date/Time: June 4, 2022, 9:00 am – 12:00 pm EDT Location: Hall A & On Demand |
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Abstract #8031 Poster |
Subgroup analyses in patients with relapsed/refractory multiple myeloma (RRMM) receiving real-life current standard of care (SOC) in the LocoMMotion study. |
Session Title: Hematologic Malignancies—Plasma Cell Dyscrasia Date/Time: June 4, 2022, 9:00 am – 12:00 pm EDT Location: Hall A & On Demand |
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Abstract #8030 Poster |
Health-related quality of life (HRQoL) in patients with relapsed/refractory multiple myeloma (RRMM) receiving real-life current standard of care (SOC) in the LocoMMotion study. |
Session Title: Hematologic Malignancies—Plasma Cell Dyscrasia Date/Time: June 4, 2022, 9:00 am – 12:00 pm EDT Location: Hall A & On Demand |
EHA Presentations (June 9-12, 2022)
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Abstract No. |
Title |
Information |
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Publication #S185 Oral Presentation |
CARTITUDE-2 Cohort B: Updated Clinical Data and Biological Correlative Analysis of Ciltacabtagene Autoleucel in Patients with Multiple Myeloma and Early Relapse After Initial Therapy
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Session Title: Relapsed/refractory myeloma: BCMA-directed therapies Date/Time: Sunday, June 12, 2022 4:30-5:45 pm CEST Location: Hall A2-A3 |
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Publication #P961 Poster |
Ciltacabtagene Autoleucel, a BCMA-Directed CAR-T Cell Therapy, in Patients with Relapsed/Refractory Multiple Myeloma: 2-Year Post LPI Results from the Phase 1b/2 CARTITUDE-1 Study |
Session Title: Poster session Date/Time: Friday, June 10 4:30-5:45 pm CEST |
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Publication #P959 Poster |
Ciltacabtagene Autoleucel in Lenalidomide-Refractory Patients with Progressive Multiple Myeloma After 1-3 Prior Lines of Therapy: CARTITUDE-2 Biological Correlative Analyses and Updated Clinical Data |
Session Title: Poster session Date/Time: Friday, June 10, 2022, 4:30-5:45 CEST |
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Publication #P899 Poster |
Real-world Assessment of Treatment Patterns and Outcomes in Patients with Lenalidomide-Refractory Relapsed/Refractory Multiple Myeloma from the Optum Database
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Session Title: Myeloma and other monoclinal gammopathies – Clinical Date/Time: Friday, June 10, 2022, 4:30-5:45 CEST |
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Publication #P958 Poster |
Real-life Current Standard of Care in Patients with Relapsed/Refractory Multiple Myeloma: Subgroup Analyses from the LocoMMotion Study
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Session Title: Poster session Date/Time: Friday, June 10, 4:30-5:45 pm CEST |
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Publication #P960 Poster |
Health-related quality of life in the LocoMMotion study of Real-Life Current Standard of Care in Patients with Relapsed/Refractory Multiple Myeloma.
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Session Title: Poster session Date/Time: Friday, June 10, 4:30-5:45 pm CEST |
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Publication #P971 Poster |
Adjusted Comparison of Patient Reported Outcomes from CARTITUDE-1 and LocoMMotion Comparing Ciltacabtagene Autoleucel Versus Real World Clinical Practice in Triple-Class Exposed Multiple Myeloma |
Session Title: Myeloma and other monoclonal gammopathies – Clinical Date/Time: Friday, June 10, 4:30-5:45 pm CEST |
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Publication #P904 Poster |
Ciltacabtagene Autoleucel vs Treatments from Real-World Clinical Practice for Triple Class Exposed Patients with Multiple Myeloma: Adjusted Comparisons Based on CARTITUDE-1 and the EMMY French Cohort
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Session Title: Myeloma and other monoclonal gammopathies – Clinical Date/Time: Friday, June 10, 4:30-5:45 pm CEST |
About CARVYKTI® (Ciltacabtagene autoleucel; cilta-cel)
CARVYKTI™ is a BCMA-directed, genetically modified autologous T-cell immunotherapy, which involves reprogramming a patient’s own T-cells with a transgene encoding a chimeric antigen receptor (CAR) that identifies and eliminates cells that express BCMA. BCMA is primarily expressed on the surface of malignant multiple myeloma B-lineage cells, as well as late-stage B-cells and plasma cells. The CARVYKTI™ CAR protein features two BCMA targeting single domain antibodies designed to confer high avidity against human BCMA. Upon binding to BCMA-expressing cells, the CAR promotes T-cell activation, expansion, and elimination of target cells.1
In December 2017, Legend Biotech Corporation entered into an exclusive worldwide license and collaboration agreement with Janssen Biotech, Inc. to develop and commercialize cilta-cel.
CARVYKTI™ received U.S. FDA approval for the treatment of adult patients with relapsed or refractory multiple myeloma in February 2022. In April 2022, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency conferred a positive opinion for the marketing authorization of CARVYKTI™ to the European Union. In addition to U.S. Breakthrough Therapy Designation granted in December 2019, cilta-cel received a Breakthrough Therapy Designation in China in August 2020. Cilta-cel also received Orphan Drug Designation from the U.S. FDA in February 2019 and from the European Commission in February 2020.
About CARTITUDE-1
CARTITUDE-1 (NCT03548207)2 is an ongoing Phase 1b/2, open-label, single arm, multi-center trial evaluating cilta-cel for the treatment of adult patients with relapsed or refractory multiple myeloma, who previously received at least three prior lines of therapy including a proteasome inhibitor (PI), an immunomodulatory agent (IMiD) and an anti-CD38 monoclonal antibody. Of the 97 patients enrolled in the trial, 99 percent were refractory to the last line of treatment and 88 percent were triple-class refractory, meaning their cancer did not respond, or no longer responds, to an IMiD, a PI and an anti-CD38 monoclonal antibody.
About CARTITUDE-2
CARTITUDE-2 (NCT04133636)3 is an ongoing Phase 2 multicohort study evaluating the safety and efficacy of cilta-cel in various clinical settings. Cohort A included patients who had progressive multiple myeloma after 1–3 prior lines of therapy, including PI and IMiD, were lenalidomide refractory, and had no prior exposure to BCMA-targeting agents. Cohort B included patients with early relapse after initial therapy that included a PI and IMiD. The primary objective was to evaluate the percentage of patients with negative minimal residual disease (MRD).
About LocoMMotion
LocoMMotion (NCT04035226)4 is a prospective non-interventional study evaluating the safety and efficacy of real-life standard-of-care treatments under routine clinical practice over a 24-month period in patients with RRMM. This study aims to understand the effectiveness of current standards of care in heavily pretreated patients with RRMM (reflecting real-world practice in the patient population progressing after PIs, IMiDs and anti-CD38 antibodies).
About Multiple Myeloma
Multiple myeloma is an incurable blood cancer that starts in the bone marrow and is characterized by an excessive proliferation of plasma cells.5 In 2022, it is estimated that more than 34,000 people will be diagnosed with multiple myeloma, and more than 12,000 people will die from the disease in the U.S.6 While some patients with multiple myeloma have no symptoms at all, most patients are diagnosed due to symptoms that can include bone problems, low blood counts, calcium elevation, kidney problems or infections.7 Although treatment may result in remission, unfortunately, patients will most likely relapse.8 Patients who relapse after treatment with standard therapies, including protease inhibitors, immunomodulatory agents, and an anti-CD38 monoclonal antibody, have poor prognoses and few treatment options available.9,10
CARVYKTI™ Important Safety Information
INDICATIONS AND USAGE
CARVYKTI™ (ciltacabtagene autoleucel) is a B-cell maturation antigen (BCMA)-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with relapsed or refractory multiple myeloma, after four or more prior lines of therapy, including a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody.
WARNING: CYTOKINE RELEASE SYNDROME, NEUROLOGIC TOXICITIES, HLH/MAS, and PROLONGED and RECURRENT CYTOPENIA
- Cytokine Release Syndrome (CRS), including fatal or life-threatening reactions, occurred in patients following treatment with CARVYKTI™. Do not administer CARVYKTI™ to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab or tocilizumab and corticosteroids.
- Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS), which may be fatal or life-threatening, occurred following treatment with CARVYKTI™, including before CRS onset, concurrently with CRS, after CRS resolution, or in the absence of CRS. Monitor for neurologic events after treatment with CARVYKTI™. Provide supportive care and/or corticosteroids as needed.
- Parkinsonism and Guillain-Barré syndrome and their associated complications resulting in fatal or life-threatening reactions have occurred following treatment with CARVYKTI™.
- Hemophagocytic Lymphohistiocytosis/Macrophage Activation Syndrome (HLH/MAS), including fatal and life-threatening reactions, occurred in patients following treatment with CARVYKTI™. HLH/MAS can occur with CRS or neurologic toxicities.
- Prolonged and/or recurrent cytopenias with bleeding and infection and requirement for stem cell transplantation for hematopoietic recovery occurred following treatment with CARVYKTI™.
- CARVYKTI™ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the CARVYKTI™ REMS Program.
WARNINGS AND PRECAUTIONS
Cytokine Release Syndrome (CRS) including fatal or life-threatening reactions, occurred following treatment with CARVYKTI™ in 95% (92/97) of patients receiving ciltacabtagene autoleucel. Grade 3 or higher CRS (2019 ASTCT grade)1 occurred in 5% (5/97) of patients, with Grade 5 CRS reported in 1 patient. The median time to onset of CRS was 7 days (range: 1-12 days). The most common manifestations of CRS included pyrexia (100%), hypotension (43%), increased aspartate aminotransferase (AST) (22%), chills (15%), increased alanine aminotransferase (14%) and sinus tachycardia (11%). Grade 3 or higher events associated with CRS included increased AST and ALT, hyperbilirubinemia, hypotension, pyrexia, hypoxia, respiratory failure, acute kidney injury, disseminated intravascular coagulation, HLH/MAS, angina pectoris, supraventricular and ventricular tachycardia, malaise, myalgias, increased C-reactive protein, ferritin, blood alkaline phosphatase and gamma-glutamyl transferase.
Identify CRS based on clinical presentation. Evaluate for and treat other causes of fever, hypoxia, and hypotension. CRS has been reported to be associated with findings of HLH/MAS, and the physiology of the syndromes may overlap. HLH/MAS is a potentially life-threatening condition. In patients with progressive symptoms of CRS or refractory CRS despite treatment, evaluate for evidence of HLH/MAS.
Sixty-nine of 97 (71%) patients received tocilizumab and/or a corticosteroid for CRS after infusion of ciltacabtagene autoleucel. Forty-four (45%) patients received only tocilizumab, of whom 33 (34%) received a single dose and 11 (11%) received more than one dose; 24 patients (25%) received tocilizumab and a corticosteroid, and one patient (1%) received only corticosteroids. Ensure that a minimum of two doses of tocilizumab are available prior to infusion of CARVYKTI™.
Monitor patients at least daily for 10 days following CARVYKTI™ infusion at a REMS-certified healthcare facility for signs and symptoms of CRS. Monitor patients for signs or symptoms of CRS for at least 4 weeks after infusion. At the first sign of CRS, immediately institute treatment with supportive care, tocilizumab, or tocilizumab and corticosteroids. Counsel patients to seek immediate medical attention should signs or symptoms of CRS occur at any time. Neurologic toxicities, which may be severe, life-threatening or fatal, occurred following treatment with CARVYKTI™.
Neurologic toxicities, which may be severe, life-threatening or fatal, occurred following treatment with CARVYKTI™. Neurologic toxicities included ICANS, neurologic toxicity with signs and symptoms of parkinsonism, Guillain-Barré Syndrome, peripheral neuropathies, and cranial nerve palsies. Counsel patients on the signs and symptoms of these neurologic toxicities, and on the delayed nature of onset of some of these toxicities. Instruct patients to seek immediate medical attention for further assessment and management if signs or symptoms of any of these neurologic toxicities occur at any time.
Overall, one or more subtypes of neurologic toxicity described below occurred following ciltacabtagene autoleucel in 26% (25/97) of patients, of which 11% (11/97) of patients experienced Grade 3 or higher events. These subtypes of neurologic toxicities were also observed in two ongoing studies.
Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): Patients receiving CARVYKTI™ may experience fatal of life-threatening ICANS following treatment with CARVYKTI™, including before CRS onset, concurrently with CRS, after CRS resolution, or in the absence of CRS.
ICANS occurred in 23% (22/97) of patients receiving ciltacabtagene autoleucel including Grade 3 or 4 events in 3% (3/97) and Grade 5 (fatal) events in 2% (2/97). The median time to onset of ICANS was 8 days (range 1-28 days). All 22 patients with ICANS had CRS. The most frequent (≥5%) manifestation of ICANS included encephalopathy (23%), aphasia (8%) and headache (6%). Monitor patients at least daily for 10 days following CARVYKTI™ infusion at the REMS-certified healthcare facility for signs and symptoms of ICANS. Rule out other causes of ICANS symptoms.
Monitor patients for signs or symptoms of ICANS for at least 4 weeks after infusion and treat promptly. Neurologic toxicity should be managed with supportive care and/or corticosteroids as needed.
Parkinsonism: Of the 25 patients in the CARTITUDE-1 study experiencing any neurotoxicity, five male patients had neurologic toxicity with several signs and symptoms of parkinsonism, distinct from immune effector cell-associated neurotoxicity syndrome (ICANS). Neurologic toxicity with parkinsonism has been reported in other ongoing trials of ciltacabtagene autoleucel. Patients had parkinsonian and nonparkinsonian symptoms that included tremor, bradykinesia, involuntary movements, stereotypy, loss of spontaneous movements, masked facies, apathy, flat affect, fatigue, rigidity, psychomotor retardation, micrographia, dysgraphia, apraxia, lethargy, confusion, somnolence, loss of consciousness, delayed reflexes, hyperreflexia, memory loss, difficulty swallowing, bowel incontinence, falls, stooped posture, shuffling gait, muscle weakness and wasting, motor dysfunction, motor and sensory loss, akinetic mutism, and frontal lobe release signs. The median onset of parkinsonism in the 5 patients in CARTITUDE-1 was 43 days (range 15-108) from infusion of ciltacabtagene autoleucel.
Monitor patients for signs and symptoms of parkinsonism that may be delayed in onset and managed with supportive care measures. There is limited efficacy information with medications used for the treatment of Parkinson’s disease, for the improvement or resolution of parkinsonism symptoms following CARVYKTI™ treatment.
Guillain-Barré Syndrome: A fatal outcome following Guillain-Barré Syndrome (GBS) has occurred in another ongoing study of ciltacabtagene autoleucel despite treatment with intravenous immunoglobulins. Symptoms reported include those consistent with MillerFisher variant of GBS, encephalopathy, motor weakness, speech disturbances and polyradiculoneuritis.
Monitor for GBS. Evaluate patients presenting with peripheral neuropathy for GBS. Consider treatment of GBS with supportive care measures and in conjunction with immunoglobulins and plasma exchange, depending on severity of GBS.
Peripheral Neuropathy: Six patients in CARTITUDE-1 developed peripheral neuropathy. These neuropathies presented as sensory, motor or sensorimotor neuropathies. Median time of onset of symptoms was 62 days (range 4-136 days), median duration of peripheral neuropathies was 256 days (range 2-465 days) including those with ongoing neuropathy. Patients who experienced peripheral neuropathy also experienced cranial nerve palsies or GBS in other ongoing trials of ciltacabtagene autoleucel.
Cranial Nerve Palsies: Three patients (3.1%) experienced cranial nerve palsies in CARTITUDE-1. All three patients had 7th cranial nerve palsy; one patient had 5th cranial nerve palsy as well. Median time to onset was 26 days (range 21-101 days) following infusion of ciltacabtagene autoleucel. Occurrence of 3rd and 6th cranial nerve palsy, bilateral 7th cranial nerve palsy, worsening of cranial nerve palsy after improvement, and occurrence of peripheral neuropathy in patients with cranial nerve palsy have also been reported in ongoing trials of ciltacabtagene autoleucel. Monitor patients for signs and symptoms of cranial nerve palsies. Consider management with systemic corticosteroids, depending on the severity and progression of signs and symptoms.
Hemophagocytic Lymphohistiocytosis (HLH)/Macrophage Activation Syndrome (MAS): Fatal HLH occurred in one patient (1%), 99 days after ciltacabtagene autoleucel. The HLH event was preceded by prolonged CRS lasting 97 days. The manifestations of HLH/MAS include hypotension, hypoxia with diffuse alveolar damage, coagulopathy, cytopenia, and multi-organ dysfunction, including renal dysfunction. HLH is a life-threatening condition with a high mortality rate if not recognized and treated early. Treatment of HLH/MAS should be administered per institutional standards.
CARVYKTI™ REMS: Because of the risk of CRS and neurologic toxicities, CARVYKTI™ is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the CARVYKTI™ REMS.
Further information is available at www.CARVYKTIrems.com or 1-844-672-0067.
Prolonged and Recurrent Cytopenias: Patients may exhibit prolonged and recurrent cytopenias following lymphodepleting chemotherapy and CARVYKTI™ infusion. One patient underwent autologous stem cell therapy for hematopoietic reconstitution due to prolonged thrombocytopenia.
In CARTITUDE-1, 30% (29/97) of patients experienced prolonged Grade 3 or 4 neutropenia and 41% (40/97) of patients experienced prolonged Grade 3 or 4 thrombocytopenia that had not resolved by Day 30 following ciltacabtagene autoleucel infusion.
Recurrent Grade 3 or 4 neutropenia, thrombocytopenia, lymphopenia and anemia were seen in 63% (61/97), 18% (17/97), 60% (58/97), and 37% (36/97) after recovery from initial Grade 3 or 4 cytopenia following infusion. After Day 60 following ciltacabtagene autoleucel infusion, 31%, 12% and 6% of patients had a recurrence of Grade 3 or higher lymphopenia, neutropenia and thrombocytopenia, respectively, after initial recovery of their Grade 3 or 4 cytopenia. Eighty-seven percent (84/97) of patients had one, two, or three or more recurrences of Grade 3 or 4 cytopenias after initial recovery of Grade 3 or 4 cytopenia. Six and 11 patients had Grade 3 or 4 neutropenia and thrombocytopenia, respectively, at the time of death.
Monitor blood counts prior to and after CARVYKTI™ infusion. Manage cytopenias with growth factors and blood product transfusion support according to local institutional guidelines.
Contacts
Investor:
Joanne Choi, Senior Manager of Investor Relations, Legend Biotech
[email protected]
Crystal Chen, Manager of Investor Relations, Legend Biotech
[email protected]
Press:
Tina Carter, Corporate Communications Lead, Legend Biotech
[email protected]
(908) 331-5025