<?xml version="1.0" encoding="UTF-8"?><?xml-stylesheet href="https://www.accessdata.fda.gov/spl/stylesheet/spl.xsl" type="text/xsl"?>
<document xmlns="urn:hl7-org:v3" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="urn:hl7-org:v3 https://www.accessdata.fda.gov/spl/schema/spl.xsd">
   <id root="b8b52ff1-6e1d-4aa8-be21-978f15748cd9"/>
   <code code="60684-8" codeSystem="2.16.840.1.113883.6.1" displayName="CELLULAR THERAPY"/>
   <title>These highlights do not include all the information needed to use TECARTUS safely and effectively. See full prescribing information for TECARTUS. <br/>
      <br/>TECARTUS<sup>®</sup> (brexucabtagene autoleucel) suspension for intravenous infusion <br/>Initial U.S. Approval: 2020</title>
   <effectiveTime value="20210730"/>
   <setId root="a16108c2-7ca7-45af-965e-54bda4713022"/>
   <versionNumber value="4"/>
   <author>
      <time/>
      <assignedEntity>
         <representedOrganization>
            <id extension="963353359" root="1.3.6.1.4.1.519.1"/>
            <name>Kite Pharma, Inc.</name>
            <assignedEntity>
               <assignedOrganization>
                  <assignedEntity>
                     <assignedOrganization>
                        <id extension="963353359" root="1.3.6.1.4.1.519.1"/>
                        <name>Kite Pharma, Inc.</name>
                     </assignedOrganization>
                     <performance>
                        <actDefinition>
                           <code code="C43360" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="MANUFACTURE"/>
                           <product>
                              <manufacturedProduct classCode="MANU">
                                 <manufacturedMaterialKind>
                                    <code code="71287-219" codeSystem="2.16.840.1.113883.6.69"/>
                                 </manufacturedMaterialKind>
                              </manufacturedProduct>
                           </product>
                        </actDefinition>
                     </performance>
                     <performance>
                        <actDefinition>
                           <code code="C84732" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="LABEL"/>
                           <product>
                              <manufacturedProduct classCode="MANU">
                                 <manufacturedMaterialKind>
                                    <code code="71287-219" codeSystem="2.16.840.1.113883.6.69"/>
                                 </manufacturedMaterialKind>
                              </manufacturedProduct>
                           </product>
                        </actDefinition>
                     </performance>
                  </assignedEntity>
                  <assignedEntity>
                     <assignedOrganization>
                        <id extension="116931311" root="1.3.6.1.4.1.519.1"/>
                        <name>Kite Pharma, Inc.</name>
                     </assignedOrganization>
                     <performance>
                        <actDefinition>
                           <code code="C25391" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="ANALYSIS"/>
                           <product>
                              <manufacturedProduct classCode="MANU">
                                 <manufacturedMaterialKind>
                                    <code code="71287-219" codeSystem="2.16.840.1.113883.6.69"/>
                                 </manufacturedMaterialKind>
                              </manufacturedProduct>
                           </product>
                        </actDefinition>
                     </performance>
                  </assignedEntity>
               </assignedOrganization>
            </assignedEntity>
         </representedOrganization>
      </assignedEntity>
   </author>
   <component>
      <structuredBody>
         <component>
            <section>
               <id root="750d8ab9-462c-411d-9799-a2868ee8eefe"/>
               <code code="48780-1" codeSystem="2.16.840.1.113883.6.1" displayName="SPL product data elements section"/>
               <effectiveTime value="20210228"/>
               <subject>
                  <manufacturedProduct>
                     <manufacturedProduct>
                        <code codeSystem="2.16.840.1.113883.6.69" code="71287-219"/>
                        <name>TECARTUS</name>
                        <formCode code="C42994" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="SUSPENSION"/>
                        <asEntityWithGeneric>
                           <genericMedicine>
                              <name>brexucabtagene autoleucel</name>
                           </genericMedicine>
                        </asEntityWithGeneric>
                        <ingredient classCode="ACTIM">
                           <quantity>
                              <numerator unit="1" value="2000000"/>
                              <denominator unit="mL" value="68"/>
                           </quantity>
                           <ingredientSubstance>
                              <code code="4MD2J2T8SJ" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>BREXUCABTAGENE AUTOLEUCEL</name>
                              <activeMoiety>
                                 <activeMoiety>
                                    <code code="4MD2J2T8SJ" codeSystem="2.16.840.1.113883.4.9"/>
                                    <name>BREXUCABTAGENE AUTOLEUCEL</name>
                                 </activeMoiety>
                              </activeMoiety>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="IACT">
                           <ingredientSubstance>
                              <code code="YOW8V9698H" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>DIMETHYL SULFOXIDE</name>
                           </ingredientSubstance>
                        </ingredient>
                        <ingredient classCode="IACT">
                           <ingredientSubstance>
                              <code code="ZIF514RVZR" codeSystem="2.16.840.1.113883.4.9"/>
                              <name>ALBUMIN HUMAN</name>
                           </ingredientSubstance>
                        </ingredient>
                        <asContent>
                           <quantity>
                              <numerator unit="mL" value="68"/>
                              <denominator value="1"/>
                           </quantity>
                           <containerPackagedProduct>
                              <code code="71287-219-01" codeSystem="2.16.840.1.113883.6.69"/>
                              <formCode code="C43167" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BAG"/>
                              <asContent>
                                 <quantity>
                                    <numerator unit="1" value="1"/>
                                    <denominator value="1"/>
                                 </quantity>
                                 <containerPackagedProduct>
                                    <code code="71287-219-02" codeSystem="2.16.840.1.113883.6.69"/>
                                    <formCode code="C43233" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="PACKAGE"/>
                                 </containerPackagedProduct>
                              </asContent>
                           </containerPackagedProduct>
                           <subjectOf>
                              <characteristic classCode="OBS">
                                 <code code="SPLCMBPRDTP" codeSystem="2.16.840.1.113883.1.11.19255"/>
                                 <value code="C102834" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="Type 1: Convenience Kit of Co-Package" xsi:type="CE"/>
                              </characteristic>
                           </subjectOf>
                        </asContent>
                     </manufacturedProduct>
                     <subjectOf>
                        <approval>
                           <id extension="BLA125703" root="2.16.840.1.113883.3.150"/>
                           <code code="C73585" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="BLA"/>
                           <author>
                              <territorialAuthority>
                                 <territory>
                                    <code code="USA" codeSystem="2.16.840.1.113883.5.28"/>
                                 </territory>
                              </territorialAuthority>
                           </author>
                        </approval>
                     </subjectOf>
                     <subjectOf>
                        <marketingAct>
                           <code code="C53292" codeSystem="2.16.840.1.113883.3.26.1.1"/>
                           <statusCode code="active"/>
                           <effectiveTime>
                              <low value="20200724"/>
                           </effectiveTime>
                        </marketingAct>
                     </subjectOf>
                     <consumedIn>
                        <substanceAdministration>
                           <routeCode code="C38276" codeSystem="2.16.840.1.113883.3.26.1.1" displayName="INTRAVENOUS"/>
                        </substanceAdministration>
                     </consumedIn>
                  </manufacturedProduct>
               </subject>
            </section>
         </component>
         <component>
            <section ID="BOX">
               <id root="0e1b4cd4-d452-4a79-99a2-89422d86f2a4"/>
               <code code="34066-1" codeSystem="2.16.840.1.113883.6.1" displayName="BOXED WARNING SECTION"/>
               <title>
                  <content styleCode="emphasis">WARNING: CYTOKINE RELEASE SYNDROME and NEUROLOGIC TOXICITIES</content>
               </title>
               <text>
                  <list listType="unordered" styleCode="disc">
                     <item>
                        <content styleCode="bold">Cytokine Release Syndrome (CRS), including life-threatening reactions, occurred in patients receiving TECARTUS. Do not administer TECARTUS to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab or tocilizumab and corticosteroids <content styleCode="italics">[see <linkHtml href="#S2.2">Dosage and Administration (2.2</linkHtml>, <linkHtml href="#S2.3">2.3)</linkHtml>, <linkHtml href="#S5.1">Warnings and Precautions (5.1)</linkHtml>]</content>.</content>
                     </item>
                     <item>
                        <content styleCode="bold">Neurologic toxicities, including life-threatening reactions, occurred in patients receiving TECARTUS, including concurrently with CRS or after CRS resolution. Monitor for neurologic toxicities after treatment with TECARTUS. Provide supportive care and/or corticosteroids, as needed <content styleCode="italics">[see <linkHtml href="#S2.2">Dosage and Administration (2.2</linkHtml>, <linkHtml href="#S2.3">2.3)</linkHtml>, <linkHtml href="#S5.2">Warnings and Precautions (5.2)</linkHtml>]</content>.</content>
                     </item>
                     <item>
                        <content styleCode="bold">TECARTUS is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the YESCARTA and TECARTUS REMS Program <content styleCode="italics">[see <linkHtml href="#S5.3">Warnings and Precautions (5.3)</linkHtml>]</content>.</content>
                     </item>
                  </list>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <paragraph>WARNING: CYTOKINE RELEASE SYNDROME AND NEUROLOGIC TOXICITIES</paragraph>
                        <paragraph>
                           <content styleCode="italics">See full prescribing information for complete boxed warning.</content>
                        </paragraph>
                        <list listType="unordered" styleCode="disc">
                           <item>
                              <content styleCode="bold">Cytokine Release Syndrome (CRS), including life-threatening reactions, occurred in patients receiving TECARTUS. Do not administer TECARTUS to patients with active infection or inflammatory disorders. Treat severe or life-threatening CRS with tocilizumab or tocilizumab and corticosteroids (<linkHtml href="#S2.2">2.2</linkHtml>, <linkHtml href="#S2.3">2.3</linkHtml>, <linkHtml href="#S5.1">5.1</linkHtml>).</content>
                           </item>
                           <item>
                              <content styleCode="bold">Neurologic toxicities, including life-threatening reactions, occurred in patients receiving TECARTUS, including concurrently with CRS or after CRS resolution. Monitor for neurologic toxicities after treatment with TECARTUS. Provide supportive care and/or corticosteroids, as needed (<linkHtml href="#S2.2">2.2</linkHtml>, <linkHtml href="#S2.3">2.3</linkHtml>, <linkHtml href="#S5.2">5.2</linkHtml>).</content>
                           </item>
                           <item>
                              <content styleCode="bold">TECARTUS is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the YESCARTA and TECARTUS REMS Program (<linkHtml href="#S5.3">5.3</linkHtml>).</content>
                           </item>
                        </list>
                     </text>
                  </highlight>
               </excerpt>
            </section>
         </component>
         <component>
            <section>
               <id root="f5ef15fc-bc01-48ee-8cea-5b67e121e066"/>
               <code code="43683-2" codeSystem="2.16.840.1.113883.6.1" displayName="RECENT MAJOR CHANGES SECTION"/>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <table width="100%" styleCode="Noautorules">
                           <col width="80%" align="left" valign="top"/>
                           <col width="20%" align="right" valign="top"/>
                           <tbody>
                              <tr>
                                 <td>Warning and Precautions, Severe  Infections (<linkHtml href="#S5.5">5.5</linkHtml>)</td>
                                 <td>02/2021</td>
                              </tr>
                           </tbody>
                        </table>
                     </text>
                  </highlight>
               </excerpt>
            </section>
         </component>
         <component>
            <section ID="S1">
               <id root="733d3b4f-5490-4b79-8e31-33df4c93a1cd"/>
               <code code="34067-9" codeSystem="2.16.840.1.113883.6.1" displayName="INDICATIONS &amp; USAGE SECTION"/>
               <title>1 INDICATIONS AND USAGE</title>
               <text>
                  <paragraph>TECARTUS is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL).</paragraph>
                  <paragraph>This indication is approved under accelerated approval based on overall response rate and durability of response[<content styleCode="italics">see <linkHtml href="#S14">Clinical Studies (14)</linkHtml>]</content>. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.</paragraph>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <paragraph>TECARTUS is a CD19-directed genetically modified autologous T cell immunotherapy indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL).</paragraph>
                        <paragraph>This indication is approved under accelerated approval based on overall response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.</paragraph>
                     </text>
                  </highlight>
               </excerpt>
            </section>
         </component>
         <component>
            <section ID="S2">
               <id root="5b9b3fb6-494c-418d-94b5-f73c523f4f75"/>
               <code code="34068-7" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE &amp; ADMINISTRATION SECTION"/>
               <title>2 DOSAGE AND ADMINISTRATION</title>
               <text>
                  <paragraph>
                     <content styleCode="bold">For autologous use only. For intravenous use only.</content>
                  </paragraph>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <paragraph>
                           <content styleCode="bold">For autologous use only. For intravenous use only.</content>
                        </paragraph>
                        <list listType="unordered" styleCode="disc">
                           <item>Do NOT use a leukodepleting filter.</item>
                           <item>Administer a lymphodepleting regimen of cyclophosphamide and fludarabine before infusion of TECARTUS. (<linkHtml href="#S2.2">2.2</linkHtml>)</item>
                           <item>Verify the patient's identity prior to infusion. (<linkHtml href="#S2.2">2.2</linkHtml>)</item>
                           <item>Premedicate with acetaminophen and diphenhydramine. (<linkHtml href="#S2.2">2.2</linkHtml>)</item>
                           <item>Confirm availability of tocilizumab prior to infusion. (<linkHtml href="#S2.1">2.1</linkHtml>, <linkHtml href="#S5.1">5.1</linkHtml>)</item>
                           <item>Dosing of TECARTUS is based on the number of chimeric antigen receptor (CAR)-positive viable T cells. (<linkHtml href="#S2.1">2.1</linkHtml>) </item>
                           <item>The TECARTUS dose is 2 × 10<sup>6</sup> CAR-positive viable T cells per kg body weight, with a maximum of 2 × 10<sup>8</sup> CAR-positive viable T cells. (<linkHtml href="#S2.1">2.1</linkHtml>)</item>
                           <item>Administer TECARTUS in a certified healthcare facility. (<linkHtml href="#S2.2">2.2</linkHtml>, <linkHtml href="#S5.1">5.1</linkHtml>, <linkHtml href="#S5.2">5.2</linkHtml>, <linkHtml href="#S5.3">5.3</linkHtml>)</item>
                        </list>
                     </text>
                  </highlight>
               </excerpt>
               <component>
                  <section ID="S2.1">
                     <id root="b6bae62c-b92c-45a2-8c47-470fdc2ad3bb"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>2.1  Dose</title>
                     <text>
                        <paragraph>Each single infusion bag of TECARTUS contains a suspension of chimeric antigen receptor (CAR)-positive T cells in approximately 68 mL. The dose is 2 × 10<sup>6</sup> CAR-positive viable T cells per kg body weight, with a maximum of 2 × 10<sup>8</sup> CAR-positive viable T cells.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S2.2">
                     <id root="8d9f579e-bbdf-4424-8be9-f9cb4bf6db76"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>2.2  Administration</title>
                     <text>
                        <paragraph>TECARTUS is for autologous use only. The patient's identity must match the patient identifiers on the TECARTUS cassette and infusion bag. Do not infuse TECARTUS if the information on the patient-specific label does not match the intended patient.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="a5e5a4ec-5ec2-41d1-9d04-944fbe48a755"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline bold italics">Preparing Patient for TECARTUS Infusion</content>
                              </paragraph>
                              <paragraph>Confirm availability of TECARTUS prior to starting the lymphodepleting chemotherapy regimen.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                           <component>
                              <section>
                                 <id root="7503b8bb-255e-438c-a2fa-7260d6886e60"/>
                                 <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                                 <text>
                                    <paragraph>
                                       <content styleCode="italics">Pre-treatment </content>
                                    </paragraph>
                                    <list listType="unordered" styleCode="disc">
                                       <item>Administer a lymphodepleting chemotherapy regimen of cyclophosphamide 500 mg/m<sup>2</sup> intravenously and fludarabine 30 mg/m<sup>2</sup> intravenously on each of the fifth, fourth, and third days before infusion of TECARTUS. </item>
                                    </list>
                                 </text>
                                 <effectiveTime value="20210228"/>
                              </section>
                           </component>
                           <component>
                              <section>
                                 <id root="3bb2b6e8-8596-40d5-ae73-0f26d8b8d579"/>
                                 <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                                 <text>
                                    <paragraph>
                                       <content styleCode="italics">Premedication</content>
                                    </paragraph>
                                    <list listType="unordered" styleCode="disc">
                                       <item>Premedicate with acetaminophen and diphenhydramine or another H1-antihistamine approximately 30 to 60 minutes prior to TECARTUS infusion.</item>
                                       <item>Avoid prophylactic use of systemic corticosteroids as it may interfere with the activity of TECARTUS.</item>
                                    </list>
                                 </text>
                                 <effectiveTime value="20210228"/>
                              </section>
                           </component>
                        </section>
                     </component>
                     <component>
                        <section>
                           <id root="89a0306c-2062-4cbf-87bc-7d06ab9e0708"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline bold italics">Preparation of TECARTUS for infusion</content>
                              </paragraph>
                              <paragraph>Coordinate the timing of TECARTUS thaw and infusion. Confirm the infusion time in advance, and adjust the start time of TECARTUS thaw such that TECARTUS will be available for infusion when the patient is ready.</paragraph>
                              <list listType="unordered" styleCode="disc">
                                 <item>Confirm patient identity: Prior to TECARTUS preparation, match the patient's identity with the patient identifiers on the TECARTUS cassette.</item>
                                 <item>Do not remove the TECARTUS infusion bag from the cassette if the patient information on the cassette label does not match the intended patient.</item>
                                 <item>Once patient identity is confirmed, remove the TECARTUS infusion bag from the cassette and check that the patient information on the cassette label matches the patient information on the bag label.</item>
                                 <item>Inspect the infusion bag for any breaches of container integrity such as breaks or cracks before thawing. If the bag is compromised, follow the local guidelines (or call Kite at 1-844-454-KITE).</item>
                                 <item>Place the infusion bag inside a second sterile bag per local guidelines.</item>
                                 <item>Thaw the infusion bag at approximately 37°C using either a water bath or dry-thaw method until there is no visible ice in the infusion bag.</item>
                                 <item>Gently mix the contents of the bag to disperse clumps of cellular material. If visible cell clumps remain, continue to gently mix the contents of the bag. Small clumps of cellular material should disperse with gentle manual mixing. Do not wash, spin down, and/or re-suspend TECARTUS in new media prior to infusion.</item>
                                 <item>Once thawed, TECARTUS should be administered within 30 minutes but may be stored at room temperature (20°C to 25°C) for up to three hours.</item>
                              </list>
                           </text>
                           <effectiveTime value="20210228"/>
                           <component>
                              <section>
                                 <id root="52ffde59-39f9-400b-bcb8-09c325fed689"/>
                                 <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                                 <text>
                                    <paragraph>
                                       <content styleCode="bold">Administration</content>
                                    </paragraph>
                                    <list listType="unordered" styleCode="disc">
                                       <item>For autologous use only.</item>
                                       <item>Ensure that tocilizumab and emergency equipment are available prior to infusion and during the recovery period.</item>
                                       <item>Do NOT use a leukodepleting filter.</item>
                                       <item>Central venous access is recommended for the administration of TECARTUS.</item>
                                       <item>Confirm that the patient's identity matches the patient identifiers on the TECARTUS infusion bag.</item>
                                       <item>Prime the tubing with normal saline prior to infusion.</item>
                                       <item>Infuse the entire contents of the TECARTUS bag within 30 minutes by either gravity or a peristaltic pump. TECARTUS is stable at room temperature for up to three hours after thaw.</item>
                                       <item>Gently agitate the TECARTUS bag during infusion to prevent cell clumping.</item>
                                       <item>After the entire contents of the TECARTUS bag are infused, rinse the tubing with normal saline at the same infusion rate to ensure all product is delivered.</item>
                                    </list>
                                    <paragraph>TECARTUS contains human blood cells that are genetically modified with replication-incompetent retroviral vector. Follow universal precautions and local biosafety guidelines for handling and disposal of TECARTUS to avoid potential transmission of infectious diseases.</paragraph>
                                 </text>
                                 <effectiveTime value="20210228"/>
                              </section>
                           </component>
                           <component>
                              <section>
                                 <id root="bff124a9-5dfe-4d2c-b518-d0da9efe6c8c"/>
                                 <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                                 <text>
                                    <paragraph>
                                       <content styleCode="bold">Monitoring</content>
                                    </paragraph>
                                    <list listType="unordered" styleCode="disc">
                                       <item>Administer TECARTUS at a certified healthcare facility.</item>
                                       <item>Monitor patients at the certified healthcare facility daily for at least seven days following infusion for signs and symptoms of Cytokine Release Syndrome (CRS) and neurologic events.</item>
                                       <item>Instruct patients to remain within proximity of the certified healthcare facility for at least four weeks following infusion.</item>
                                    </list>
                                 </text>
                                 <effectiveTime value="20210228"/>
                              </section>
                           </component>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S2.3">
                     <id root="1711fc0e-16fc-4c48-9141-f0e2d3d75f30"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>2.3	Management of Severe Adverse Reactions </title>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="5e2fe4a8-ba7d-44e8-be8a-7f129aeddfb5"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="bold italics">Cytokine Release Syndrome</content>
                              </paragraph>
                              <paragraph>Identify CRS based on clinical presentation <content styleCode="italics">[see <linkHtml href="#S5.1">Warnings and Precautions (5.1)</linkHtml>]</content>. Evaluate for and treat other causes of fever, hypoxia, and hypotension. If CRS is suspected, manage according to the recommendations in Table 1. Patients who experience Grade 2 or higher CRS (e.g., hypotension, not responsive to fluids, or hypoxia requiring supplemental oxygenation) should be monitored with continuous cardiac telemetry and pulse oximetry. For patients experiencing severe CRS, consider performing an echocardiogram to assess cardiac function. For severe or life-threatening CRS, consider intensive care supportive therapy.</paragraph>
                              <table width="95%" ID="table1">
                                 <caption>Table 1.	CRS Grading and Management Guidance</caption>
                                 <col width="34%" align="left" valign="top"/>
                                 <col width="33%" align="left" valign="top"/>
                                 <col width="33%" align="left" valign="top"/>
                                 <thead>
                                    <tr>
                                       <th styleCode="Lrule Rrule">CRS Grade<footnote>Lee et al. 2014.</footnote>
                                       </th>
                                       <th styleCode="Rrule">Tocilizumab</th>
                                       <th styleCode="Rrule">Corticosteroids</th>
                                    </tr>
                                 </thead>
                                 <tbody>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule">
                                          <content styleCode="bold">Grade 1</content>
                                          <br/>Symptoms require symptomatic treatment only (e.g., fever, nausea, fatigue, headache, myalgia, malaise).</td>
                                       <td styleCode="Rrule">If not improving after 24 hours, administer tocilizumab<footnote>Refer to tocilizumab Prescribing Information for details.</footnote> 8 mg/kg intravenously over 1 hour (not to exceed 800 mg).</td>
                                       <td styleCode="Rrule">Not applicable.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule">
                                          <content styleCode="bold">Grade 2</content>
                                          <br/>Symptoms require and respond to moderate intervention.<br/>Oxygen requirement less than 40% FiO<sub>2</sub> or hypotension responsive to fluids or low dose of one vasopressor or Grade 2 organ toxicity.<footnote>Refer to Table 2 for management of neurologic toxicity.</footnote>
                                       </td>
                                       <td styleCode="Rrule">Administer tocilizumab 8 mg/kg intravenously over 1 hour (not to exceed 800 mg).<br/>Repeat tocilizumab every 8 hours as needed if not responsive to intravenous fluids or increasing supplemental oxygen. Limit to a maximum of 3 doses in a 24-hour period; maximum total of 4 doses if no clinical improvement in the signs and symptoms of CRS.<br/>If improving, discontinue tocilizumab.</td>
                                       <td styleCode="Rrule">Manage per Grade 3 if no improvement within 24 hours after starting tocilizumab.<br/>If improving, taper corticosteroids.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule">
                                          <content styleCode="bold">Grade 3</content>
                                          <br/>Symptoms require and respond to aggressive intervention.<br/>Oxygen requirement greater than or equal to 40% FiO<sub>2</sub> or hypotension requiring high-dose or multiple vasopressors or Grade 3 organ toxicity or Grade 4 transaminitis.</td>
                                       <td styleCode="Rrule">Per Grade 2<br/>If improving, discontinue tocilizumab.</td>
                                       <td styleCode="Rrule">Administer methylprednisolone 1 mg/kg intravenously twice daily or equivalent dexamethasone (e.g., 10 mg intravenously every 6 hours) until Grade 1, then taper corticosteroids.<br/>If improving, manage as Grade 2.<br/>If not improving, manage as Grade 4.</td>
                                    </tr>
                                    <tr>
                                       <td styleCode="Lrule Rrule">
                                          <content styleCode="bold">Grade 4</content>
                                          <br/>Life-threatening symptoms.<br/>Requirements for ventilator support or continuous veno-venous hemodialysis (CVVHD), or Grade 4 organ toxicity (excluding transaminitis).</td>
                                       <td styleCode="Rrule">Per Grade 2<br/>If improving, discontinue tocilizumab.</td>
                                       <td styleCode="Rrule">Administer methylprednisolone 1000 mg intravenously per day for 3 days.<br/>If improving, taper corticosteroids, and manage as Grade 3.<br/>If not improving, consider alternate immunosuppressants.</td>
                                    </tr>
                                 </tbody>
                              </table>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                     <component>
                        <section>
                           <id root="5346e5b8-1f9a-4999-bfc1-78b297b37df7"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="bold italics">Neurologic Toxicity</content>
                              </paragraph>
                              <paragraph>Monitor patients for signs and symptoms of neurologic toxicities (Table 2). Rule out other causes of neurologic symptoms. Patients who experience Grade 2 or higher neurologic toxicities should be monitored with continuous cardiac telemetry and pulse oximetry. Provide intensive care supportive therapy for severe or life-threatening neurologic toxicities. Consider non-sedating anti-seizure medicines (e.g., levetiracetam) for seizure prophylaxis for any Grade 2 or higher neurologic toxicities.</paragraph>
                              <table width="95%" ID="table2">
                                 <caption>Table 2.	Neurologic Toxicity Grading and Management Guidance</caption>
                                 <col width="20%" align="left" valign="top"/>
                                 <col width="40%" align="left" valign="top"/>
                                 <col width="40%" align="left" valign="top"/>
                                 <thead>
                                    <tr>
                                       <th styleCode="Lrule Rrule">Neurologic Event<footnote>Severity based on Common Terminology Criteria for Adverse Events.</footnote>
                                       </th>
                                       <th styleCode="Rrule">Concurrent CRS</th>
                                       <th styleCode="Rrule">No Concurrent CRS</th>
                                    </tr>
                                 </thead>
                                 <tfoot>
                                    <tr>
                                       <td align="left" colspan="3">Abbreviation:  ADLs, activities of daily living.</td>
                                    </tr>
                                 </tfoot>
                                 <tbody>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule">
                                          <content styleCode="bold">Grade 1</content>
                                          <br/>Examples include:<br/>Somnolence – mild drowsiness or sleepiness<br/>Confusion – mild disorientation<br/>Encephalopathy – mild limiting of ADLs<br/>Dysphasia– not impairing ability to communicate</td>
                                       <td styleCode="Rrule">Administer tocilizumab per Table 1 for management of Grade 1 CRS.</td>
                                       <td styleCode="Rrule">Supportive care.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule" rowspan="2">
                                          <content styleCode="bold">Grade 2</content>
                                          <br/>Examples include:<br/>Somnolence – moderate limiting instrumental ADLs<br/>Confusion – moderate disorientation<br/>Encephalopathy - limiting instrumental ADLs<br/>Dysphasia moderate impairing ability to communicate spontaneously<br/>Seizure(s)</td>
                                       <td styleCode="Rrule">Administer tocilizumab per Table 1 for management of Grade 2 CRS.<br/>If not improving within 24 hours after starting tocilizumab, administer dexamethasone 10 mg intravenously every 6 hours until the event is Grade 1 or less, then taper corticosteroids. <br/>If improving, discontinue tocilizumab.<br/>If still not improving, manage as Grade 3.</td>
                                       <td styleCode="Rrule">Administer dexamethasone 10 mg intravenously every 6 hours until the event is Grade 1 or less.<br/>If improving, taper corticosteroids.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule" colspan="2">Consider non-sedating, anti-seizure medicines (e.g., levetiracetam) for seizure prophylaxis.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule" rowspan="2">
                                          <content styleCode="bold">Grade 3</content>
                                          <br/>Examples include:<br/>Somnolence – obtundation or stupor<br/>Confusion – severe disorientation<br/>Encephalopathy - limiting self-care ADLs<br/>Dysphasia – severe receptive or expressive characteristics, impairing ability to read, write, or communicate intelligibly</td>
                                       <td styleCode="Rrule">Administer tocilizumab per Table 1 for management of Grade 2 CRS. <br/>In addition, administer dexamethasone 10 mg intravenously with the first dose of tocilizumab and repeat dose every 6 hours. Continue dexamethasone use until the event is Grade 1 or less, then taper corticosteroids.<br/>If improving, discontinue tocilizumab and manage as Grade 2.<br/>If still not improving, manage as Grade 4.</td>
                                       <td styleCode="Rrule">Administer dexamethasone 10 mg intravenously every 6 hours. <br/>Continue dexamethasone use until the event is Grade 1 or less, then taper corticosteroids <br/>If not improving, manage as Grade 4.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule" colspan="2">Consider non-sedating anti-seizure medicines (e.g., levetiracetam) for seizure prophylaxis.</td>
                                    </tr>
                                    <tr styleCode="Botrule">
                                       <td styleCode="Lrule Rrule" rowspan="2">
                                          <content styleCode="bold">Grade 4</content>
                                          <br/>Life-threatening consequences<br/>Urgent intervention indicated<br/>Requirement for mechanical ventilation<br/>Consider cerebral edema</td>
                                       <td styleCode="Rrule">Administer tocilizumab per Table 1 for management of Grade 2 CRS. <br/>Administer methylprednisolone 1000 mg intravenously per day with first dose of tocilizumab and continue methylprednisolone 1000 mg intravenously per day for 2 more days.<br/>If improving, then manage as Grade 3.<br/>If not improving, consider alternate immunosuppressants.</td>
                                       <td styleCode="Rrule">Administer methylprednisolone 1000 mg intravenously per day for 3 days.<br/>If improving, then manage as Grade 3.<br/>If not improving, consider alternate immunosuppressants.</td>
                                    </tr>
                                    <tr>
                                       <td styleCode="Lrule Rrule" colspan="2">Consider non-sedating anti-seizure medicines (e.g., levetiracetam) for seizure prophylaxis.</td>
                                    </tr>
                                 </tbody>
                              </table>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S3">
               <id root="f6ad0c74-8d23-41cb-acfc-42e6b9efdacd"/>
               <code code="43678-2" codeSystem="2.16.840.1.113883.6.1" displayName="DOSAGE FORMS &amp; STRENGTHS SECTION"/>
               <title>3 DOSAGE FORMS AND STRENGTHS</title>
               <text>
                  <paragraph>TECARTUS is available as a cell suspension for infusion.</paragraph>
                  <paragraph>A single dose of TECARTUS contains 2 × 10<sup>6</sup> CAR-positive viable T cells per kg of body weight (maximum of 2 × 10<sup>8</sup> CAR-positive viable T cells (for patients 100 kg and above) in approximately 68 mL suspension in an infusion bag <content styleCode="italics">[see <linkHtml href="#S16">How Supplied/Storage and Handling (16)</linkHtml>]</content>.</paragraph>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <list listType="unordered" styleCode="disc">
                           <item>TECARTUS is available as a cell suspension for infusion.</item>
                           <item>TECARTUS comprises a suspension of 2 × 10<sup>6</sup> CAR-positive viable T cells per kg of body weight, with a maximum of 2 × 10<sup>8</sup> CAR-positive viable T cells in approximately 68 mL. (<linkHtml href="#S3">3</linkHtml>)</item>
                        </list>
                     </text>
                  </highlight>
               </excerpt>
            </section>
         </component>
         <component>
            <section ID="S4">
               <id root="cc052e24-39bd-42ac-87c4-8d3742fd3b41"/>
               <code code="34070-3" codeSystem="2.16.840.1.113883.6.1" displayName="CONTRAINDICATIONS SECTION"/>
               <title>4 CONTRAINDICATIONS</title>
               <text>
                  <paragraph>None.</paragraph>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <list listType="unordered" styleCode="disc">
                           <item>None. (<linkHtml href="#S4">4</linkHtml>)</item>
                        </list>
                     </text>
                  </highlight>
               </excerpt>
            </section>
         </component>
         <component>
            <section ID="S5">
               <id root="7a89f96f-f810-43cf-b10f-831468b2fe15"/>
               <code code="43685-7" codeSystem="2.16.840.1.113883.6.1" displayName="WARNINGS AND PRECAUTIONS SECTION"/>
               <title>5 WARNINGS AND PRECAUTIONS</title>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <list listType="unordered" styleCode="disc">
                           <item>Hypersensitivity Reactions: Monitor for hypersensitivity reactions during infusion. (<linkHtml href="#S5.4">5.4</linkHtml>)</item>
                           <item>Severe Infections: Monitor patients for signs and symptoms of infection; treat appropriately. (<linkHtml href="#S5.5">5.5</linkHtml>) </item>
                           <item>Prolonged Cytopenias: Patients may exhibit Grade 3 or higher cytopenias for several weeks following TECARTUS infusion. Monitor complete blood counts. (<linkHtml href="#S5.6">5.6</linkHtml>)</item>
                           <item>Hypogammaglobulinemia: Monitor and provide replacement therapy. (<linkHtml href="#S5.7">5.7</linkHtml>)</item>
                           <item>Secondary Malignancies: In the event that a secondary malignancy occurs after treatment with TECARTUS, contact Kite at 1-844-454-KITE (5483). (<linkHtml href="#S5.8">5.8</linkHtml>)</item>
                           <item>Effects on Ability to Drive and Use Machines: 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 after receiving TECARTUS. (<linkHtml href="#S5.9">5.9</linkHtml>)</item>
                        </list>
                     </text>
                  </highlight>
               </excerpt>
               <component>
                  <section ID="S5.1">
                     <id root="d68edac2-d16d-4bd9-a9c0-fb1080f0bafa"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.1	Cytokine Release Syndrome</title>
                     <text>
                        <paragraph>CRS, including life-threatening reactions, occurred following treatment with TECARTUS. In ZUMA-2, CRS occurred in 91% (75/82) of patients receiving TECARTUS, including ≥ Grade 3 (Lee grading system<sup>1</sup>) CRS in 18% of patients. Among the patients who died after receiving TECARTUS, one had a fatal CRS event. The median time to onset of CRS was three days (range: 1 to 13 days) and the median duration of CRS was ten days (range: 1 to 50 days). Among patients with CRS, key manifestations (&gt;10%) included fever (99%), hypotension (60%), hypoxia (37%), chills (33%), tachycardia (37%), headache (24%), fatigue (19%), nausea (13%), alanine aminotransferase increased (13%), aspartate aminotransferase increased (12%), and diarrhea (11%). Serious events associated with CRS included hypotension, fever, hypoxia, acute kidney injury, and tachycardia <content styleCode="italics">[see <linkHtml href="#S6">Adverse Reactions (6)</linkHtml>]</content>.</paragraph>
                        <paragraph>Ensure that a minimum of two doses of tocilizumab are available for each patient prior to infusion of TECARTUS. Monitor patients daily for at least seven days at the certified healthcare facility following infusion for signs and symptoms of CRS. Monitor patients for signs or symptoms of CRS for four weeks after infusion. Counsel patients to seek immediate medical attention should signs or symptoms of CRS occur at any time <content styleCode="italics">[see <linkHtml href="#S17">Patient Counseling Information (17)</linkHtml>]</content>. At the first sign of CRS, institute treatment with supportive care, tocilizumab, or tocilizumab and corticosteroids as indicated <content styleCode="italics">[see <linkHtml href="#S2.3">Dosage and Administration (2.3)</linkHtml>]</content>.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.2">
                     <id root="07034120-5317-4299-9c33-c77b24dd5a3e"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.2	Neurologic Toxicities</title>
                     <text>
                        <paragraph>Neurologic events, including those that were life-threatening, occurred following treatment with TECARTUS. In ZUMA-2, neurologic events occurred in 81% of patients, 37% of whom experienced Grade 3 or higher (severe or life-threatening) adverse reactions. The median time to onset for neurologic events was six days (range: 1 to 32 days). Neurologic events resolved for 52 out of 66 (79%) patients with a median duration of 21 days (range: 2 to 454 days). Three patients had ongoing neurologic events at the time of death, including one patient with serious encephalopathy. The remaining unresolved neurologic events were either Grade 1 or Grade 2. Fifty-four (66%) patients experienced CRS before the onset of neurological events. Five (6%) patients did not experience CRS with neurologic events and eight patients (10%) developed neurological events after the resolution of CRS. Eighty-five percent of all treated patients experienced the first CRS or neurological event within the first seven days after TECARTUS infusion.</paragraph>
                        <paragraph>The most common neurologic events (&gt;10%) included encephalopathy (51%), headache (35%), tremor (38%), aphasia (23%), and delirium (16%). Serious events including encephalopathy, aphasia, and seizures occurred after treatment with TECARTUS.</paragraph>
                        <paragraph>Monitor patients daily for at least seven days at the certified healthcare facility following infusion for signs and symptoms of neurologic toxicities. Monitor patients for signs or symptoms of neurologic toxicities for four weeks after infusion and treat promptly. <content styleCode="italics">[see <linkHtml href="#S2.3">Dosage and Administration (2.3)</linkHtml>]</content>.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.3">
                     <id root="af66525f-6f21-4fbf-a2c0-156571ae785c"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.3	YESCARTA and TECARTUS REMS Program</title>
                     <text>
                        <paragraph>Because of the risk of CRS and neurologic toxicities, TECARTUS is available only through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the YESCARTA and TECARTUS REMS Program <content styleCode="italics">[see <linkHtml href="#BOX">Boxed Warning</linkHtml> and <linkHtml href="#S5.1">Warnings and Precautions (5.1</linkHtml> and <linkHtml href="#S5.2">5.2)</linkHtml>]</content>. The required components of the YESCARTA and TECARTUS REMS Program are:</paragraph>
                        <list listType="unordered" styleCode="disc">
                           <item>Healthcare facilities that dispense and administer TECARTUS must be enrolled and comply with the REMS requirements. Certified healthcare facilities must have on-site, immediate access to tocilizumab, and ensure that a minimum of two doses of tocilizumab are available for each patient for infusion within two hours after TECARTUS infusion, if needed for treatment of CRS.</item>
                           <item>Certified healthcare facilities must ensure that healthcare providers who prescribe, dispense, or administer TECARTUS are trained in the management of CRS and neurologic toxicities.</item>
                        </list>
                        <paragraph>Further information is available at www.YescartaTecartusREMS.com or 1-844-454-KITE (5483).</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.4">
                     <id root="0bb2e34a-a15a-47f6-910b-f4e6695847bf"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.4	Hypersensitivity Reactions</title>
                     <text>
                        <paragraph>Serious hypersensitivity reactions, including anaphylaxis, may occur due to dimethyl sulfoxide (DMSO) or residual gentamicin in TECARTUS.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.5">
                     <id root="94b1a9e5-3184-4456-8ee4-7c4f623b65a1"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.5	Severe Infections</title>
                     <text>
                        <paragraph>Severe or life-threatening infections occurred in patients after TECARTUS infusion. In ZUMA-2, infections (all grades) occurred in 56% of patients. Grade 3 or higher infections, including bacterial, viral, and fungal infections, occurred in 30% of patients. TECARTUS should not be administered to patients with clinically significant active systemic infections. Monitor patients for signs and symptoms of infection before and after TECARTUS infusion and treat appropriately. Administer prophylactic antimicrobials according to local guidelines.</paragraph>
                        <paragraph>Febrile neutropenia was observed in 6% of patients after TECARTUS infusion and 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. 								</paragraph>
                        <paragraph>
                           <content styleCode="xmChange">In immunosuppressed patients, including those who have received TECARTUS, life-threatening and fatal opportunistic infections including disseminated fungal infections (e.g., candida sepsis and aspergillus infections) and viral reactivation (e.g., human herpes virus-6 [HHV-6] encephalitis and JC virus progressive multifocal leukoencephalopathy [PML]) have been reported. The possibility of HHV-6 encephalitis and PML should be considered in immunosuppressed patients with neurologic events and appropriate diagnostic evaluations should be performed.</content>
                        </paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="ca4ce660-b90f-41fc-9b45-3f6c319ce9b7"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="italics">Hepatitis B Reactivation</content>
                              </paragraph>
                              <paragraph>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. Perform screening for HBV, hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in accordance with clinical guidelines before collection of cells for manufacturing.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S5.6">
                     <id root="9bacb8c8-1e7d-44ac-8bab-c0c2c4b8e7ae"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.6	Prolonged Cytopenias</title>
                     <text>
                        <paragraph>Patients may exhibit cytopenias for several weeks following lymphodepleting chemotherapy and TECARTUS infusion. In ZUMA-2, Grade 3 or higher cytopenias not resolved by Day 30 following TECARTUS infusion occurred in 55% of patients and included thrombocytopenia (38%), neutropenia (37%), and anemia (17%). Monitor blood counts after TECARTUS infusion.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.7">
                     <id root="146ccaff-c410-4532-b045-b52b18dbbebb"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.7	Hypogammaglobulinemia</title>
                     <text>
                        <paragraph>B cell aplasia and hypogammaglobulinemia can occur in patients receiving treatment with TECARTUS. In ZUMA-2, hypogammaglobulinemia occurred in 16% of patients. Monitor immunoglobulin levels after treatment with TECARTUS and manage using infection precautions, antibiotic prophylaxis, and immunoglobulin replacement. </paragraph>
                        <paragraph>The safety of immunization with live viral vaccines during or following TECARTUS treatment has not been studied. Vaccination with live virus vaccines is not recommended for at least six weeks prior to the start of lymphodepleting chemotherapy, during TECARTUS treatment, and until immune recovery following treatment with TECARTUS.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.8">
                     <id root="f84849a5-52f7-4be6-9f72-bba3563c389c"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.8	Secondary Malignancies</title>
                     <text>
                        <paragraph>Patients treated with TECARTUS may develop secondary malignancies. Monitor life-long for secondary malignancies. In the event that a secondary malignancy occurs, contact Kite at 1-844-454-KITE (5483) to obtain instructions on patient samples to collect for testing.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S5.9">
                     <id root="ea60c8c7-dab2-4af9-a0cc-32d91c786170"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>5.9	Effects on Ability to Drive and Use Machines</title>
                     <text>
                        <paragraph>Due to the potential for neurologic events, including altered mental status or seizures, patients receiving TECARTUS are at risk for altered or decreased consciousness or coordination in the eight weeks following TECARTUS infusion. Advise patients to refrain from driving and engaging in hazardous occupations or activities, such as operating heavy or potentially dangerous machinery, during this initial period.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S6">
               <id root="b7c4c75d-6591-4881-ae70-2c97f06427d1"/>
               <code code="34084-4" codeSystem="2.16.840.1.113883.6.1" displayName="ADVERSE REACTIONS SECTION"/>
               <title>6 ADVERSE REACTIONS</title>
               <text>
                  <paragraph>The following clinically significant adverse reactions are described elsewhere in the labeling:</paragraph>
                  <list listType="unordered" styleCode="disc">
                     <item>Cytokine Release Syndrome <content styleCode="italics">[see <linkHtml href="#S5.1">Warnings and Precautions (5.1)</linkHtml>]</content>
                     </item>
                     <item>Neurologic Toxicities <content styleCode="italics">[see <linkHtml href="#S5.2">Warnings and Precautions (5.2)</linkHtml>]</content>
                     </item>
                     <item>Hypersensitivity Reactions <content styleCode="italics">[see <linkHtml href="#S5.4">Warnings and Precautions (5.4)</linkHtml>]</content>
                     </item>
                     <item>Severe Infections <content styleCode="italics">[see <linkHtml href="#S5.5">Warnings and Precautions (5.5)</linkHtml>]</content>
                     </item>
                     <item>Prolonged Cytopenias <content styleCode="italics">[see <linkHtml href="#S5.6">Warnings and Precautions (5.6)</linkHtml>]</content>
                     </item>
                     <item>Hypogammaglobulinemia <content styleCode="italics">[see <linkHtml href="#S5.7">Warnings and Precautions (5.7)</linkHtml>]</content>
                     </item>
                  </list>
               </text>
               <effectiveTime value="20210228"/>
               <excerpt>
                  <highlight>
                     <text>
                        <paragraph>The most common non-laboratory adverse reactions (incidence greater than or equal to 20%) are: pyrexia, CRS, hypotension, encephalopathy, fatigue, tachycardia, arrhythmia, infection – pathogen unspecified, chills, hypoxia, cough, tremor, musculoskeletal pain, headache, nausea, edema, motor dysfunction, constipation, diarrhea, decreased appetite, dyspnea, rash, insomnia, pleural effusion, and aphasia. (<linkHtml href="#S6.1">6.1</linkHtml>).</paragraph>
                        <br/>
                        <paragraph>
                           <content styleCode="bold">To report SUSPECTED ADVERSE REACTIONS, contact Kite at 1-844-454-KITE (5483) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.</content>
                        </paragraph>
                     </text>
                  </highlight>
               </excerpt>
               <component>
                  <section ID="S6.1">
                     <id root="1c659838-e151-4f83-924b-2e45f46cd5c4"/>
                     <code code="90374-0" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL TRIALS EXPERIENCE SECTION"/>
                     <title>6.1	Clinical Trials Experience</title>
                     <text>
                        <paragraph>Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="6d4447c3-909b-4b35-b10a-a74a84d9e2b0"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="italics">Patients with Relapsed/Refractory Mantle Cell Lymphoma (MCL)</content>
                              </paragraph>
                              <paragraph>The safety of TECARTUS was evaluated in a Phase 2 single-arm clinical study (ZUMA-2) in which a total of 82 patients with relapsed/refractory MCL received a single dose of CAR-positive viable T cells (2 × 10<sup>6</sup> or 0.5 × 10<sup>6</sup> anti-CD19 CAR T cells/kg) that was weight-based <content styleCode="italics">[see <linkHtml href="#S14.1">Clinical Studies (14.1)</linkHtml>]</content>.</paragraph>
                              <paragraph>The most common adverse reactions (incidence ≥ 20%) were pyrexia, CRS, hypotension, encephalopathy, fatigue, tachycardia, arrhythmia, infection – pathogen unspecified, chills, hypoxia, cough, tremor, musculoskeletal pain, headache, nausea, edema, motor dysfunction, constipation, diarrhea, decreased appetite, dyspnea, rash, insomnia, pleural effusion, and aphasia. Serious adverse reactions occurred in 66% of patients. The most common serious adverse reactions (&gt; 2%) were encephalopathy, pyrexia, infection – pathogen unspecified, CRS, hypoxia, aphasia, renal insufficiency, pleural effusion, respiratory failure, bacterial infections, dyspnea, fatigue, arrhythmia, tachycardia, and viral infections.</paragraph>
                              <paragraph>The most common (≥ 10%) Grade 3 or higher reactions were anemia, neutropenia, thrombocytopenia, hypotension, hypophosphatemia, encephalopathy, leukopenia, hypoxia,pyrexia, hyponatremia, hypertension, infection-pathogen unspecified, pneumonia, hypocalcemia, and lymphopenia.</paragraph>
                              <paragraph>Table 3 summarizes the adverse reactions that occurred in at least 10% of patients treated with TECARTUS and Table 4 describes the laboratory abnormalities of Grade 3 or 4 that occurred in at least 10% of patients.</paragraph>
                              <table width="95%">
                                 <caption>Table 3.	Summary of Adverse Reactions Observed in at Least 10% of Patients Treated with TECARTUS in ZUMA-2 (N=82)</caption>
                                 <col width="50%" align="left" valign="top"/>
                                 <col width="25%" align="center" valign="top"/>
                                 <col width="25%" align="center" valign="top"/>
                                 <thead>
                                    <tr>
                                       <th>Adverse Reaction</th>
                                       <th>Any Grade (%)</th>
                                       <th>Grade 3 or Higher (%)</th>
                                    </tr>
                                 </thead>
                                 <tbody>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Blood and Lymphatic System Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Coagulopathy <footnote ID="t3fa">Coagulopathy includes coagulopathy, disseminated intravascular coagulation, international normalized ratio increased.</footnote>
                                       </td>
                                       <td>10</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Cardiac Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Tachycardias <footnote>Tachycardias includes tachycardia, sinus tachycardia.</footnote>
                                       </td>
                                       <td>45</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Bradycardias <footnote>Bradycardias includes bradycardia, sinus bradycardia.</footnote>
                                       </td>
                                       <td>10</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Non-ventricular Arrhythmias <footnote>Non-ventricular arrhythmias includes atrial fibrillation, atrial flutter, cardiac flutter, palpitations, supraventricular tachycardia.</footnote>
                                       </td>
                                       <td>10</td>
                                       <td>4</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Gastrointestinal Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Nausea</td>
                                       <td>35</td>
                                       <td>1</td>
                                    </tr>
                                    <tr>
                                       <td>  Constipation</td>
                                       <td>29</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Diarrhea</td>
                                       <td>28</td>
                                       <td>5</td>
                                    </tr>
                                    <tr>
                                       <td>  Abdominal pain <footnote>Abdominal pain includes abdominal pain, abdominal pain lower, abdominal pain upper, abdominal tenderness.</footnote>
                                       </td>
                                       <td>17</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Oral pain <footnote>	Oral pain includes oral pain, gingival pain, lip pain, oral mucosal erythema, oropharyngeal pain.</footnote>
                                       </td>
                                       <td>16</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Vomiting <footnote>Vomiting includes vomiting, retching.</footnote>
                                       </td>
                                       <td>13</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Dysphagia</td>
                                       <td>10</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">General Disorders and Administration Site Conditions</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Pyrexia</td>
                                       <td>94</td>
                                       <td>15</td>
                                    </tr>
                                    <tr>
                                       <td>  Fatigue <footnote>Fatigue includes fatigue, lethargy, malaise.</footnote>
                                       </td>
                                       <td>48</td>
                                       <td>1</td>
                                    </tr>
                                    <tr>
                                       <td>  Chills</td>
                                       <td>41</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Edema <footnote>Edema includes eyelid edema, face edema, generalized edema, localised edema, edema, edema peripheral, periorbital edema, peripheral swelling, scrotal edema, swelling face.</footnote>
                                       </td>
                                       <td>35</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td>  Pain <footnote>Pain includes pain, allodynia, dysaesthesia, ear pain, facial pain, non-cardiac chest pain.</footnote>
                                       </td>
                                       <td>17</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Immune System Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Cytokine release syndrome</td>
                                       <td>91</td>
                                       <td>18</td>
                                    </tr>
                                    <tr>
                                       <td>  Hypogammaglobulinemia <footnote>Hypogammaglobulinemia includes hypogammaglobulinemia, blood immunoglobulin G decreased. </footnote>
                                       </td>
                                       <td>16</td>
                                       <td>1</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Infections and Infestations</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Infection – pathogen unspecified</td>
                                       <td>43</td>
                                       <td>24</td>
                                    </tr>
                                    <tr>
                                       <td>  Viral infections</td>
                                       <td>18</td>
                                       <td>4</td>
                                    </tr>
                                    <tr>
                                       <td>  Bacterial infections</td>
                                       <td>13</td>
                                       <td>6</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Metabolism and nutrition disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Decreased appetite</td>
                                       <td>26</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Musculoskeletal and Connective Tissue Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Musculoskeletal pain <footnote>Musculoskeletal pain includes musculoskeletal pain, arthralgia, back pain, bone pain, dysarthria, flank pain, groin pain, myalgia, neck pain, pain in extremity.</footnote>
                                       </td>
                                       <td>37</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td>  Motor dysfunction <footnote>Motor dysfunction includes asthenia, intensive care acquired weakness, mobility decreased, muscle twitching, muscular weakness, myopathy. </footnote>
                                       </td>
                                       <td>17</td>
                                       <td>4</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Nervous System Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Encephalopathy <footnote>Encephalopathy includes encephalopathy, altered state of consciousness, amnesia, balance disorder, cognitive disorder, confusional state, disturbance in attention, dysgraphia, dyskinesia, memory impairment, mental status changes, neurotoxicity, somnolence.</footnote>
                                       </td>
                                       <td>51</td>
                                       <td>24</td>
                                    </tr>
                                    <tr>
                                       <td>  Tremor </td>
                                       <td>38</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td>  Headache <footnote>Headache includes headache, migraine.</footnote>
                                       </td>
                                       <td>35</td>
                                       <td>1</td>
                                    </tr>
                                    <tr>
                                       <td>  Aphasia <footnote>Aphasia includes aphasia, communication disorder.</footnote>
                                       </td>
                                       <td>20</td>
                                       <td>7</td>
                                    </tr>
                                    <tr>
                                       <td>  Dizziness <footnote>Dizziness includes dizziness, presyncope, syncope.</footnote>
                                       </td>
                                       <td>18</td>
                                       <td>6</td>
                                    </tr>
                                    <tr>
                                       <td>  Neuropathy <footnote>Neuropathy includes hyperaesthesia, neuropathy peripheral, paraesthesia, paraesthesia oral.</footnote>
                                       </td>
                                       <td>13</td>
                                       <td>2</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Psychiatric Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Insomnia</td>
                                       <td>21</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Delirium <footnote>Delirium includes delirium, agitation, disorientation, hallucination, hypomania, irritability, nervousness, personality change.</footnote>
                                       </td>
                                       <td>18</td>
                                       <td>5</td>
                                    </tr>
                                    <tr>
                                       <td>  Anxiety</td>
                                       <td>16</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Renal and Urinary Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Renal insufficiency <footnote>Renal insufficiency includes acute kidney injury, blood creatinine increased.</footnote>
                                       </td>
                                       <td>18</td>
                                       <td>9</td>
                                    </tr>
                                    <tr>
                                       <td>  Urine output decreased <footnote>Urine output decreased includes urine output decreased, urinary retention.</footnote>
                                       </td>
                                       <td>11</td>
                                       <td>1</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Respiratory, Thoracic and Mediastinal Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Hypoxia</td>
                                       <td>40</td>
                                       <td>20</td>
                                    </tr>
                                    <tr>
                                       <td>  Cough <footnote>Cough includes cough, upper-airway cough syndrome.</footnote>
                                       </td>
                                       <td>38</td>
                                       <td>0</td>
                                    </tr>
                                    <tr>
                                       <td>  Dyspnea <footnote>Dyspnea includes dyspnea, dyspnea exertional.</footnote>
                                       </td>
                                       <td>24</td>
                                       <td>6</td>
                                    </tr>
                                    <tr>
                                       <td>  Pleural effusion</td>
                                       <td>21</td>
                                       <td>5</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Skin and Subcutaneous Tissue Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Rash <footnote>Rash includes rash, erythema, rash erythematous, rash maculo-papular, rash pustular.</footnote>
                                       </td>
                                       <td>22</td>
                                       <td>4</td>
                                    </tr>
                                    <tr>
                                       <td colspan="3">
                                          <content styleCode="italics">Vascular Disorders</content>
                                       </td>
                                    </tr>
                                    <tr>
                                       <td>  Hypotension <footnote>Hypotension includes hypotension, orthostatic hypotension.</footnote>
                                       </td>
                                       <td>57</td>
                                       <td>27</td>
                                    </tr>
                                    <tr>
                                       <td>  Hypertension</td>
                                       <td>18</td>
                                       <td>11</td>
                                    </tr>
                                    <tr>
                                       <td>  Thrombosis <footnote>Thrombosis includes thrombosis, deep vein thrombosis, embolism, pulmonary embolism.</footnote>
                                       </td>
                                       <td>17</td>
                                       <td>4</td>
                                    </tr>
                                 </tbody>
                              </table>
                              <paragraph>Other clinically important adverse reactions that occurred in less than 10% of patients treated with TECARTUS include the following:</paragraph>
                              <list listType="unordered" styleCode="disc">
                                 <item>
                                    <content styleCode="italics">Gastrointestinal disorders:</content> dry mouth (7%)</item>
                                 <item>
                                    <content styleCode="italics">Infections and infestations disorders:</content> fungal infections (9%)</item>
                                 <item>
                                    <content styleCode="italics">Metabolism and nutrition disorders:</content> dehydration (6%)</item>
                                 <item>
                                    <content styleCode="italics">Nervous system disorders:</content> ataxia (7%), seizure (5%), increased intracranial pressure (2%)</item>
                                 <item>
                                    <content styleCode="italics">Respiratory, thoracic and mediastinal disorders:</content> respiratory failure (6%), pulmonary edema (4%)</item>
                                 <item>
                                    <content styleCode="italics">Skin and subcutaneous tissue disorders:</content> rash (9%)</item>
                                 <item>
                                    <content styleCode="italics">Vascular disorders:</content> hemorrhage (7%)</item>
                              </list>
                              <table width="75%">
                                 <caption>Table 4.	Grade 3 or 4 Laboratory Abnormalities Occurring in ≥ 10% of Patients in ZUMA-2 Following TECARTUS Infusion (N = 82)</caption>
                                 <col width="70%" align="left" valign="top"/>
                                 <col width="30%" align="center" valign="top"/>
                                 <thead>
                                    <tr>
                                       <th/>
                                       <th>Grades 3 or 4 (%)</th>
                                    </tr>
                                 </thead>
                                 <tbody>
                                    <tr>
                                       <td>Leukopenia</td>
                                       <td>95</td>
                                    </tr>
                                    <tr>
                                       <td>Neutropenia</td>
                                       <td>95</td>
                                    </tr>
                                    <tr>
                                       <td>Lymphopenia</td>
                                       <td>86</td>
                                    </tr>
                                    <tr>
                                       <td>Thrombocytopenia</td>
                                       <td>63</td>
                                    </tr>
                                    <tr>
                                       <td>Anemia</td>
                                       <td>55</td>
                                    </tr>
                                    <tr>
                                       <td>Hypophosphatemia</td>
                                       <td>30</td>
                                    </tr>
                                    <tr>
                                       <td>Hypocalcemia</td>
                                       <td>21</td>
                                    </tr>
                                    <tr>
                                       <td>Blood uric acid increased</td>
                                       <td>17</td>
                                    </tr>
                                    <tr>
                                       <td>Hyponatremia</td>
                                       <td>16</td>
                                    </tr>
                                    <tr>
                                       <td>Aspartate Aminotransferase increased</td>
                                       <td>15</td>
                                    </tr>
                                    <tr>
                                       <td>Alanine Aminotransferase increased</td>
                                       <td>15</td>
                                    </tr>
                                    <tr>
                                       <td>Hypokalemia</td>
                                       <td>10</td>
                                    </tr>
                                 </tbody>
                              </table>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S6.2">
                     <id root="21cffbe4-6f1a-4f73-b7a3-7e2f5424dca1"/>
                     <code code="88830-5" codeSystem="2.16.840.1.113883.6.1" displayName="IMMUNOGENICITY"/>
                     <title>6.2 Immunogenicity</title>
                     <text>
                        <paragraph>TECARTUS has the potential to induce anti-product antibodies, which has been evaluated using an enzyme-linked immunosorbent assay (ELISA) for the detection of binding antibodies against FMC63, the originating antibody of the anti-CD19 CAR. To date, no anti-CAR T-cell antibody immunogenicity has been observed. Based on an initial screening assay, 17 patients tested positive for antibodies; however, a confirmatory orthogonal cell-based assay demonstrated that all 17 patients were antibody negative at all time points tested. There is no evidence that the kinetics of initial expansion and persistence of TECARTUS, or the safety or effectiveness of TECARTUS, was altered in these patients.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S8">
               <id root="e49c55cb-b678-4e46-be49-1dcdb1d8d05b"/>
               <code code="43684-0" codeSystem="2.16.840.1.113883.6.1" displayName="USE IN SPECIFIC POPULATIONS SECTION"/>
               <title>8 USE IN SPECIFIC POPULATIONS</title>
               <effectiveTime value="20210228"/>
               <component>
                  <section ID="S8.1">
                     <id root="6fbc0cb0-e0fe-4240-9b00-035012f34d05"/>
                     <code code="42228-7" codeSystem="2.16.840.1.113883.6.1" displayName="PREGNANCY SECTION"/>
                     <title>8.1 Pregnancy</title>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="9f7a09a9-a9ef-4f3e-8a66-18ff71658442"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline">Risk Summary</content>
                              </paragraph>
                              <paragraph>There are no available data with TECARTUS use in pregnant women. No animal reproductive and developmental toxicity studies have been conducted with TECARTUS to assess whether TECARTUS can cause fetal harm when administered to a pregnant woman. It is not known if TECARTUS has the potential to be transferred to the fetus. Based on the mechanism of action of TECARTUS, if the transduced cells cross the placenta, they may cause fetal toxicity, including B cell lymphocytopenia. Therefore, TECARTUS is not recommended for women who are pregnant. Pregnancy after TECARTUS infusion should be discussed with the treating physician.</paragraph>
                              <paragraph>In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% – 4% and 15% – 20%, respectively.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S8.2">
                     <id root="884fb856-08e4-41ac-8c7f-45927da03cab"/>
                     <code code="77290-5" codeSystem="2.16.840.1.113883.6.1" displayName="LACTATION SECTION"/>
                     <title>8.2 Lactation</title>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="d0dea0b3-64f6-4661-adf7-aab1797d03d0"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline">Risk Summary</content>
                              </paragraph>
                              <paragraph>There is no information regarding the presence of TECARTUS in human milk, the effect on the breastfed infant, and the effects on milk production. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for TECARTUS and any potential adverse effects on the breastfed infant from TECARTUS or from the underlying maternal condition.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S8.3">
                     <id root="7da07e7f-244c-46a0-b223-fc3a62971dab"/>
                     <code code="77291-3" codeSystem="2.16.840.1.113883.6.1" displayName="FEMALES &amp; MALES OF REPRODUCTIVE POTENTIAL SECTION"/>
                     <title>8.3 Females and Males of Reproductive Potential</title>
                     <effectiveTime value="20210228"/>
                     <component>
                        <section>
                           <id root="3af055f3-e387-48ef-9e10-8e974812819c"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline">Pregnancy Testing</content>
                              </paragraph>
                              <paragraph>Pregnancy status of females with reproductive potential should be verified. Sexually active females of reproductive potential should have a negative pregnancy test prior to starting treatment with TECARTUS.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                     <component>
                        <section>
                           <id root="86d6f263-b329-4840-a08f-fedca0250dca"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline">Contraception</content>
                              </paragraph>
                              <paragraph>See the prescribing information for fludarabine and cyclophosphamide for information on the need for effective contraception in patients who receive the lymphodepleting chemotherapy.</paragraph>
                              <paragraph>There are insufficient exposure data to provide a recommendation concerning duration of contraception following treatment with TECARTUS.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                     <component>
                        <section>
                           <id root="3db32ea6-de21-4179-88ed-5eb29c251b60"/>
                           <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                           <text>
                              <paragraph>
                                 <content styleCode="underline">Infertility</content>
                              </paragraph>
                              <paragraph>There are no data on the effect of TECARTUS on fertility.</paragraph>
                           </text>
                           <effectiveTime value="20210228"/>
                        </section>
                     </component>
                  </section>
               </component>
               <component>
                  <section ID="S8.4">
                     <id root="2131bc29-e945-40ea-8972-437a5452f929"/>
                     <code code="34081-0" codeSystem="2.16.840.1.113883.6.1" displayName="PEDIATRIC USE SECTION"/>
                     <title>8.4 Pediatric Use</title>
                     <text>
                        <paragraph>The safety and efficacy of TECARTUS have not been established in pediatric patients. </paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S8.5">
                     <id root="077b3965-38c4-40b9-8863-18b9deaec4c8"/>
                     <code code="34082-8" codeSystem="2.16.840.1.113883.6.1" displayName="GERIATRIC USE SECTION"/>
                     <title>8.5 Geriatric Use</title>
                     <text>
                        <paragraph>Of the 82 patients treated with TECARTUS, 42 were ≥ 65 years of age and 40 were &lt; 65 years of age. No overall differences in safety or effectiveness were observed between patients ≥ 65 years of age and younger patients.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S11">
               <id root="635145f4-3479-40d6-97b6-dcc6eaccd0f2"/>
               <code code="34089-3" codeSystem="2.16.840.1.113883.6.1" displayName="DESCRIPTION SECTION"/>
               <title>11 DESCRIPTION</title>
               <text>
                  <paragraph>TECARTUS (brexucabtagene autoleucel) is a CD19-directed genetically modified autologous T cell immunotherapy. To prepare TECARTUS, a patient's own T cells are harvested and genetically modified <content styleCode="italics">ex vivo</content> by retroviral transduction to express a chimeric antigen receptor (CAR) comprising a murine anti-CD19 single-chain variable fragment (scFv) linked to CD28 and CD3-zeta co-stimulatory domains. The anti-CD19 CAR T cells are expanded and infused back into the patient, where they can recognize and eliminate CD19-expressing target cells.</paragraph>
                  <paragraph>TECARTUS is prepared from the patient's peripheral blood mononuclear cells, which are obtained via a standard leukapheresis procedure. The mononuclear cells are enriched for T cells and activated with anti-CD3 and anti-CD28 antibodies in the presence of IL-2, then transduced with a replication-incompetent retroviral vector containing the anti-CD19 CAR transgene. The transduced T cells are expanded in cell culture, washed, formulated into a suspension, and cryopreserved. The manufacture of TECARTUS includes a T cell enrichment step that may reduce the likelihood of circulating CD19-expressing tumor cells in patients' leukapheresis material driving the activation, expansion, and exhaustion of the anti-CD19 CAR T cells during the <content styleCode="italics">ex vivo</content> manufacturing process. The product must pass a sterility test before release for shipping as a frozen suspension in a patient-specific infusion bag. The product is thawed prior to infusion <content styleCode="italics">[see <linkHtml href="#S2.2">Dosage and Administration (2.2)</linkHtml>, <linkHtml href="#S16">How Supplied/Storage and Handling (16)</linkHtml>]</content>.</paragraph>
                  <paragraph>In addition to T cells, TECARTUS may contain natural killer (NK) cells. The formulation contains CryoStor (dimethyl sulfoxide [DMSO], final concentration, 5%), sodium chloride (NaCl), and Human Serum Albumin (HSA).</paragraph>
               </text>
               <effectiveTime value="20210228"/>
            </section>
         </component>
         <component>
            <section ID="S12">
               <id root="98ed88d1-d61c-4a4c-950e-e1858a61bb22"/>
               <code code="34090-1" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL PHARMACOLOGY SECTION"/>
               <title>12 CLINICAL PHARMACOLOGY</title>
               <effectiveTime value="20210228"/>
               <component>
                  <section ID="S12.1">
                     <id root="9cefff7a-5b5c-4b26-8460-b6cfa60ab8be"/>
                     <code code="43679-0" codeSystem="2.16.840.1.113883.6.1" displayName="MECHANISM OF ACTION SECTION"/>
                     <title>12.1 Mechanism of Action</title>
                     <text>
                        <paragraph>TECARTUS, a CD19-directed genetically modified autologous T cell immunotherapy, binds to CD19-expressing cancer cells and normal B cells. Studies demonstrated that following anti-CD19 CAR T cell engagement with CD19-expressing target cells, the CD28 and CD3-zeta co-stimulatory domains activate downstream signaling cascades that lead to T cell activation, proliferation, acquisition of effector functions, and secretion of inflammatory cytokines and chemokines. This sequence of events leads to killing of CD19-expressing cells.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S12.2">
                     <id root="173c0d42-6f2c-4828-b6d5-45b9629dd054"/>
                     <code code="43681-6" codeSystem="2.16.840.1.113883.6.1" displayName="PHARMACODYNAMICS SECTION"/>
                     <title>12.2 Pharmacodynamics</title>
                     <text>
                        <paragraph>After TECARTUS infusion, pharmacodynamic responses were evaluated over a four-week interval by measuring transient elevation of cytokines, chemokines, and other molecules in blood. Levels of cytokines and chemokines such as IL-6, IL-8, IL-10, IL-15, TNF-α, IFN-γ, and sIL2Rα were analyzed. Peak elevation was generally observed between four and eight days after infusion, and levels generally returned to baseline within 28 days.</paragraph>
                        <paragraph>Due to the on-target effect of TECARTUS, a period of B cell aplasia is expected.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
               <component>
                  <section ID="S12.3">
                     <id root="6ef942f9-2b14-478a-959e-f1ae925b5039"/>
                     <code code="43682-4" codeSystem="2.16.840.1.113883.6.1" displayName="PHARMACOKINETICS SECTION"/>
                     <title>12.3 Pharmacokinetics</title>
                     <text>
                        <paragraph>Following infusion (target dose of 2 × 10<sup>6</sup> anti-CD19 CAR T cells/kg) of TECARTUS, anti-CD19 CAR T cells exhibited an initial rapid expansion followed by a decline to near baseline levels by three months. Peak levels of anti-CD19 CAR T cells occurred within the first seven to 15 days after TECARTUS infusion.</paragraph>
                        <paragraph>The number of anti-CD19 CAR T cells in blood was associated with objective response [complete remission (CR) or partial remission (PR)]. The median peak anti-CD19 CAR T cell level in responders was 102.4 cells/μL (range: 0.2 to 2589.5 cells/μL; n = 51), and in nonresponders was 12.0 cells/μL (range: 0.2 to 1364.0 cells/μL, n = 8). The median AUC<sub>Day 0–28</sub> in patients with an objective response was 1487.0 cells/μL∙days (range: 3.8 to 2.77E+04 cells/μL∙days; n = 51) versus 169.5 cells/μL∙days in nonresponders (range: 1.8 to 1.17E+04 cells/μL∙days; n = 8).</paragraph>
                        <paragraph>Median peak anti-CD19 CAR T-cell and AUC<sub>0–28</sub> levels in patients who received neither corticosteroids nor tocilizumab (peak: 24.7 cells/μL; AUC<sub>0–28</sub>: 360.4 cells/μL∙days, n = 18) was similar to patients who received corticosteroids alone (peak: 24.2 cells/μL; AUC<sub>0–28</sub>: 367.8 cells/μL∙days, n = 2); both groups were lower than patients who received tocilizumab alone (peak: 86.5 cells/μL; AUC<sub>0–28</sub>: 1188.9 cells/μL∙days, n = 10); the highest exposure was in patients who received both corticosteroids and tocilizumab (peak: 167.2 cells/μL; AUC<sub>0–28</sub>: 1996.0 cells/μL∙days, n = 37).</paragraph>
                        <paragraph>Median peak anti-CD19 CAR T-cell values were 74.1 cells/μL in patients ≥ 65 years of age (n = 39) and 112.5 cells/μL in patients &lt; 65 years of age (n = 28). Median anti-CD19 CAR T-cell AUC <sub>Day 0–28</sub> values were 876.5 cells/μL∙day in patients ≥ 65 years of age and 1640.2 cells/μL∙day in patients &lt; 65 years of age.</paragraph>
                        <paragraph>Gender had no significant impact on AUC<sub>Day 0–28</sub> and C<sub>max</sub> of TECARTUS.</paragraph>
                        <paragraph>Hepatic and renal impairment studies of TECARTUS were not conducted.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S13">
               <id root="de117881-26b7-4816-81f8-2b9691213c99"/>
               <code code="43680-8" codeSystem="2.16.840.1.113883.6.1" displayName="NONCLINICAL TOXICOLOGY SECTION"/>
               <title>13 NONCLINICAL TOXICOLOGY</title>
               <effectiveTime value="20210228"/>
               <component>
                  <section ID="S13.1">
                     <id root="b09275cc-24b7-4555-8d23-aa7b59359dee"/>
                     <code code="34083-6" codeSystem="2.16.840.1.113883.6.1" displayName="CARCINOGENESIS &amp; MUTAGENESIS &amp; IMPAIRMENT OF FERTILITY SECTION"/>
                     <title>13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility</title>
                     <text>
                        <paragraph>No carcinogenicity or genotoxicity studies have been conducted with TECARTUS. No studies have been conducted to evaluate the effects of TECARTUS on fertility.</paragraph>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S14">
               <id root="0d778b2b-101f-463e-807a-2439a2e4afcf"/>
               <code code="34092-7" codeSystem="2.16.840.1.113883.6.1" displayName="CLINICAL STUDIES SECTION"/>
               <title>14 CLINICAL STUDIES</title>
               <effectiveTime value="20210228"/>
               <component>
                  <section ID="S14.1">
                     <id root="16500240-984c-420a-b947-386f2c4c55fa"/>
                     <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
                     <title>14.1  Relapsed or Refractory Mantle Cell Lymphoma</title>
                     <text>
                        <paragraph>A single-arm, open-label, multicenter trial (ZUMA-2; NCT02601313) evaluated the efficacy and safety of a single infusion of TECARTUS in adult patients with relapsed or refractory mantle cell lymphoma (MCL) who had previously received anthracycline- or bendamustine-containing chemotherapy, an anti-CD20 antibody, and a Bruton tyrosine kinase inhibitor (BTKi; ibrutinib or acalabrutinib). Eligible patients also had disease progression after their last regimen or refractory disease to their most recent therapy. The study excluded patients with active or serious infections, prior allogeneic hematopoietic stem cell transplant (HSCT), detectable cerebrospinal fluid malignant cells or brain metastases, and any history of central nervous system (CNS) lymphoma or CNS disorders.</paragraph>
                        <paragraph>Seventy-four patients were leukapheresed, five (7%) of whom did not begin conditioning chemotherapy or receive TECARTUS: three (4%) experienced manufacturing failure, one (1%) died of progressive disease, and one (1%) withdrew from the study. One patient (1%) received lymphodepleting chemotherapy but did not receive TECARTUS due to ongoing active atrial fibrillation. Sixty-eight of the patients who were leukapheresed received a single infusion of TECARTUS, and 60 of these patients were followed for at least six months after their first objective disease response, qualifying them as efficacy-evaluable. Among the 60 efficacy-evaluable patients, 2 × 10<sup>6</sup> CAR-positive viable T cells/kg were administered to 54 (90%). The remaining six (10%) patients received doses of 1.0, 1.6, 1.8, 1.8, 1.9, and 1.9 × 10<sup>6</sup> CAR-positive viable T cells/kg.</paragraph>
                        <paragraph>Of the 60 efficacy-evaluable patients, the median age was 65 years (range: 38 to 79 years), 51 (85%) were male, and 56 (93%) were white. Most (50 patients; 83%) had stage IV disease. Twenty patients (33% of 60) had baseline bone marrow examinations performed per protocol; of these, ten (50%) were negative, eight (40%) were positive, and two (10%) were indeterminate. The median number of prior therapies among all 60 efficacy-evaluable patients was three (range: two to five). Twenty-six (43%) of the patients had relapsed after or were refractory to autologous HSCT. Twenty-one (35%) had relapsed after their last therapy for MCL, while 36 (60%) were refractory to their last therapy for MCL. Among the 60 efficacy-evaluable patients, 14 (23%) had blastoid MCL. Following leukapheresis and prior to administration of TECARTUS, 21 (35%) of the 60 patients received bridging therapy. Sixteen (27%) were treated with a BTKi, 9 (15%) with a corticosteroid, and 4 (7%) with both a BTKi and a corticosteroid.</paragraph>
                        <paragraph>Among the 60 efficacy-evaluable patients, the median time from leukapheresis to product delivery was 15 days (range: 11 to 28 days), and the median time from leukapheresis to product infusion was 27 days (range: 19 to 63 days). The protocol-defined lymphodepleting chemotherapy regimen of cyclophosphamide 500 mg/m<sup>2</sup> intravenously and fludarabine 30 mg/m<sup>2</sup> intravenously, both given on each of the fifth, fourth, and third days before TECARTUS infusion, was administered to 53 (88%) of the 60 efficacy-evaluable patients. The remaining seven patients (12%) either received lymphodepletion over four or more days or received TECARTUS four or more days after completing lymphodepletion. All treated patients received TECARTUS infusion on Day 0 and were hospitalized until at least Day 7.</paragraph>
                        <paragraph>The primary endpoint of objective response rate (ORR) per the Lugano Classification (2014) in patients treated with TECARTUS as determined by an independent review committee is provided in Table 5. The median time to response was 28 days (range: 24 to 92 days) with a median follow-up time for DOR of 8.6 months.</paragraph>
                        <table width="75%" ID="table5">
                           <caption>Table 5	Efficacy Results in Adult Patients with Relapsed/Refractory MCL</caption>
                           <col width="34%" align="left" valign="top"/>
                           <col width="33%" align="center" valign="top"/>
                           <col width="33%" align="center" valign="top"/>
                           <thead>
                              <tr>
                                 <th styleCode="Lrule Rrule"/>
                                 <th styleCode="Rrule">Efficacy-Evaluable Patients<br/>N = 60</th>
                                 <th styleCode="Rrule">All Leukapheresed Patients (ITT)<br/>N = 74</th>
                              </tr>
                           </thead>
                           <tfoot>
                              <tr>
                                 <td align="left" colspan="3">CI, confidence interval; CR, complete remission; DOR, duration of response; NE, not estimable; NR, not reached; PR, partial remission.</td>
                              </tr>
                           </tfoot>
                           <tbody>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule" colspan="3">
                                    <content styleCode="bold">Response Rate </content>
                                 </td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">Objective Response Rate<footnote>Among all responders. DOR is measured from the date of first objective response to the date of progression or death.</footnote>, n (%) [95% CI]</td>
                                 <td styleCode="Rrule" valign="middle">52 (87%) [75, 94]</td>
                                 <td styleCode="Rrule">59 (80%) [69, 88]</td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">Complete Remission Rate, n (%)[95% CI]</td>
                                 <td styleCode="Rrule" valign="middle">37 (62%) [48, 74]</td>
                                 <td styleCode="Rrule">41 (55%) [43, 67]</td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">Partial Remission Rate, n (%) [95% CI]</td>
                                 <td styleCode="Rrule" valign="middle">15 (25%) [15, 38]</td>
                                 <td styleCode="Rrule">18 (24%) [15, 36]</td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule" colspan="3">
                                    <content styleCode="bold">Duration of Response (DOR)</content>
                                 </td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">Median in months [95% CI]<br/>  Range<footnote ID="t5fb">A + sign indicates a censored value.</footnote>  in months</td>
                                 <td styleCode="Rrule">NR [8.6, NE]<br/>0.0+, 29.2+</td>
                                 <td styleCode="Rrule">NR [8.6, NE]<br/>0.0+, 29.2+</td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">DOR, if best response is CR, median in months [95% CI]<br/>  Range<footnoteRef IDREF="t5fb"/> in months</td>
                                 <td styleCode="Rrule">NR [13.6, NE]<br/>1.9+, 29.2+</td>
                                 <td styleCode="Rrule">NR [13.6, NE]<br/>0.0+, 29.2+</td>
                              </tr>
                              <tr styleCode="Botrule">
                                 <td styleCode="Lrule Rrule">DOR, if best response is PR, median in months [95% CI]<br/>  Range<footnoteRef IDREF="t5fb"/> in months</td>
                                 <td styleCode="Rrule">2.2 [1.5, 5.1]<br/>0.0+, 22.1+</td>
                                 <td styleCode="Rrule">2.2 [1.5, 5.1]<br/>0.0+, 22.1+</td>
                              </tr>
                              <tr>
                                 <td styleCode="Lrule Rrule">Median Follow-up for DOR in months<footnote>At the time of primary analysis.</footnote>
                                 </td>
                                 <td styleCode="Rrule">8.6</td>
                                 <td styleCode="Rrule">8.1</td>
                              </tr>
                           </tbody>
                        </table>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S15">
               <id root="81b802a8-6be6-4ba4-b370-a8312c002c9c"/>
               <code code="34093-5" codeSystem="2.16.840.1.113883.6.1" displayName="REFERENCES SECTION"/>
               <title>15 REFERENCES</title>
               <text>
                  <list listType="ordered" styleCode="Arabic">
                     <item>Lee DW et al (2014). Current concepts in the diagnosis and management of cytokine release syndrome. Blood. 2014 Jul 10; 124(2): 188-195.</item>
                  </list>
               </text>
               <effectiveTime value="20210228"/>
            </section>
         </component>
         <component>
            <section ID="S16">
               <id root="32728460-c7db-4800-88a1-4f44b7c61a60"/>
               <code code="34069-5" codeSystem="2.16.840.1.113883.6.1" displayName="HOW SUPPLIED SECTION"/>
               <title>16 HOW SUPPLIED/STORAGE AND HANDLING</title>
               <text>
                  <paragraph>TECARTUS is supplied in an infusion bag (NDC 71287-219-01) containing approximately 68 mL of frozen suspension of genetically modified autologous T cells in 5% DMSO and  human serum albumin.</paragraph>
                  <paragraph>Each TECARTUS infusion bag is individually packed in a metal cassette (NDC 71287-219-02). TECARTUS is stored in the vapor phase of liquid nitrogen and supplied in a liquid nitrogen dry shipper.</paragraph>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <section>
                     <id root="acebcecf-743e-464a-a494-91817efbda18"/>
                     <code code="44425-7" codeSystem="2.16.840.1.113883.6.1" displayName="STORAGE AND HANDLING SECTION"/>
                     <text>
                        <list listType="unordered" styleCode="disc">
                           <item>Match the identity of the patient with the patient identifiers on the cassette and infusion bag upon receipt.</item>
                           <item>Store TECARTUS frozen in the vapor phase of liquid nitrogen (less than or equal to minus 150°C).</item>
                           <item>Thaw before using <content styleCode="italics">[see <linkHtml href="#S2">Dosage and Administration (2)</linkHtml>].</content>
                           </item>
                        </list>
                     </text>
                     <effectiveTime value="20210228"/>
                  </section>
               </component>
            </section>
         </component>
         <component>
            <section ID="S17">
               <id root="bf908878-69a9-4578-b104-f4275843ef62"/>
               <code code="34076-0" codeSystem="2.16.840.1.113883.6.1" displayName="INFORMATION FOR PATIENTS SECTION"/>
               <title>17 PATIENT COUNSELING INFORMATION</title>
               <text>
                  <paragraph>Advise the patient to read the FDA-approved patient labeling (Medication Guide).</paragraph>
                  <paragraph>Ensure that patients understand the risk of manufacturing failure (4% in clinical trial). In case of a manufacturing failure, a second manufacturing of TECARTUS may be attempted. In addition, while the patient awaits the product, additional chemotherapy (not the lymphodepletion) may be necessary and may increase the risk of adverse events during the pre-infusion period.</paragraph>
                  <paragraph>Advise patients to seek immediate attention for any of the following:</paragraph>
                  <list listType="unordered" styleCode="disc">
                     <item>
                        <content styleCode="underline">Cytokine Release Syndrome (CRS)</content> - Signs or symptoms associated with CRS, including fever, chills, fatigue, tachycardia, nausea, hypoxia, and hypotension <content styleCode="italics">[see <linkHtml href="#S5.1">Warnings and Precautions (5.1)</linkHtml> and <linkHtml href="#S6">Adverse Reactions (6)</linkHtml>]</content>.</item>
                     <item>
                        <content styleCode="underline">Neurologic Toxicities</content> - Signs or symptoms associated with neurologic events, including encephalopathy, seizures, changes in level of consciousness, speech disorders, tremors, and confusion <content styleCode="italics">[see <linkHtml href="#S5.2">Warnings and Precautions (5.2)</linkHtml> and <linkHtml href="#S6">Adverse Reactions (6)</linkHtml>]</content>.</item>
                     <item>
                        <content styleCode="underline">Severe Infections</content> - Signs or symptoms associated with infection <content styleCode="italics">[see <linkHtml href="#S5.5">Warnings and Precautions (5.5)</linkHtml> and <linkHtml href="#S6">Adverse Reactions (6)</linkHtml>]</content>.</item>
                     <item>
                        <content styleCode="underline">Prolonged Cytopenia</content> - Signs or symptoms associated with bone marrow suppression, including neutropenia, anemia, thrombocytopenia, or febrile neutropenia <content styleCode="italics">[see <linkHtml href="#S5.6">Warnings and Precautions (5.6)</linkHtml> and <linkHtml href="#S6">Adverse Reactions (6)</linkHtml>].</content>
                     </item>
                  </list>
                  <paragraph>Advise patients of the need to:</paragraph>
                  <list listType="unordered" styleCode="disc">
                     <item>Refrain from driving or operating heavy or potentially dangerous machinery for at least eight weeks after TECARTUS infusion <content styleCode="italics">[see <linkHtml href="#S5.9">Warnings and Precautions (5.9)</linkHtml>]</content>.</item>
                     <item>Have periodic monitoring of blood counts.</item>
                     <item>Contact Kite at 1-844-454-KITE (5483) if they are diagnosed with a secondary malignancy <content styleCode="italics">[see <linkHtml href="#S5.8">Warnings and Precautions (5.8)</linkHtml>]</content>.</item>
                  </list>
               </text>
               <effectiveTime value="20210228"/>
            </section>
         </component>
         <component>
            <section>
               <id root="deb840a4-0824-470b-be71-9154862bae93"/>
               <code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
               <text>
                  <paragraph>Manufactured by, Packed by, Distributed by: <br/>Kite Pharma, Inc.<br/>Santa Monica, CA 90404<br/>US License No 2064</paragraph>
                  <paragraph>© 2021 Kite Pharma, Inc.  All Rights Reserved.</paragraph>
                  <paragraph>125703-GS-001</paragraph>
               </text>
               <effectiveTime value="20210228"/>
            </section>
         </component>
         <component>
            <section ID="MEDGUIDE">
               <id root="594d9990-7559-478a-a984-69a09cb2b06a"/>
               <code code="42231-1" codeSystem="2.16.840.1.113883.6.1" displayName="SPL MEDGUIDE SECTION"/>
               <text>
                  <table width="100%">
                     <col width="100%" align="left" valign="top"/>
                     <tbody>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule" align="center">
                              <content styleCode="bold">MEDICATION GUIDE<br/>TECARTUS (pronounced tek-ahr-tuhs)<br/>(brexucabtagene autoleucel)</content>
                           </td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">Read this Medication Guide before you start your TECARTUS treatment. The more you know about your treatment, the more active you can be in your care. Talk with your healthcare provider if you have questions about your health condition or treatment. Reading this Medication Guide does not take the place of talking with your healthcare provider about your treatment. </td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">What is the most important information I should know about TECARTUS?</content>
                              <br/>TECARTUS may cause side effects that are life-threatening and can lead to death. Call or see your doctor or get emergency help right away if you get any of the following:<list listType="unordered" styleCode="disc">
                                 <item>Fever (100.4°F/38°C or higher)</item>
                                 <item>Difficulty breathing </item>
                                 <item>Chills or shaking chills</item>
                                 <item>Confusion</item>
                                 <item>Dizziness or lightheadedness</item>
                                 <item>Severe nausea, vomiting, or diarrhea</item>
                                 <item>Fast or irregular heartbeat</item>
                                 <item>Severe fatigue or weakness</item>
                              </list>It is important to tell your healthcare provider that you received TECARTUS and to show them your TECARTUS Patient Wallet Card. Your healthcare provider may give you other medicines to treat your side effects.</td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">What is TECARTUS?</content>
                              <br/>TECARTUS is a treatment for your mantle cell lymphoma. It is used following disease progression while on or after other treatment. TECARTUS is different than other cancer medicines because it is made from your own white blood cells, which have been modified to recognize and attack your lymphoma cells.</td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">Before getting TECARTUS, tell your healthcare provider about all your medical problems, including if you have or have had:</content>
                              <list listType="unordered" styleCode="disc">
                                 <item>Neurologic problems (such as seizures, stroke, or memory loss)</item>
                                 <item>Lung or breathing problems</item>
                                 <item>Heart problems</item>
                                 <item>Liver problems</item>
                                 <item>Kidney problems</item>
                                 <item>A recent or active infection</item>
                              </list>
                              <content styleCode="bold">Tell your healthcare provider about all the medications you take</content>, including prescription and over-the-counter medicines, vitamins, and herbal supplements.</td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">How will I receive TECARTUS?</content>
                              <list listType="unordered" styleCode="disc">
                                 <item>Since TECARTUS is made from your own white blood cells, your blood will be collected by a process called "leukapheresis" (loo-kah-fur-ee-sis), which will concentrate your white blood cells. </item>
                                 <item>Your blood cells will be sent to a manufacturing center to make your TECARTUS.</item>
                                 <item>Before you get TECARTUS, you will get three days of chemotherapy to prepare your body. </item>
                                 <item>When your TECARTUS is ready, your healthcare provider will give it to you through a catheter placed into your vein (intravenous infusion). The infusion usually takes less than 30 minutes. </item>
                                 <item>You will be monitored where you received your treatment daily for at least seven days after the infusion. </item>
                                 <item>You should plan to stay close to the location where you received your treatment for at least four weeks after getting TECARTUS. Your healthcare provider will help you with any side effects that may occur.</item>
                                 <item>You may be hospitalized for side effects. Your healthcare provider will discharge you if your side effects are under control and it is safe for you to leave the hospital.</item>
                                 <item>Your healthcare provider will want to do blood tests to follow your progress. It is important that you do have your blood tested. If you miss an appointment, call your healthcare provider as soon as possible to reschedule.</item>
                              </list>
                              <content styleCode="bold">What should I avoid after receiving TECARTUS?</content>
                              <list listType="unordered" styleCode="disc">
                                 <item>Do not drive, operate heavy machinery, or do other dangerous things for eight weeks after you get TECARTUS because the treatment can cause sleepiness, confusion, weakness, and temporary memory and coordination problems. </item>
                                 <item>Do not donate blood, organs, tissues, or cells for transplantation.</item>
                              </list>
                           </td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">What are the possible or reasonably likely side effects of TECARTUS?</content>
                              <br/>The most common side effects of TECARTUS include<content styleCode="bold">:</content>
                              <list listType="unordered" styleCode="disc">
                                 <item>Fever (100.4°F/38°C or higher)</item>
                                 <item>Low white blood cells (can occur with a fever)</item>
                                 <item>Low red blood cells</item>
                                 <item>Low blood pressure (dizziness or lightheadedness, headache, feeling tired, short of breath)</item>
                                 <item>Fast heartbeat</item>
                                 <item>Confusion</item>
                                 <item>Difficulty speaking or slurred speech</item>
                                 <item>Nausea</item>
                                 <item>Diarrhea</item>
                              </list>These are not all the possible side effects of TECARTUS. Call your healthcare provider about any side effects that concern you. You may report side effects to the FDA at 1-800-FDA-1088.</td>
                        </tr>
                        <tr styleCode="Botrule">
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">General information about the safe and effective use of TECARTUS</content>
                              <br/>Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. If you would like more information about TECARTUS, talk with your healthcare provider. You can ask your healthcare provider for information about TECARTUS that is written for health professionals. You can get additional information by contacting Kite at 1-844-454-KITE (5483) or at www.Tecartus.com.</td>
                        </tr>
                        <tr>
                           <td styleCode="Lrule Rrule">
                              <content styleCode="bold">What are the ingredients in TECARTUS?<br/>Active ingredients:</content> brexucabtagene autoleucel.<br/>
                              <content styleCode="bold">Inactive ingredients:</content> albumin (human); DMSO.</td>
                        </tr>
                     </tbody>
                  </table>
                  <paragraph>TECARTUS is a trademark of Kite Pharma, Inc.  All other trademarks referenced herein are the property of their respective owners.</paragraph>
                  <paragraph>© 2021 Kite Pharma, Inc.  All Rights Reserved.</paragraph>
               </text>
               <effectiveTime value="20210228"/>
            </section>
         </component>
         <component>
            <section>
               <id root="d29f7be7-0b30-4f15-83a3-10312a2a46d7"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 68 mL Bag Label - Product</title>
               <text>
                  <paragraph>NDC 71287-219-01</paragraph>
                  <paragraph>brexucabtagene autoleucel<br/>TECARTUS<sup>®</sup>
                  </paragraph>
                  <paragraph>Rx ONLY<br/>FOR AUTOLOGOUS &amp; INTRAVENOUS USE ONLY<br/>No U.S. standard of potency</paragraph>
                  <paragraph>Dose: One sterile bag for infusion.</paragraph>
                  <paragraph>Contents: Maximum of 2 x 10<sup>8</sup> autologous anti-CD19 CAR T cells in<br/>approximately 68 mL suspension containing 5% DMSO USP.</paragraph>
                  <paragraph>Gently mix the contents of<br/>the bag while thawing</paragraph>
                  <paragraph>See package insert for full<br/>prescribing information and<br/>instructions for administration</paragraph>
                  <paragraph>Ship and store in vapor phase<br/>of liquid nitrogen ≤ -150°C</paragraph>
                  <paragraph>DO NOT USE A<br/>LEUKODEPLETING FILTER</paragraph>
                  <paragraph>DO NOT IRRADIATE</paragraph>
                  <paragraph>Manufactured with gentamicin</paragraph>
                  <paragraph>Not evaluated for infectious<br/>substances</paragraph>
                  <paragraph>Preservative free</paragraph>
                  <paragraph>Manufacturer: Kite Pharma, Inc., El Segundo, CA 90245<br/>Phone: 1-844-454-KITE U.S. Lic. #2064</paragraph>
                  <paragraph>AS-02443</paragraph>
                  <renderMultiMedia referencedObject="MM1"/>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <observationMedia ID="MM1">
                     <text>PRINCIPAL DISPLAY PANEL - 68 mL Bag Label - Product</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="brexucabtagene-01.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="708096ae-6044-42a7-8b3a-42d7a087e635"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 68 mL Cassette Label - Product</title>
               <text>
                  <paragraph>NDC 71287-219-02</paragraph>
                  <paragraph>brexucabtagene autoleucel<br/>TECARTUS<sup>®</sup>
                  </paragraph>
                  <paragraph>Rx ONLY<br/>FOR AUTOLOGOUS &amp; INTRAVENOUS USE ONLY<br/>No U.S. standard of potency</paragraph>
                  <paragraph>Dose: One sterile bag for infusion.</paragraph>
                  <paragraph>Contents: Maximum of 2 x 10<sup>8</sup> autologous anti-CD19 CAR T cells in<br/>approximately 68 mL suspension containing 5% DMSO USP.</paragraph>
                  <paragraph>Gently mix the contents of<br/>the bag while thawing</paragraph>
                  <paragraph>See package insert for full<br/>prescribing information and<br/>instructions for administration</paragraph>
                  <paragraph>Ship and store in vapor phase<br/>of liquid nitrogen ≤ -150°C</paragraph>
                  <paragraph>DO NOT USE A<br/>LEUKODEPLETING FILTER</paragraph>
                  <paragraph>DO NOT IRRADIATE</paragraph>
                  <paragraph>Manufactured with gentamicin</paragraph>
                  <paragraph>Not evaluated for infectious<br/>substances</paragraph>
                  <paragraph>Preservative free</paragraph>
                  <paragraph>Manufacturer: Kite Pharma, Inc., El Segundo, CA 90245<br/>Phone: 1-844-454-KITE U.S. Lic. #2064</paragraph>
                  <paragraph>AS-02445</paragraph>
                  <renderMultiMedia referencedObject="MM2"/>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <observationMedia ID="MM2">
                     <text>PRINCIPAL DISPLAY PANEL - 68 mL Cassette Label - Product</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="brexucabtagene-02.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="9aefcd69-0281-492f-81c9-56b5a817db45"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 68 mL Bag Label - Patient</title>
               <text>
                  <paragraph>VERIFY<br/>PATIENT ID</paragraph>
                  <paragraph>brexucabtagene autoleucel<br/>TECARTUS<sup>®</sup>
                  </paragraph>
                  <paragraph>Lot: 123456789-0X</paragraph>
                  <paragraph>Kite Patient ID: 123456789</paragraph>
                  <paragraph>Expiration Date: 31-Dec-2900</paragraph>
                  <paragraph>First Name M.I.: FIRST NAME W</paragraph>
                  <paragraph>Last Name: LAST NAME</paragraph>
                  <paragraph>DOB: 31-Dec-1900</paragraph>
                  <paragraph>Hospital Patient ID: 1234567890123456</paragraph>
                  <paragraph>DIN:</paragraph>
                  <paragraph>W0123 45 678900<br/>00<br/>9</paragraph>
                  <paragraph>AS-02442</paragraph>
                  <renderMultiMedia referencedObject="MM3"/>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <observationMedia ID="MM3">
                     <text>PRINCIPAL DISPLAY PANEL - 68 mL Bag Label - Patient</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="brexucabtagene-03.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="a0273f76-9893-45cc-af8c-7623b9d1c9cd"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 68 mL Cassette Label - Patient</title>
               <text>
                  <paragraph>STOP<br/>Confirm patient<br/>ID prior to<br/>infusion</paragraph>
                  <paragraph>VERIFY<br/>PATIENT ID</paragraph>
                  <paragraph>brexucabtagene autoleucel<br/>TECARTUS<sup>®</sup>
                  </paragraph>
                  <paragraph>Lot: 123456789-0X</paragraph>
                  <paragraph>Kite Patient ID: 123456789</paragraph>
                  <paragraph>Expiration Date: 31-Dec-2900</paragraph>
                  <paragraph>First Name M.I.: FIRST NAME W</paragraph>
                  <paragraph>Last Name: LAST NAME</paragraph>
                  <paragraph>DOB: 31-Dec-1900</paragraph>
                  <paragraph>Hospital Patient ID: 1234567890123456</paragraph>
                  <paragraph>DIN:</paragraph>
                  <paragraph>W0123 45 678900<br/>00<br/>9</paragraph>
                  <paragraph>AS-02444</paragraph>
                  <renderMultiMedia referencedObject="MM4"/>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <observationMedia ID="MM4">
                     <text>PRINCIPAL DISPLAY PANEL - 68 mL Cassette Label - Patient</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="brexucabtagene-04.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
         <component>
            <section>
               <id root="9179bea7-1f77-4440-b9c0-d87320c65c33"/>
               <code code="51945-4" codeSystem="2.16.840.1.113883.6.1" displayName="PACKAGE LABEL.PRINCIPAL DISPLAY PANEL"/>
               <title>PRINCIPAL DISPLAY PANEL - 68 mL LN2 Label</title>
               <text>
                  <paragraph>brexucabtagene autoleucel<br/>TECARTUS<sup>®</sup>
                     <br/>
                  </paragraph>
                  <paragraph>Kite Pharma, Inc.<br/>Site: FXX</paragraph>
                  <paragraph>Cell Order: 123456789</paragraph>
                  <paragraph>LOT: 123456789-01</paragraph>
                  <paragraph>Mfg Address Street, City, State Postal Code<br/>(XXX) XXX-XXXX</paragraph>
                  <paragraph>AS-02447</paragraph>
                  <renderMultiMedia referencedObject="MM5"/>
               </text>
               <effectiveTime value="20210228"/>
               <component>
                  <observationMedia ID="MM5">
                     <text>PRINCIPAL DISPLAY PANEL - 68 mL LN2 Label</text>
                     <value xsi:type="ED" mediaType="image/jpeg">
                        <reference value="brexucabtagene-05.jpg"/>
                     </value>
                  </observationMedia>
               </component>
            </section>
         </component>
      </structuredBody>
   </component>
</document>