A Phase II, single arm, multicenter open label trial to determine the safety and efficacy of tisagenlecleucel in pediatric patients with relapsed or refractory mature B-cell non-Hodgkin lymphoma (NHL) (BIANCA)

The purpose of the study was to assess the efficacy and safety of tisagenlecleucel in
pediatric, adolescent and young adult patients with relapsed/refractory B-cell non-Hodgkin
lymphoma (r/r B-NHL) including Burkitt Lymphoma and Burkitt Leukemia.

For pediatric patients who have r/r B-NHL including Burkitt Lymphoma and Burkitt Leukemia,
survival rates are dismal, only ~20-50% subjects are alive at 2 years with overall response
rate (ORR) of 20-30% after conventional salvage chemotherapy.

Inclusion Criteria:

- Histologically confirmed pediatric mature B-cell non-Hodgkin lymphoma (B-cell NHL)
including the following subtypes; Burkitt lymphoma/ Burkitt leukemia (BL), diffuse
large B-cell lymphoma (DLBCL), primary mediastinal B-cell lymphoma (PMBCL), gray zone
lymphoma (GZL), and follicular lymphoma (FL) Note: Patients with B-cell NHL associated
with Nijmegen breakage syndrome will be allowed.

- Patients <25 years of age and weighing at least 6 kg at the time of screening

- Patients who have relapsed after one or more prior therapies (can include allogeneic
and autologous hematopoietic stem cell transplant) or are primary refractory (have not
achieved a CR or PR after the first line of therapy)

- Measurable disease by radiological criteria in all patients at the time of screening.
Patients with Burkitt leukemia who don't meet radiological criteria must have bone
marrow involvement of >25% by local assessment of bone marrow aspirate and/or biopsy.

- Karnofsky (age ≥16 years) or Lansky (age <16 years) performance status ≥60.

- Adequate bone marrow reserve without transfusions (transfusion >2 weeks prior to
laboratory assessment is allowed) defined as:

1. Absolute neutrophil count (ANC) >1000/mm3

2. Platelets ≥50000//mm3

3. Hemoglobin ≥8.0 g/dl

- Adequate organ function defined as:

1. a serum creatinine (sCR) based on gender/age as follows: Maximum Serum Creatinine
(mg/dL) Age Male Female

1 to <2 years 0.6 0.6 2 to <6 years 0.8 0.8 6 to <10 years 1.0 1.0 10 to <13
years 1.2 1.2 13 to <16 years 1.5 1.4

≥16 years 1.7 1.4

2. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤5 times the
upper limit of normal (ULN) for age

3. Total bilirubin <2 mg/dL (for Gilbert's Syndrome patients total bilirubin <4
mg/dL)

4. Adequate pulmonary function

i. Oxygen saturation of >91% on room air ii. No or mild dyspnea (≤Grade 1)

- Must have a leukapheresis material of non-mobilized cells accepted for manufacturing.

Exclusion Criteria:

- Prior gene therapy or engineered T cell therapy.

- Prior treatment with any anti-CD19 therapy.

- Allogeneic hematopoietic stem cell transplant (HSCT) <3 months prior to screening and
≤4 months prior to infusion.

- Presence of grade 2 to 4 acute or extensive chronic graft-versus-host disease (GVHD)
in patients who received prior allogeneic HSCT.

- Prior diagnosis of malignancy other than study indication, and not disease free for 5
years.

- Clinically significant active infection confirmed by clinical evidence, imaging, or
positive laboratory tests (e.g., blood cultures, PCR for DNA/RNA, etc.)

- Presence of active hepatitis B or C as indicated by serology.

- Human Immunodeficiency Virus (HIV) positive test.

- Active neurological autoimmune or inflammatory disorders not related to B cell NHL
(eg: Guillain-Barre syndrome, Amyotrophic Lateral Sclerosis)

- Active central nervous system (CNS) involvement by malignancy.

- Patients with B-cell NHL in the context of post-transplant lymphoproliferative
disorders (PTLD) associated lymphomas.