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Lyfgenia
lovotibeglogene autotemcel
Black Box Warnings .
Hematologic Malignancy
incl. acute myeloid leukemia and myelodysplastic syndrome has occurred; monitor CBC w/ diff at least q6mo for at least 15y after tx; perform integration site analysis at 6mo, 12mo, and as warranted; contact bluebird bio at 1-833-999-6378 to report malignancy occurrence and obtain instructions on sample collection for testing
Adult Dosing .
Dosage forms: INJ
Restricted Distribution in US
- [1-833-999-6378 or www.lyfgenia.com for more info]
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, prophylactic regimens, and dosing
sickle cell dz
- [3 x10^6 CD34+ cells/kg/dose IV x1]
- Start: at least 48h after myeloablative conditioning w/ busulfan; Info: for pts w/ vaso-occlusive event hx; target Hgb 8-10, HgbS <30% for at least 60 days before mobilization, through myeloablative conditioning; do not start myeloablative conditioning until confirming lovotibeglogene autotemcel infusion bag(s) at tx facility and back-up collection of CD34+ cells available
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Peds Dosing .
- Dosage forms: INJ
Restricted Distribution in US
- [1-833-999-6378 or www.lyfgenia.com for more info]
Special Note
- [uses, dosing may vary]
- Info: refer to institution protocols and pkg insert prior to prescribing for uses, prophylactic regimens, and dosing
sickle cell dz
- [12 yo and older]
- Dose: 3 x10^6 CD34+ cells/kg/dose IV x1; Start: at least 48h after myeloablative conditioning w/ busulfan; Info: for pts w/ vaso-occlusive event hx; target Hgb 8-10, HgbS <30% for at least 60 days before mobilization, through myeloablative conditioning; do not start myeloablative conditioning until confirming lovotibeglogene autotemcel infusion bag(s) at tx facility and back-up collection of CD34+ cells available
renal dosing
- [not defined]
- renal impairment: not defined
- HD/PD: not defined
hepatic dosing
- [not defined]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- HIV status, positive or unknown
- pregnancy
- hydroxyurea use w/in 2mo before mobilization and until apheresis completed
- dz-modifying agent use w/in 2mo before mobilization
- erythropoietin use w/in 2mo before mobilization
- iron chelator use w/in 7 days before mobilization
- G-CSF use before and during mobilization
- antiretroviral use w/in at least 1mo before mobilization and until apheresis completed
- hydroxyurea use w/in 2 days before myeloablative conditioning
- dz-modifying agent use w/in 2mo before myeloablative conditioning
- iron chelator use w/in 7 days before myeloablative conditioning
- G-CSF use between mobilization and myeloablative conditioning
- <48h post-myeloablative conditioning
- avoid: non-myelosuppressive iron chelator use x3mo after lovotibeglogene autotemcel tx
- avoid: myelosuppressive iron chelator use x6mo after lovotibeglogene autotemcel tx
- avoid: G-CSF use x21 days after lovotibeglogene autotemcel tx
- avoid: blood donation indefinitely
- avoid: organ donation indefinitely
- avoid: tissue donation indefinitely
- avoid: cell donation indefinitely
- avoid: PCR-based HIV testing after lovotibeglogene autotemcel tx
- caution: female pts of reproductive potential
- caution: male pts of reproductive potential
- caution: alpha-thalassemia trait
Drug Interactions .
Overview
lovotibeglogene autotemcel
gene therapy
- gene therapy
- myelosuppressive effects
Avoid/Use Alternative
- abacavir
- atazanavir
- bictegravir
- cabotegravir
- chloramphenicol
- cladribine oral
- cobicistat
- crizanlizumab
- darunavir
- deferasirox
- deferiprone
- deferoxamine
- dolutegravir
- doravirine
- efavirenz
- eflapegrastim (G-CSF)
- elvitegravir
- emtricitabine
- enfuvirtide
- etravirine
- fexinidazole
- filgrastim (G-CSF)
- fostemsavir
- ganciclovir
- hydroxyurea
- ibalizumab
- L-glutamine
- lamivudine
- lopinavir/ritonavir
- maraviroc
- nevirapine
- pegfilgrastim (G-CSF)
- primaquine
- radium Ra 223 dichloride
- raltegravir
- rilpivirine
- ritonavir
- ropeginterferon alfa-2b
- sargramostim (GM-CSF)
- tenofovir alafenamide
- tenofovir disoproxil
- valganciclovir
- voxelotor
- zidovudine
Monitor/Modify Tx
- abemaciclib
- acalabrutinib
- ado-trastuzumab emtansine
- afamitresgene autoleucel
- albendazole
- aldesleukin
- alemtuzumab
- allopurinol
- anti-thymocyte globulin
- arsenic trioxide
- asciminib
- asenapine
- atidarsagene autotemcel
- auranofin
- axicabtagene ciloleucel
- azacitidine
- azathioprine
- balsalazide
- baricitinib
- belantamab mafodotin
- belinostat
- bendamustine
- benznidazole
- betibeglogene autotemcel
- bevacizumab
- bexarotene
- blinatumomab
- bortezomib
- bosutinib
- brentuximab vedotin
- brexucabtagene autoleucel
- busulfan
- cabazitaxel
- capecitabine
- carboplatin
- carfilzomib
- carmustine
- chlorambucil
- cidofovir
- ciltacabtagene autoleucel
- cisplatin
- cladribine injection
- clofarabine
- clozapine
- colchicine
- copanlisib
- crizotinib
- cyclophosphamide
- cytarabine
- dacarbazine
- dactinomycin
- dapsone
- daratumumab
- dasatinib
- daunorubicin
- decitabine
- deuruxolitinib
- dexrazoxane
- dinutuximab
- docetaxel
- dostarlimab
- doxorubicin
- duvelisib
- eflornithine
- elivaldogene autotemcel
- elranatamab
- enfortumab vedotin
- entrectinib
- epcoritamab
- epirubicin
- eribulin
- etoposide
- everolimus
- fam-trastuzumab deruxtecan
- fedratinib
- floxuridine
- flucytosine
- fludarabine
- fluorouracil
- fluphenazine
- foscarnet
- fostamatinib
- gemcitabine
- gemtuzumab ozogamicin
- givinostat
- glasdegib
- glofitamab
- hydroxychloroquine
- ibritumomab tiuxetan
- ibrutinib
- idarubicin
- idecabtagene vicleucel
- idelalisib
- ifosfamide
- iloperidone
- imatinib
- imetelstat
- inotuzumab ozogamicin
- interferon beta 1a
- interferon beta 1b
- interferon gamma 1b
- irinotecan
- isatuximab
- ivosidenib
- ixabepilone
- leflunomide
- lenalidomide
- lifileucel
- linezolid
- lisocabtagene maraleucel
- lomustine
- lonafarnib
- loncastuximab tesirine
- lumateperone
- lurbinectedin
- lutetium Lu 177 dotatate
- lutetium Lu 177 vipivotide tetraxetan
- lymphocyte immune globulin, anti-thymocyte globulin
- melphalan
- mercaptopurine
- mesalamine
- mesalamine rectal
- methotrexate
- midostaurin
- mitomycin
- mitotane
- mitoxantrone
- mogamulizumab
- momelotinib
- mosunetuzumab
- mycophenolate mofetil
- mycophenolic acid
- nelarabine
- nilotinib
- niraparib
- obecabtagene autoleucel
- obinutuzumab
- ofatumumab
- olaparib
- olsalazine
- omacetaxine mepesuccinate
- oxaliplatin
- paclitaxel
- pacritinib
- palbociclib
- panobinostat
- peginterferon alfa 2a
- peginterferon beta 1a
- pemetrexed
- penicillamine
- pentamidine
- pentostatin
- pirtobrutinib
- polatuzumab vedotin
- pomalidomide
- ponatinib
- pralatrexate
- procarbazine
- proguanil
- pyrimethamine
- quizartinib
- ribavirin
- ribociclib
- rifabutin
- rituximab
- romidepsin
- rucaparib
- ruxolitinib
- ruxolitinib topical
- sacituzumab govitecan
- sarilumab
- satralizumab
- selinexor
- sirolimus
- sirolimus albumin-bound
- stiripentol
- streptozocin
- succimer
- sulfasalazine
- tafasitamab
- tagraxofusp
- talazoparib
- talquetamab
- tarlatamab
- tazemetostat
- teclistamab
- temozolomide
- temsirolimus
- teplizumab
- teriflunomide
- thalidomide
- thioguanine
- thiotepa
- tisagenlecleucel
- tocilizumab
- tofacitinib
- topotecan
- trabectedin
- trastuzumab
- treosulfan
- trifluridine
- trimethoprim
- upadacitinib
- valproic acid
- venetoclax
- vinblastine
- vincristine
- vinorelbine
- zanubrutinib
- ziv-aflibercept
Adverse Reactions .
Serious Reactions
- hematologic malignancy
- Plt engraftment delay
- thrombocytopenia, incl. prolonged
- neutrophil engraftment failure
- neutropenia, incl. prolonged
- febrile neutropenia
- anemia
- lentiviral vector-mediated insertional oncogenesis
- hypersensitivity rxn
- sickle cell crisis
Common Reactions
- stomatitis
- thrombocytopenia
- neutropenia
- febrile neutropenia
- anemia
- ALT or AST incr.
- sickle cell crisis
- GGT incr.
- appetite decr.
- pharyngitis
- nausea
- fever
- infection
- bilirubin incr.
Safety/Monitoring .
Monitoring Parameters
pregnancy test before start of mobilization, before myeloablative conditioning, then before lovotibeglogene autotemcel tx; screening for HIV-1/HIV-2 before apheresis; CBC w/ diff until engraftment achieved, then at least q6mo for at least 15y; integration site analysis at 6mo, 12mo, then as needed clinically; s/sx bleeding
Pregnancy/Lactation .
Pregnancy
Clinical Summary
avoid use during pregnancy; no human or animal data available
Individuals of Reproductive Potential
obtain negative pregnancy test before start of mobilization, before myeloablative conditioning, then before lovotibeglogene autotemcel tx; avoid pregnancy by using effective contraception (IUD or combined hormonal and barrier contraceptive methods) from start of mobilization through at least 6mo after lovotibeglogene autotemcel tx in female and male pts
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no human data available to assess risk of infant harm or effects on milk production
Pharmacology .
Metabolism: other; CYP450: unknown
Excretion: unknown; Half-life: unknown
Subclass: Gene Therapy, Hemoglobin Disorders ; Sickle Cell Disease
Mechanism of Action
adds functional copies of modified beta-globin gene into hematopoietic stem cells via CD34+ cells transduced w/ BB305 lentiviral vector, promoting functional Hgb production, reducing Hgb S levels, and sterically inhibiting polymerization of Hgb S, thereby limiting sickling of RBCs
Formulary .
No Formulary Selected
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