Phase II Open Label Trial to Determine Safety & Efficacy of Tisagenlecleucel in Pediatric Non-Hodgkin Lymphoma Patients

This study is part of an agreed Pediatric Investigation Plan (PIP). The single-arm study
design includes r/r B-cell NHL subject population with poor prognosis, lack of approved
effective therapies in this setting. Subject population will include aggressive subtypes of
B-cell NHL and will be allowed to receive "bridging therapy" of investigator's choice After
assessment of eligibility, subjects qualifying for the study will be enrolled and are allowed
to start lymphodepleting chemotherapy as recommended in protocol after which a single dose of
tisagenlecleucel product will be infused. The efficacy of tisagenlecleucel will be evaluated
through the primary endpoint of Overall Response Rate (ORR) which includes complete response
(CR) and partial response (PR) as determined by local assessment. Safety assessments will be
conducted through the study completion.

Inclusion Criteria:

- Histologically confirmed pediatric mature B-cell non-Hodgkin lymphoma (B-cell NHL)
including the following subtypes; Burkitt lymphoma (BL), diffuse large B-cell lymphoma
(DLBCL), primary mediastinal B-cell lymphoma (PMBCL), gray zone lymphoma (GZL), and
follicular lymphoma (FL) Note: Patients with bone marrow involvement of >25% lymphoma
cells by bone marrow biopsy/aspirate evaluation, will be excluded. Patients with
B-cell NHL associated with Nijmegen breakage syndrome will be allowed.

- Patients <18 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.

- 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. Absolute lymphocyte count (ALC) >300/mm3

3. absolute number of CD3+ T cells >150/mm3

4. Platelets ≥50000//mm3

5. 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.

- Active, uncontrolled infection despite treatment at screening.

- Presence of active or prior 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.

Other protocol-defined inclusion/exclusion criteria may apply.