Hepatotoxicity, Including Hepatic Veno-Occlusive Disease (VOD - also known as Sinusoidal Obstruction Syndrome) and Increased Risk of Post-Hematopoietic Stem Cell Transplant (HSCT) Non-Relapse Mortality

Hepatotoxicity, Including VOD

• Hepatotoxicity, including fatal and life-threatening VOD occurred in patients with relapsed or refractory acute lymphoblastic leukemia (ALL) who received BESPONSA. The risk of VOD was greater in patients who underwent HSCT after BESPONSA treatment; use of HSCT conditioning regimens containing 2 alkylating agents and last total bilirubin level ? upper limit of normal (ULN) before HSCT were significantly associated with an increased risk of VOD.
• Other risk factors for VOD in patients treated with BESPONSA included ongoing or prior liver disease, prior HSCT, increased age, later salvage lines, and a greater number of BESPONSA treatment cycles.
• Elevation of liver tests may require dosing interruption, dose reduction, or permanent discontinuation of BESPONSA. Permanently discontinue treatment if VOD occurs. If severe VOD occurs, treat according to standard medical practice [see DOSAGE AND ADMINISTRATION (2.3) and WARNINGS AND PRECAUTIONS (5.1)].

Increased Risk of Post-HSCT Non-Relapse Mortality

• There was higher post-HSCT non-relapse mortality rate in patients receiving BESPONSA, resulting in a higher Day 100 post-HSCT mortality rate [see WARNINGS AND PRECAUTIONS (5.2)].