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Zalmoxis: what safety margin did regulators accept?

allogeneic T cells modified with HSV-TK / dLNGFR (nalotimagene carmaleucel) · HSV-TK suicide-gene T cells
Safety margin at NOAEL
Mouse target dose ~two log above proposed clinical dose; this dose caused 100% GvHD mortality (no NOAEL)
“In preliminary studies a dose dependent GvHD-induced mortality was observed with a 100% incidence at the dose of 20x106 cells/mouse, which was chosen as the target dose. Of note, the chosen target dose is around two log higher than the proposed clinical dose, thus providing large safety margins.”
✓ VerifiedEMA assessment report, p. 18Source ↗
NOAEL / key findings
No NOAEL; GvHD occurred in mice but with lower incidence/severity than unmanipulated PBL; limited safety assessment
“Non clinical safety data obtained in two different immunedeficient animal models for Graft Versus Host disease did not indicate special hazards for humans, but allowed only a very limited safety assessment.”
✓ VerifiedEMA assessment report, p. 26Source ↗

Same question, other cell therapies

Encelto

revakinagene taroretcel · CNTF (encapsulated RPE cell implant)
rhCNTF DART NOAEL margins of exposure above 100 vs modelled maximum blood rhCNTF from intraocular implant

Spherox

spheroids of autologous matrix-associated chondrocytes · Autologous chondrocyte spheroids
Minipig study up to 3.2-fold the maximum clinical dose; other studies at doses similar to the clinical dose

Zemcelpro

dorocubicel · UM171-expanded cord blood CD34+
UM171: no toxicity in rat/monkey at doses 8,000-20,000x estimated human exposure

Abecma

idecabtagene vicleucel · BCMA CAR-T
Not stated in public reviews

Alofisel

darvadstrocel · Allogeneic adipose MSC
Not stated in public reviews

Amtagvi

lifileucel · TIL therapy
Not stated in public reviews

Aucatzyl

obecabtagene autoleucel · CD19 CAR-T
Not stated in public reviews

Breyanzi

lisocabtagene maraleucel · CD19 CAR-T
Not stated in public reviews

Carvykti

ciltacabtagene autoleucel · BCMA CAR-T
Not stated in public reviews

ChondroCelect

characterised viable autologous cartilage cells · Autologous chondrocytes
Not stated in public reviews

Ebvallo

tabelecleucel · EBV-specific allogeneic T cells
Not stated in public reviews

Gintuit

allogeneic cultured keratinocytes and fibroblasts in bovine collagen · Allogeneic keratinocytes + fibroblasts
Not stated in public reviews

Holoclar

autologous corneal epithelial cells containing limbal stem cells · Autologous limbal stem cells
Not stated in public reviews

Kymriah

tisagenlecleucel · CD19 CAR-T
Not stated in public reviews

Lantidra

donislecel · Allogeneic pancreatic islets
Not stated in public reviews

Laviv

azficel-T · Autologous fibroblasts
Not stated in public reviews

MACI

autologous cultured chondrocytes on porcine collagen membrane · Autologous chondrocytes
Not stated in public reviews

Omisirge

omidubicel · Expanded cord blood HPC
Not stated in public reviews

Provenge

sipuleucel-T · PAP-GM-CSF (autologous APC)
Not stated in public reviews

Rethymic

allogeneic processed thymus tissue · Allogeneic thymus tissue
Not stated in public reviews

Ryoncil

remestemcel-L · Allogeneic BM-MSC
Not stated in public reviews

StrataGraft

allogeneic cultured keratinocytes and dermal fibroblasts in murine collagen · Allogeneic keratinocytes + fibroblasts
Not stated in public reviews

Tecartus

brexucabtagene autoleucel · CD19 CAR-T
Not stated in public reviews

Tecelra

afamitresgene autoleucel · MAGE-A4 TCR-T
Not stated in public reviews

Tregzi

allogeneic Treg immunotherapy with HSPC and T cells (Orca-T) · Allogeneic Treg + HSPC + Tcon
Not stated in public reviews

Yescarta

axicabtagene ciloleucel · CD19 CAR-T
Not stated in public reviews

Summary across all 27 cell therapies →