GenericBrandHICLGCNHCPC
AFAMITRESGENE AUTOLEUCELTECELRA49787Q2057

Guidelines for Use

GUIDELINES FOR USE

Our guideline named AFAMITRESGENE AUTOLEUCEL requires the following rule(s) be met for approval:

  1. You have a diagnosis of advanced synovial sarcoma (unresectable or metastatic)
  2. You are ≥ 18 and ≤ 75 years of age
  3. You meet BOTH of the following:
    1. You are HLA-A*02:01P, -A*02:02P, -A*02:03P, or -A*02:06P positive
    2. You do not have HLA-A*02:05P in either allele
  4. You have the MAGE-A4 antigen as detected by a Food and Drug Administration (FDA)-approved test or cleared companion diagnostic devices
  5. Your disease has progressed following ≥ 1 or more prior systemic chemotherapy regimens
  6. You have not previously received Tecelra
  7. You do not meet ANY of the following:
    1. ECOG performance status greater than 1 
    2. Absolute neutrophil count (ANC) less than or equal to 1 x 109/L 
    3. Platelets less than 75,000/mm3 
    4. Alanine transaminase (ALT) and aspartate transaminase (AST) greater than 2.5 times the upper limit of normal (ULN) 
    5. Creatinine clearance less than 40 mL/min 
    6. Left ventricular ejection fraction (LVEF) less than 40% 
    7. Symptomatic central nervous system metastases 
    8. History of another primary malignancy that is not considered to be in complete remission 
    9. Infection that is uncontrolled or requires IV or long-term oral antimicrobial therapy 
    10. HIV infection; hepatitis B or C virus infection permitted only if viral load undetectable; or human T-cell leukemia virus 
    11. Any primary immunodeficiency

Created: 10/10/2025 9:02:14 PM


Last Modified: Monday, October 13, 2025

Approval code: DR-10-2025-18827/HHW-HIPP1047 (10/25)