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NeedyMeds www.needymeds.org Find help with the cost of medicine Thank you for downloading this patient assistance document from NeedyMeds. We hope this program will help you get the medicine you need. REMEMBER - Send your completed application to address on the form, NOT to NeedyMeds. Did you know that NeedyMeds has thousands of other free resources? Here s a look at more ways we can help you save money on medicine and healthcare costs. Each one can be found under the Patient Savings tab on our website: Diagnosis-Based Assistance NeedyMeds lists thousands of assistance programs for almost any health condition. If you are going through chemo treatment for cancer, there are programs that can help with wig costs and scalp-cooling products. We also list resources for free diabetes testing supplies, caregiver lodging support, and much more. Free, Low Cost, and Sliding Scale Clinics This popular collection contains information on 16,000+ free, low cost, and sliding scale medical and dental clinics across the U.S. It s a great resource if you need affordable medical treatment and don t know where to go. Coupons, Rebates & More You can use the NeedyMeds website to find nearly 2,000 cost-saving opportunities for both prescription and over-the-counter drugs and medical supplies. Medical Transportation Need help getting to the doctor s office or medical facility? You may be eligible for financial assistance if you meet certain requirements. Finally, I want to tell you about the NeedyMeds Drug Discount Card. Thousands of people use this free, anonymous, and easy-to-use tool to get the best price on their medications. To date, our drug discount card has saved patients over $244,000,000. Check out the next page to learn more. Feel free to call our toll-free helpline if you have any questions. You can reach us at 1-800-503-6897 Monday-Friday, 9am-5pm Eastern Time. Thanks for using NeedyMeds! Please let us know if we can do anything else to help you afford the costs of your healthcare. Rich Sagall, MD Richard J. Sagall, MD President, NeedyMeds NeedyMeds.org P.O. Box 219 Gloucester, MA 01931 Phone: 978-281-6666 Email: info@needymeds.org www.needymeds.org

Clip the card and save NeedyMeds NeedyMeds.org DRUG DISCOUNT CARD BIN: 019520 RX PCN: NMEDS RX GRP: PDFPDF ID: NMNA019309901930 This is a drug discount program, not an insurance plan. NeedyMeds Drug Discount Card www.needymeds.org Patient: Simply present this card to a participating pharmacy to receive a discount on your prescription. Patients who have Medicare, including Part D, Medicaid or any state or federal prescription insurance can only use this card if they choose not to use their government-sponsored drug plan for their purchase. The card is not valid in combination with those programs. For questions concerning the card, call 1-888-602-2978 or visit www.drugdiscountcardinfo.com. Pharmacist: Card must be presented to receive program benefits. Clear system of prior cardholder information associated with this universal cardholder ID. For processing questions, call Argus Health Systems at 1-866-921-7286. Save up to 80% Use at over 65,000 pharmacies nationwide including all major chains Share the card with friends and family Use the card as often as needed Free, no fees or registration Never expires What if I have insurance? Anyone can use the card, but it can t be combined with insurance. You can use the card instead of insurance if: A drug isn t covered by your insurance Your insurance has no drug coverage You have a high drug deductible You have met a low medicine cap The card offers a better price than your copay You are in the Medicare Part D donut hole What drugs are covered? The card is good for prescription drugs, over-the-counter medicines and medical supplies if written on a prescription blank, and pet prescription medicines purchased at a pharmacy. You ll save on most, but not all, prescriptions. To obtain a plastic drug discount card, send a self-addressed stamped envelope to: NeedyMeds-PAP PO Box 219 Gloucester, MA 01931 The card is not valid in combination with other insurance plans, including Medicare, Medicaid or any state or federal prescription insurance. The card can be used only if you decide not to use your government-sponsored drug plan for your purchases.

TREATMENT TRANSFORMED CARThe first FDA-approved Transform your T cells for a transformed tomorrow Children portrayed throughout are not real KYMRIAH patients. Your guide to KYMRIAH therapy IMPORTANT INFORMATION What is KYMRIAH? KYMRIAH (tisagenlecleucel) is a prescription cancer treatment used in patients up to 25 years old who have acute lymphoblastic leukemia (ALL) that has relapsed (went into remission, then came back) or is refractory (did not go into remission with other leukemia treatments). KYMRIAH is made from your own white blood cells. What is the most important information I should know about KYMRIAH? KYMRIAH may cause side effects that are severe or life-threatening, such as cytokine release syndrome (CRS) and neurological toxicities. Call your health care provider or get emergency help right away if you get any of the following signs and symptoms of: Cytokine Release Syndrome: difficulty breathing severe nausea, very low blood pressure vomiting, diarrhea fever (100.4 F/38 C or higher) dizziness/lightheadedness severe muscle or joint pain chills/shaking chills Information on pages 26 to 27.

Time for the Next Step Finding out that your cancer has returned, or hasn t responded to treatment, can feel like you ve lost your way. But learning about another treatment option may help you find your next step. This brochure is a place for you and the people who care for you to start. It is here to help you, whether you are considering therapy or are already preparing for treatment. What can I find in this brochure? What is B-cell acute lymphoblastic leukemia? 4 What is KYMRIAH? 6 Is KYMRIAH right for me? 8 KYMRIAH Overview The team at Novartis* wants you to have the background you need to talk to your doctor about the next step in your cancer treatment. Read on to learn more about a different treatment option that uses your inner strength to treat your cancer: KYMRIAH (tisagenlecleucel). How well does KYMRIAH work? 9 What makes KYMRIAH different from other therapies? 10 What should I know before starting treatment? 11 What is the process for getting KYMRIAH? 12 KYMRIAH FOR KIDS Children with cancer may have questions about their condition and treatment. KYMRIAH FOR KIDS is a way to explain KYMRIAH to young children. Each section of this brochure includes a question a child might have, and a simple answer. If you are caring for a young child with cancer, look for KYMRIAH FOR KIDS throughout the brochure for ways to talk with your child about KYMRIAH. What side effects may I experience with KYMRIAH? 14 What kind of support is available? 16 How do I learn more about KYMRIAH? 18 What should I ask my treatment team? 19 Summary of Important Information 26 *Novartis Pharmaceuticals Corporation. 2 What is the most important information I should know about KYMRIAH? (continued) Call your health care provider or get emergency help right away if you get any of the following signs and symptoms of: Neurological Toxicities: altered or decreased consciousness delirium confusion agitation difficulty speaking and understanding loss of balance seizures You may be admitted to the hospital, and treated with other medications, if you have CRS. If you are admitted to the hospital, tell the health care provider that you have received KYMRIAH. Because of the risk of CRS, and neurological toxicities, KYMRIAH is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the KYMRIAH REMS.

What is B-cell acute lymphoblastic leukemia? B cells are defenders of your body. Along with other cells, they make up your body s adaptive immune system. When B cells become cancerous, they can grow out of control and cause a type of blood cancer called B-cell acute lymphoblastic leukemia (ALL). B-cell ALL is the most common form of pediatric leukemia. While many children with leukemia get better after their first treatment, some may not. About 20% of children with B-cell ALL will not have success with initial treatments. These children experience a relapse, which means their cancer has returned, or their cancer is refractory, which means it did not respond to treatment. IDS OR K F AH KYMRI What does relapsed or refractory mean? It means that your cancer is tough, and other treatments haven't been able to beat it. KYMRIAH (tisagenlecleucel) is a treatment for kids like you who have had other treatments that have not been able to beat their cancer. 4 What are other serious side effects of KYMRIAH? A llergic Reactions: Serious allergic reactions, including anaphylaxis, which is a life-threatening allergic reaction, may occur after you receive KYMRIAH. Some signs and symptoms may include difficulty breathing, very low blood pressure, dizziness, swelling under skin, rash, nausea, and vomiting. You should seek emergency medical treatment right away if you have an allergic reaction. S erious Infections: KYMRIAH can increase the risk of life-threatening infections that may lead to death. Tell your health care provider right away if you develop fever, chills, or any signs or symptoms of an infection. In the past, the only choices for children and young adults with relapsed or refractory B-cell ALL have been chemotherapy or stem cell transplant. But there is now a different treatment option with KYMRIAH. KYMRIAH is a therapy option for pediatric and young adult patients with relapsed or refractory B-cell ALL looking for a different way to try to treat their cancer because previous treatments have not kept their cancer in remission.

What is KYMRIAH? KYMRIAH (tisagenlecleucel) is not a pill, chemotherapy, or transplant. KYMRIAH is a type of cutting edge immunocellular therapy that uses the power of your own immune system to treat your cancer. A natural defender, the T cell is a part of your immune system. T cells detect and destroy infected or cancerous cells by looking for certain antigens. Antigens are markers on cells that help your immune system identify normal cells from infected or cancerous cells; however, your cancerous B cells look like normal B cells. After KYMRIAH, your T cells will be able to recognize an antigen on your B cells called CD19. By reprogramming your T cells, KYMRIAH enhances their ability to detect and destroy your B cells, including those with cancer in them. Because KYMRIAH uses your own T cells, you may hear it referred to as an individualized therapy made just for you. After being treated with KYMRIAH, you may not need any other treatment for your cancer. To learn more about the therapy process with KYMRIAH, see What is the process for getting KYMRIAH? on pages 12 to 13. MY T CELLS JOURNEY Collection First, your doctor takes some of your blood to collect your T cells. Then, they are frozen and sent to be reprogrammed into KYMRIAH CAR-T cells. Reprogramming Next, your T cells are reprogrammed into KYMRIAH CAR-T cells. The CAR in CAR-T stands for chimeric antigen receptor. This CD19-detecting receptor gives your T cells a new way to target your B cells. KYMRIAH FOR KIDS Infusion Once your KYMRIAH CAR-T cells are returned to your body, they are ready to begin detecting and destroying your cancer. How does KYMRIAH work? KYMRIAH is a special kind of medicine that trains some of your cells to be cancer-fighting cells. Your trained cells will help fight your cancer. 6 What are other serious side effects of KYMRIAH? (continued) Prolonged Low Blood Cell Counts (Cytopenia): KYMRIAH can lower one or more types of your blood cells (red blood cells, white blood cells, or platelets). After treatment, your health care provider may test your blood to check cell counts. Tell your health care provider right away if you get a fever or other symptoms of an infection, are feeling tired, or have unusual bruising or bleeding. Hypogammaglobulinemia: A condition in which the level of immunoglobulins (antibodies) in your blood is low and the risk of infection is increased. It is expected that you may develop hypogammaglobulinemia with KYMRIAH, and you may need to receive immunoglobulin replacement for an indefinite amount of time following treatment with KYMRIAH. Tell your health care provider about your treatment with KYMRIAH before receiving a live virus vaccine.

Is KYMRIAH right for me? KYMRIAH (tisagenlecleucel) is approved to treat children and young adults whose B-cell ALL is refractory or in second or later relapse. If you are considering treatment options, ask your doctor about KYMRIAH. How well does KYMRIAH work? Because other treatment options have not kept your cancer in remission, the goal of KYMRIAH therapy is long-term remission of your cancer. CAR-T studies first began in 2012, and Novartis has since treated many patients with CAR-T therapy. Since 2015, KYMRIAH has been studied in a global clinical trial of children and young adults with relapsed or refractory B-cell ALL, with many achieving an early and lasting remission. While many patients have been successfully treated with KYMRIAH, not all patients will respond the same way. Topics to discuss with your doctor: Your treatment history Your cancer s past response to chemotherapy Any previous bone marrow transplants Overall health (for example, organ function) In a clinical trial of 63 participants: 83 % 100 % 52 of 63 children and young adults treated with KYMRIAH had their cancer go into remission. For nearly everyone, remission happened between 26 and 31 days after KYMRIAH infusion. All 52 of those in remission after KYMRIAH had undetectable levels of cancer left in their bone marrow (MRD ).* 88 % 46 of the 52 children and young adults who went into remission after treatment with KYMRIAH did not need an allogeneic transplant. Other conditions you may have (for example, genetic syndromes, hepatitis, viruses) 6 months after remission, children and young adults have more than a 75% estimated chance of still being in remission as estimated during the trial follow-up. Trials are still ongoing to see how long remissions last 6 months after infusion, children and young adults have an 89% estimated chance of still being alive as estimated during the trial follow-up. Trials are still ongoing to see if patients live longer with treatment *Doctors can use highly sensitive tests to look for traces of cancer in bone marrow called minimal residual disease or MRD. These tests give a very precise measure of remission that may indicate to your treatment team how well KYMRIAH is working. 8 What are other serious side effects of KYMRIAH? (continued) Secondary Cancers: After treatment with KYMRIAH, your health care provider will monitor you for the rest of your life, as you may develop secondary cancers or recurrence of your leukemia. Effects on Ability to Drive and Use Machines: Do not drive, operate heavy machinery, or do other dangerous things for 8 weeks after you get KYMRIAH because the treatment can cause temporary memory and coordination problems, including sleepiness, confusion, weakness, dizziness, and seizures. What are the most common side effects of KYMRIAH? Some of the most common side effects of KYMRIAH include: difficulty breathing fever (100.4 F/38 C or higher) chills/shaking chills confusion severe nausea, vomiting, diarrhea severe muscle or joint pain very low blood pressure dizziness/lightheadedness headache These are not all the possible side effects of KYMRIAH. Talk to your health care provider for medical advice about side effects. KYMRIAH FOR KIDS How has KYMRIAH helped kids like me? KYMRIAH has helped kids with the same type of cancer that you have. Not everyone's experience is the same but, for many kids, KYMRIAH helped them beat their cancer.

What makes KYMRIAH different from other therapies? What should I know before starting treatment? KYMRIAH (tisagenlecleucel) is different from other cancer therapies because it is a treatment that comes from within you. You and your treatment team will discuss the KYMRIAH therapy process. Not all treatment centers can offer KYMRIAH, so the first step could be getting a referral to a different treatment center. KYMRIAH is a one-time treatment unlike other treatments delivered more than once KYMRIAH targets only your B cells rather than all of your body s cells KYMRIAH uses a short course (4 days) of chemotherapy to prepare your body for infusion Even if you aren t in remission, you can start KYMRIAH therapy Because KYMRIAH uses your own cells, you do not need a donor IDS OR K F AH KYMRI How is KYMRIAH different from other medicines? KYMRIAH is not like other medicines you may have tried. KYMRIAH uses your own body s strength to fight your cancer. 10 What should I tell my health care provider before receiving KYMRIAH? Your health care provider may do a pregnancy test prior to you starting treatment. There is no information available of KYMRIAH use in pregnant or breastfeeding women. Therefore, KYMRIAH is not recommended for women who are pregnant or breastfeeding. Talk to your health care provider about birth control and pregnancy. Tell your health care provider about all the medicines you take, including prescription and over-thecounter medicines, vitamins, and herbal supplements. What should I be aware of after receiving KYMRIAH? Some commercial HIV tests may cause a false positive HIV test result Do not donate blood, organs, tissues or cells for transplantation You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. Please visit KYMRIAH.com or call KYMRIAH CARES at 1-844-4KYMRIAH (1-844-459-6742) for an up-to-date list of KYMRIAH Treatment Centers.

What is the process for getting KYMRIAH? 1 6 Initial Discussion KYMRIAH (tisagenlecleucel) is a therapy for children and young adults up to 25 years of age with B-cell ALL that is refractory or in second or later relapse. Discuss your treatment history and overall health with your doctor to see if you are a candidate for KYMRIAH therapy. Refer to Is KYMRIAH right for me? on page 8 for more details. Infusion After your cells are reprogrammed into KYMRIAH CAR-T cells, they are ready to return to you. About 30 to 60 minutes before your KYMRIAH infusion, you will receive acetaminophen and an antihistamine. Your KYMRIAH cells are put back into your body through a standard IV infusion that usually takes less than 30 minutes. 12 2 7 3 4 5 Find a KYMRIAH Treatment Center Some people are already receiving treatment for their B-cell ALL at a treatment center that administers KYMRIAH. Others will get a referral for KYMRIAH from their primary oncologist. If you haven t already selected your KYMRIAH Treatment Center, visit KYMRIAH.com or call KYMRIAH CARES at 1-844-4KYMRIAH (1-844-459-6742) for an up-to-date list of centers in the United States so you can find a center near you. Collection Treatment with KYMRIAH uses your own cells, so the process begins with T cell collection. A small, temporary tube (IV catheter) will be placed into your vein to collect your T cells. This process is called leukapheresis (pronounced loo-kuh-fuh-ree-sis) and takes about 3 to 6 hours. Reprogramming Your cells will be sent to a manufacturing facility to be reprogrammed into KYMRIAH CAR-T cells. The reprogramming process takes about 3 to 4 weeks, but this timing can vary. Your T cells need to be changed to be able to detect and destroy your cancer. To do this, KYMRIAH uses a deactivated HIV virus because HIV is very good at getting into your T cells. Because it is deactivated, it is no longer harmful and cannot cause HIV. It may cause a false positive on some commercial HIV tests though, but your doctor can use other, more accurate tests for patients who have been treated with KYMRIAH. Preinfusion Lymphodepleting Chemotherapy About 2 to 14 days before the infusion, you will receive a short course of chemotherapy over 4 days. This chemotherapy helps prepare your body to receive your reprogrammed KYMRIAH CAR-T cells. IMPORTANT INFORMATION What is KYMRIAH? KYMRIAH is a prescription cancer treatment used in patients up to 25 years old who have acute lymphoblastic leukemia (ALL) that has relapsed (went into remission, then came back) or refractory (did not go into remission with other leukemia treatments). KYMRIAH is made from your own white blood cells. What is the most important information I should know about KYMRIAH? KYMRIAH may cause side effects that are severe or life-threatening, such as cytokine release syndrome (CRS) and neurological toxicities. Observation Once your KYMRIAH CAR-T cells are in your body, they will begin to detect and destroy your cancerous and normal B cells. During the weeks after KYMRIAH infusion, your treatment team will monitor you closely to manage any side effects, some of which may require you to go to the hospital. Remember that some side effects are expected and your treatment team is prepared to help. Your KYMRIAH cells are designed to continue fighting your cancer even after you have left the hospital. You should plan to stay within 2 hours of your KYMRIAH Treatment Center for at least 4 weeks after receiving KYMRIAH, unless otherwise indicated by your treatment team, so that if you experience certain side effects you can return to the treatment center quickly. During this time, someone should be with you to check for fever or other side effects. Your treatment team may check your progress about a month after your infusion. After that, they may decide that you can get back to your daily activities. KYMRIAH FOR KIDS How do I get KYMRIAH? You may go see a different doctor who will take some of your cells from your blood and teach them how to look for your cancer cells. Once your cells know how to find your cancer cells, they will be put back into your body to start fighting your cancer. KYMRIAH Experience

What side effects may I experience with KYMRIAH? There are side effects you may experience with KYMRIAH (tisagenlecleucel) therapy. KYMRIAH may cause side effects that are severe or life-threatening. Call your health care provider or get emergency help right away if you get any of the following: difficulty breathing Some side effects can be expected with KYMRIAH and your treatment team is prepared to help manage them. fever (100.4 F/38 C or higher) chills/shaking chills confusion severe nausea, vomiting, diarrhea severe muscle or joint pain very low blood pressure dizziness/lightheadedness Cytokine Release Syndrome (CRS) CRS is a common and expected side effect that happens when the immune system is highly activated, as with KYMRIAH therapy. It can range from mild symptoms like fever and muscle pains, to severe symptoms like low blood pressure and breathing trouble. Your treatment team is prepared to manage CRS. Mild-to-moderate CRS may require hospitalization, antibiotics, and pain medications. Severe CRS may require medication, a stay in the intensive care unit (ICU), or breathing support. Neurological Events KYMRIAH may also have effects on the brain. You may feel very confused, unaware, or agitated. More severe symptoms might affect your speech, or cause hallucinations or seizures. In most cases, symptoms occur within 8 weeks of receiving KYMRIAH and resolve within 12 days. They may go away on their own, but be sure to tell your doctor right away if you experience any neurological signs or symptoms. Prolonged Low Blood Cell Counts (Cytopenia) KYMRIAH may cause a condition called cytopenia. This is when you have low levels of one or more types of blood cells. Your treatment team will do blood tests to check all your blood cell counts after treatment with KYMRIAH. Cytopenia that lasts a long time (prolonged) may increase your risk of infection. Cytopenia will be monitored, and your treatment team is prepared to manage it. Tell your doctor right away if you get a fever, are feeling tired, or have bruising or bleeding. Low Antibody Levels (Hypogammaglobulinemia) Because KYMRIAH CAR-T cells are designed to detect and destroy your B cells, they will also attack the normal B cells in your body. B cells defend your body by producing antibodies. Antibodies bind to invaders so other immune cells can destroy them. After KYMRIAH, you may have fewer normal B cells and, therefore, fewer antibodies. A low level of antibodies in your blood is a condition called hypogammaglobulinemia (hy-po-gam-muhglob-u-lin-eem-ee-uh). If untreated, a low antibody level may increase your risk for infections. Your treatment team can manage this with antibody replacement medications (for example, IVIG infusions). Tell your doctor right away if you develop signs or symptoms of an infection. KYMRIAH FOR KIDS How will I feel after KYMRIAH? Common Side Effects The most common side effects of KYMRIAH are: difficulty breathing fever (100.4 F/38 C or higher) chills/shaking chills confusion severe nausea, vomiting, diarrhea severe muscle or joint pain very low blood pressure dizziness/lightheadedness headache After you get your new KYMRIAH cells, you may feel bad in different ways including feeling sick, tired, or very warm. Sometimes these feelings will go away on their own, but your doctor is here to help you if they don't. These are not all the possible side effects of KYMRIAH treatment. Talk to your treatment team about other possible side effects and medical advice about side effects. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/safety/medwatch, or call 1-800-FDA-1088. 14 Please see important safety information throughout and Summary of Important

What kind of support is available? From information on financial assistance to patient support programs, KYMRIAH CARES has resources to help you throughout your treatment journey. Personalized suppor t for a personalized treatment Whether you have questions about KYMRIAH (tisagenlecleucel), treatment center locations, or insurance coverage, KYMRIAH CARES is here to help. Please call 1-844-4KYMRIAH (1-844-459-6742) to learn more. Support and Resources for Family and Friends A cancer treatment journey can take a toll on the whole family. It s important to seek care for not only physical health, but also mental and emotional well-being. If you are caring for a child with cancer: Know that it is okay to ask for help. Establish a support network of family, friends, and/or religious or spiritual groups Consider counseling services for yourself and for those close to you Keep a notebook of important information such as appointments, business cards, or emergency numbers Maintain a schedule to help bring a sense of normalcy to a family setting with planned times for meals, homework, or play Keep in mind that no 2 cancer experiences are the same and that patients, families, and caregivers may cope with cancer differently Remember to care for your own health and wellness. Take time to exercise, meet a friend for coffee, or see a movie General Support Day-to-Day Patient Support Resources The Novartis Oncology Day-to-Day Patient Support Resource provides information on a range of independent, third-party organizations that can provide support to help complement your treatment plan and care. Services may include transportation, lodging, healthy meals, home cleaning, and more. Go to www.patientsupportmadesimple.com to learn more. American Cancer Society Visit www.cancer.org/treatment/supportprogramsservices/index to find support programs and services in your area, as well as an information center and online support communities. Leukemia & Lymphoma Society (LLS) Family Support Groups Visit www.lls.org/support/support-groups to find support groups near you for patients, family members, and caregivers. Cancer Research Institute Visit www.cancerresearch.org/patients to learn about the immune system and immunotherapies, to read a helpbook for patients with cancer, and to connect with a support community for immunotherapy patients and caregivers. Support for Young Adults 13thirty Visit www.13thirty.org to connect with a local support chapter and learn how to cope with cancer. Group Loop Visit www.cancersupportcommunity.org/group-loop to connect with teens who have been affected by cancer. Stupid Cancer Visit www.stupidcancer.org to find regional support groups, join online community forums, and register for patient support events. Support for Families 16 What is the most important information I should know about KYMRIAH? (continued) Call your health care provider or get emergency help right away if you get any of the following signs and symptoms of: Cytokine Release Syndrome: difficulty breathing fever (100.4 F/38 C or higher) chills/shaking chills severe nausea, vomiting, diarrhea severe muscle or joint pain very low blood pressure dizziness/lightheadedness The organizations and websites listed on this page are maintained by third parties over whom Novartis Pharmaceuticals Corporation has no control. As such, Novartis Pharmaceuticals Corporation makes no representation as to the accuracy or any other aspect of the information supplied by these organizations or contained in these websites.

How do I learn more about KYMRIAH? Making treatment decisions for relapsed or refractory cancer can be hard. Talk with your treatment team about questions you may have. To learn more, visit KYMRIAH.com for educational materials and frequently asked questions. Share your KYMRIAH story Sometimes, hearing other families experiences with relapsed or refractory B-cell ALL can make all the difference to a new patient. If you would like to share your family s story, please call 1-844-606-3339 or e-mail Inspire@hastrategies.com. What should I ask my treatment team? Initial Discussion How does my treatment history affect my eligibility for KYMRIAH (tisagenlecleucel)? Can I receive KYMRIAH after a bone marrow transplant? What if I have other health conditions? How will I feel throughout the treatment process? Notes: Find a Treatment Center Where can I receive KYMRIAH therapy? Will my insurance cover KYMRIAH therapy? How long will I need to stay near the treatment center? Notes: 18 What is the most important information I should know about KYMRIAH? (continued) Call your health care provider or get emergency help right away if you get any of the following signs and symptoms of: Neurological Toxicities: altered or decreased consciousness delirium confusion agitation seizures difficulty speaking and understanding loss of balance You may be admitted to the hospital, and treated with other medications, if you have CRS. If you are admitted to the hospital, tell the health care provider that you have received KYMRIAH. Because of the risk of CRS, and neurological toxicities, KYMRIAH is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the KYMRIAH REMS.

Collection How should I prepare for collection? How long will it take? What can I do during collection? Will there be any limitations or side effects afterward? When will my KYMRIAH (tisagenlecleucel) CAR-T cells be ready for infusion? Notes: Infusion How should I prepare for infusion? What will infusion be like? How long will it take? Notes: Preinfusion Lymphodepleting Chemotherapy How is this chemotherapy different from the chemotherapy I previously received? How long will it take? Will there be side effects? How far in advance of my infusion do I receive chemotherapy? Notes: Side Effects and Observation What side effects should I expect after infusion? How will serious side effects be managed after therapy? How will I know KYMRIAH is working? When do I need to check in with my treatment team? How long do I need to stay in or near my hospital? After returning home, what kind of side effects require a hospital visit? How quickly can I get back to my daily routine? Notes: 20 What are other serious side effects of KYMRIAH? Allergic Reactions: Serious allergic reactions, including anaphylaxis, which is a life-threatening allergic reaction, may occur after you receive KYMRIAH. Some signs and symptoms may include difficulty breathing, very low blood pressure, dizziness, swelling under skin, rash, nausea, and vomiting. You should seek emergency medical treatment right away if you have an allergic reaction. Serious Infections: KYMRIAH can increase the risk of life-threatening infections that may lead to death. Tell your health care provider right away if you develop fever, chills, or any signs or symptoms of an infection.

Treatment Team Contact Information It is important to know who is on your KYMRIAH (tisagenlecleucel) treatment team and how to get in touch with them. Remember to ask for names, phone numbers, e-mail addresses, and any other contact information. Use this space to keep track of your treatment team s information. Notes: Renewed Hope There is new hope in a different treatment option for your relapsed or refractory B-cell ALL. An option that uses your inner strength. The treatment for your cancer may be inside your own cells. To see patients go from leaving the hospital, and starting to recover, to basically going to school, playing soccer and looking like every other kid is just wonderful. I think it s the best thing about doing what we do. Stephan Grupp, MD, PhD, Oncologist 22 What are other serious side effects of KYMRIAH? (continued) Prolonged Low Blood Cell Counts (Cytopenia): KYMRIAH can lower one or more types of your blood cells (red blood cells, white blood cells, or platelets). After treatment, your health care provider may test your blood to check cell counts. Tell your health care provider right away if you get a fever or other symptoms of an infection, are feeling tired, or have unusual bruising or bleeding. Hypogammaglobulinemia: A condition in which the level of immunoglobulins (antibodies) in your blood is low and the risk of infection is increased. It is expected that you may develop hypogammaglobulinemia with KYMRIAH, and you may need to receive immunoglobulin replacement for an indefinite amount of time following treatment with KYMRIAH. Tell your health care provider about your treatment with KYMRIAH before receiving a live virus vaccine.

My Notes Use these pages to write down any notes or questions you may have for your treatment team. 24

26 Summary of Important Information What is KYMRIAH? KYMRIAH (tisagenlecleucel) is a prescription cancer treatment used in patients up to 25 years old who have acute lymphoblastic leukemia (ALL) that has relapsed (went into remission, then came back) or is refractory (did not go into remission with other leukemia treatments). KYMRIAH is made from your own white blood cells. What is the most important information I should know about KYMRIAH? KYMRIAH may cause side effects that are severe or life-threatening, such as cytokine release syndrome (CRS) and neurological toxicities. Call your health care provider or get emergency help right away if you get any of the following signs and symptoms of: Cytokine Release Syndrome: difficulty breathing fever (100.4 F/38 C or higher) chills/shaking chills Neurological Toxicities: altered or decreased consciousness delirium severe nausea, vomiting, diarrhea severe muscle or joint pain confusion agitation very low blood pressure dizziness/lightheadedness difficulty speaking and understanding loss of balance seizures You may be admitted to the hospital, and treated with other medications, if you have CRS. If you are admitted to the hospital, tell the health care provider that you have received KYMRIAH. Because of the risk of CRS, and neurological toxicities, KYMRIAH is only available through a restricted program under a Risk Evaluation and Mitigation Strategy (REMS) called the KYMRIAH REMS. What are other serious side effects of KYMRIAH? Allergic Reactions: Serious allergic reactions, including anaphylaxis, which is a life-threatening allergic reaction, may occur after you receive KYMRIAH. Some signs and symptoms may include difficulty breathing, very low blood pressure, dizziness, swelling under skin, rash, nausea, and vomiting. You should seek emergency medical treatment right away if you have an allergic reaction. Serious Infections: KYMRIAH can increase the risk of life-threatening infections that may lead to death. Tell your health care provider right away if you develop fever, chills, or any signs or symptoms of an infection. Prolonged Low Blood Cell Counts (Cytopenia): KYMRIAH can lower one or more types of your blood cells (red blood cells, white blood cells, or platelets). After treatment, your health care provider may test your blood to check cell counts. Tell your health care provider right away if you get a fever or other symptoms of an infection, are feeling tired, or have unusual bruising or bleeding. Hypogammaglobulinemia: A condition in which the level of immunoglobulins (antibodies) in your blood is low and the risk of infection is increased. It is expected that you may develop hypogammaglobulinemia with KYMRIAH, and you may need to receive immunoglobulin replacement for an indefinite amount of time following treatment with KYMRIAH. Tell your health care provider about your treatment with KYMRIAH before receiving a live virus vaccine. Summary of Important Information (continued) Secondary Cancers: After treatment with KYMRIAH, your health care provider will monitor you for the rest of your life, as you may develop secondary cancers or recurrence of your leukemia. Effects on Ability to Drive and Use Machines: Do not drive, operate heavy machinery, or do other dangerous things for 8 weeks after you get KYMRIAH because the treatment can cause temporary memory and coordination problems, including sleepiness, confusion, weakness, dizziness, and seizures. What are the most common side effects of KYMRIAH? Some of the most common side effects of KYMRIAH include: difficulty breathing fever (100.4 F/38 C or higher) chills/shaking chills confusion severe nausea, vomiting, diarrhea severe muscle or joint pain very low blood pressure dizziness/lightheadedness headache These are not all the possible side effects of KYMRIAH. Talk to your health care provider for medical advice about side effects. What should I tell my health care provider before receiving KYMRIAH? Your health care provider may do a pregnancy test prior to you starting treatment. There is no information available of KYMRIAH use in pregnant or breastfeeding women. Therefore, KYMRIAH is not recommended for women who are pregnant or breastfeeding. Talk to your health care provider about birth control and pregnancy. Tell your health care provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. What should I be aware of after receiving KYMRIAH? Some commercial HIV tests may cause a false positive HIV test result Do not donate blood, organs, tissues or cells for transplantation You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088. This is a summary of the most important safety information about KYMRIAH. Talk with your health care provider or pharmacist about side effects. If you would like more information, the FDA-approved product labeling for KYMRIAH can be found at www.kymriah.com, or call 1-844-NVS-CART (1-844-687-2278). Summary of Important Information

TREATMENT TRANSFORMED CAR- To learn more about KYMRIAH (tisagenlecleucel), talk to your doctor or visit KYMRIAH.com. Children portrayed throughout are not real KYMRIAH patients. IMPORTANT INFORMATION What is the most important information I should know about KYMRIAH? KYMRIAH may cause side effects that are severe or life-threatening, such as cytokine release syndrome (CRS) and neurological toxicities. Call your health care provider or get emergency help right away if you get any signs and symptoms of CRS or neurological toxicities. Please see important safety information throughout and Summary of Important Novartis Pharmaceuticals Corporation East Hanover, New Jersey 07936-1080 2018 Novartis 7/18 KYM-1192723