Benda LD vs. Flu/Cy LD prior to axi-cel immunotherapy
Ghilardi G, Paruzzo L, Svoboda J, et al. Bendamustine Lymphodepletion Before Axicabtagene Ciloleucel Is Safe and Associated With Reduced Inflammatory Cytokines. Blood Advances. 2023; (doi: 10.1182/bloodadvances.2023011492).
In patients undergoing axicabtagene ciloleucel (axi-cel) immunotherapy, study findings suggest that bendamustine lymphodepletion (Benda LD) works as well as fludarabine/cyclophosphamide (Flu/Cy) LD with lower toxicity. The research involved 48 patients with large B-cell lymphomas (LBCL) and 11 diagnosed with follicular lymphoma (FL), all of whom received CD19-directed, CD28-costimulated chimeric antigen receptor T-cell axi-cel. The complete remission rate for those who received Benda LD before their infusion was 50%, not substantially different from the 51.4% rate for those who received Flu/Cy. There were also no significant between-group differences in progression-free and overall survival, researchers report. While efficacy was similar with both approaches, toxicity was reduced with Benda LD. Compared with Flu/Cy, Benda LD boosted the presence of inflammatory cytokines linked to cytokine release syndrome (CRS) and neurotoxicity to a lesser degree. CRS and neurotoxicity of any severity was documented in 91.9% and 45.9% of Flu/Cy recipients, respectively, vs. 72.7% and 18.2% of Benda LD recipients, respectively. The incidence of grade ≥3 neutropenia, infections, and neutropenic fever was also observed more frequently in the Flu/Cy group.