The following is a summary of “Recent Bendamustine Treatment Before Apheresis Has a Negative Impact on Outcomes in Patients With Large B-Cell Lymphoma Receiving Chimeric Antigen Receptor T-Cell Therapy,” published in the October 2023 issue of Oncology by Iacoboni et al.
Researchers sought to investigate the impact of bendamustine exposure before apheresis on the safety and efficacy of CD19-targeted chimeric antigen receptor (CAR) T-cell therapy in patients with relapsed/refractory (r/r) large B-cell lymphoma (LBCL).
They involved 439 patients with r/r LBCL who received CD19-targeted CAR T cells across seven European sites. Safety, efficacy, and CAR T-cell expansion kinetics were analyzed based on pre-apheresis bendamustine exposure. Subsequent investigations explored the effects of the washout period and bendamustine dose. Inverse probability treatment weighting (IPTW) and propensity score matching (PSM) analyses were performed for efficacy comparisons between bendamustine-exposed and bendamustine-naïve patients.
The results showed that of 439 patients, 80 had received bendamustine before apheresis. Patients with bendamustine exposure exhibited lower CD3+ cell and platelet counts at apheresis. Lower ORR (53% vs. 72%, P < .01), shorter PFS (3.1 vs. 6.2 months, P=.04), and OS (10.3 vs. 23.5 months, P=.01) were demonstrated and compared to the bendamustine-naïve group. However, these differences were mitigated after adjusting for baseline variables using IPTW and PSM. Notably, recent bendamustine exposure (<9 months) showed a significantly lower ORR (40% vs. 72%, P<.01), shorter PFSl (1.3 vs. 6.2 months, P<.01), and OS (4.6 vs. 23.5 months, P<.01) even after adjustment. Conversely, the cumulative dose of bendamustine before apheresis did not impact CAR-T efficacy outcomes.
Recent exposure to bendamustine before apheresis was associated with adverse treatment outcomes following CD19-targeted CAR T-cell therapy in patients with r/rLBCL.