Comparison of Fludarabine Versus Bendamustine as a Lymphodepleting Chemotherapy Prior to CAR-T for Large Cell Lymphoma.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Ahmed Nausheen, Ali Alaa, Kim Soyoung, Oloyede Temitope, Bye Matthew, Gowda Lohith, Kamble Rammurti T, Mirza Abu-Sayeef, Nadiminti Kalyan V, Pophali Priyanka A, Rodriguez-Bonilla Carlos, Sieg Alex, Strouse Christopher, Abid Muhammad Bilal, Afrough Aimaz, Aljurf Mahmoud, Beitinjaneh Amer M, Chhabra Saurabh, Choe Michelle, Hilal Talal, Iqbal Madiha, Jain Tania, Kharfan-Dabaja Mohamed A, Modi Dipenkumar, Orti Guillermo, Pawarode Attaphol, Rao Uttam, Riedell Peter A, Saad Ayman, Seo Sachiko, Balari Anna Sureda, Wagner John L, Wudhikarn Kitsada, Turtle Cameron J, Phillips Christine L, Pasquini Marcelo C, Ahmed Sairah, Ganguly Siddhartha, Moskop Amy
Аннотация
Lymphodepleting chemotherapy (LD) enhances chimeric antigen receptor T cell (CAR-T) expansion, persistence, and clinical activity. Fludarabine-cyclophosphamide is most used, but the benefit of alternative agents is unknown. This study compares fludarabine- versus bendamustine-based LD in the real-world setting prior to CAR-T treatment of relapsed or refractory large cell lymphoma (LBCL). We assessed outcomes of patients with LBCL who received commercial CD19 CAR-T therapies during 2017 to 2023, using data from Center for International Blood and Marrow Transplant Research. Of 5256 patients with LBCL treated with axicabtagene ciloleucel, tisagenlecleucel, or lisocabtagene maraleucel, 92% and 9% received fludarabine and bendamustine LD, respectively. Multivariate analyses showed bendamustine had inferior overall response rate (ORR) (hazard ratio [HR] 0.773, P = .0013), but there was no difference in complete response (HR 0.828, P = .0606). The 1-year and 2-year rates of progression-free survival (PFS) were lower for bendamustine (P = .04), and the 1-year and 2-year rates of overall survival (OS) were similar (P = .65) The bendamustine group had lower rates of toxicities than the fludarabine group, including severe cytokine release syndrome (odds ratio [OR] 0.445, P < .0001), immune effector cell-associated neurotoxicity syndrome (OR 0.432, P < .0001), prolonged cytopenia (OR 0.479, P < .0001) Treatment-related mortality (TRM) was lower in the bendamustine group. In a subset analysis adjusting for distribution of LD regimens, the main conclusions were the same. Regardless of CAR-T products used, compared to patients who received bendamustine, patients who received fludarabine LD had higher ORR and PFS, without significant impact on OS. Bendamustine was associated with a reduced incidence of toxicities and TRM. Providers can consider relevant patient characteristics when choosing LD and the trade-off between efficacy and safety. Bendamustine can be considered an alternative LD prior to CAR-T for LBCL.