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Ghilardi G, Chong EA, Svoboda J, Wohlfarth P, Nasta SD, Williamson S, Landsburg JD, Gerson JN, Barta SK, Pajarillo R, Myers J, Chen AI, Schachter L, Yelton R, Ballard HJ, Hodges Dwinal A, Gier S, Victoriano D, Weber E, Napier E, Garfall A, Porter DL, Jäger U, Maziarz RT, Ruella M, Schuster SJ. Bendamustine is safe and effective for lymphodepletion before tisagenlecleucel in patients with refractory or relapsed large B-cell lymphomas. Ann Oncol 2022; 33:916-928. [PMID: 35690221 DOI: 10.1016/j.annonc.2022.05.521] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Anti-CD19 chimeric antigen receptor T-cell immunotherapy (CAR-T) is now a standard treatment of relapsed or refractory B-cell non-Hodgkin lymphomas; however, a significant portion of patients do not respond to CAR-T and/or experience toxicities. Lymphodepleting chemotherapy is a critical component of CAR-T that enhances CAR-T-cell engraftment, expansion, cytotoxicity, and persistence. We hypothesized that the lymphodepletion regimen might affect the safety and efficacy of CAR-T. PATIENTS AND METHODS We compared the safety and efficacy of lymphodepletion using either fludarabine/cyclophosphamide (n = 42) or bendamustine (n = 90) before tisagenlecleucel in two cohorts of patients with relapsed or refractory large B-cell lymphomas treated consecutively at three academic institutions in the United States (University of Pennsylvania, n = 90; Oregon Health & Science University, n = 35) and Europe (University of Vienna, n = 7). Response was assessed using the Lugano 2014 criteria and toxicities were assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 and, when possible, the American Society for Transplantation and Cellular Therapy (ASTCT) consensus grading. RESULTS Fludarabine/cyclophosphamide led to more profound lymphocytopenia after tisagenlecleucel infusion compared with bendamustine, although the efficacy of tisagenlecleucel was similar between the two groups. We observed significant differences, however, in the frequency and severity of adverse events. In particular, patients treated with bendamustine had lower rates of cytokine release syndrome and neurotoxicity. In addition, higher rates of hematological toxicities were observed in patients receiving fludarabine/cyclophosphamide. Bendamustine-treated patients had higher nadir neutrophil counts, hemoglobin levels, and platelet counts, as well as a shorter time to blood count recovery, and received fewer platelet and red cell transfusions. Fewer episodes of infection, neutropenic fever, and post-infusion hospitalization were observed in the bendamustine cohort compared with patients receiving fludarabine/cyclophosphamide. CONCLUSIONS Bendamustine for lymphodepletion before tisagenlecleucel has efficacy similar to fludarabine/cyclophosphamide with reduced toxicities, including cytokine release syndrome, neurotoxicity, infectious and hematological toxicities, as well as reduced hospital utilization.
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Affiliation(s)
- G Ghilardi
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - E A Chong
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Svoboda
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - P Wohlfarth
- Medical University of Vienna, Division of Hematology and Hemostaseology, Department of Medicine I Wien, Comprehensive Cancer Center, Vienna, Austria
| | - S D Nasta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - S Williamson
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - J D Landsburg
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J N Gerson
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - S K Barta
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - R Pajarillo
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - J Myers
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - A I Chen
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - L Schachter
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - R Yelton
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA
| | - H J Ballard
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - A Hodges Dwinal
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - S Gier
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - D Victoriano
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - E Weber
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - E Napier
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - A Garfall
- Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - D L Porter
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - U Jäger
- Medical University of Vienna, Division of Hematology and Hemostaseology, Department of Medicine I Wien, Comprehensive Cancer Center, Vienna, Austria
| | - R T Maziarz
- Oregon Health & Science University Knight Cancer Institute, Adult Blood and Marrow Stem Cell Transplant & Cell Therapy Program, Portland, USA
| | - M Ruella
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - S J Schuster
- Lymphoma Program, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA; Center for Cellular Immunotherapies and Cellular Therapy and Transplant, University of Pennsylvania, Philadelphia, USA; Division of Hematology-Oncology, Hospital of the University of Pennsylvania, Philadelphia, USA.
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Karmali R, Donovan A, Wagner‐Johntson N, Messmer M, Mehta A, Anderson JK, Reddy N, Kovach AE, Landsburg DJ, Glenn M, Inwards DJ, Ristow K, Lansigan F, Kaplan JB, Caimi PB, Rajguru S, Evens A, Klein A, Umyarova E, Amengual JE, Lue JK, Diefenbach C, Epperla N, Barta SK, Hernandez‐Ilizaliturri FJ, Handorf E, Villa D, Gerrie AS, Li S, Mederios J, Wang M, Cohen J, Calzada O, Churnetski M, Hill B, Sawalha Y, Gerson JN, Kothari S, Vose JM, Bast M, Fenske TS, Narayana Rao Gari S, Maddocks KJ, Bond D, Bachanova V, Kolla B, Chavez J, Shah B. SURVIVAL FOLLOWING FIRST RELAPSE IN YOUNGER PATIENTS WITH MANTLE CELL LYMPHOMA. Hematol Oncol 2021. [DOI: 10.1002/hon.60_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - A. Donovan
- Dartmouth Hitchcock, Hem Onc Lebanon USA
| | | | - M. Messmer
- Johns Hopkins University, Hem Onc Baltimore USA
| | - A. Mehta
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - J. K. Anderson
- University of Alabama Cancer Center, Hem Onc Birmingham USA
| | - N. Reddy
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - A. E. Kovach
- Vanderbilt Ingram Cancer Center, Hem Onc Nashville USA
| | - D. J. Landsburg
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | - M. Glenn
- Huntsman Cancer Institute, Hem Onc Salt Lake City USA
| | | | | | | | | | - P. B. Caimi
- Case Western Reserve University, Hem Onc Cleveland USA
| | - S. Rajguru
- University of Wisconsin, Hem Onc Madison USA
| | - A. Evens
- Rutgers, Hem Onc New Brunswick USA
| | | | - E. Umyarova
- University of Vermont, Hem Onc Burlington USA
| | | | | | | | - N. Epperla
- Ohio State University, Hem Onc Columbus USA
| | - S. K. Barta
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - E. Handorf
- Fox Chase Cancer Center, Hematology Oncology Philadelphia USA
| | - D. Villa
- BC Cancer, Hem Onc Vancouver Canada
| | | | - S. Li
- MD Anderson, Hem Onc Houstin USA
| | | | - M. Wang
- MD Anderson, Hem Onc Houstin USA
| | | | | | | | | | | | - J. N. Gerson
- University of Pennsylvania, Hematology Oncology Philadelphia Pennsylvania USA
| | | | - J. M. Vose
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - M. Bast
- University of Nebraska Cancer Center, Hem Onc Omaha USA
| | - T. S. Fenske
- Medical College of Wisconsin, Hem Onc Milwaukee USA
| | | | | | - D. Bond
- Ohio State University, Hem Onc Columbus USA
| | - V. Bachanova
- University of Minnesota , Hem Onc Minneapolis USA
| | - B. Kolla
- University of Minnesota , Hem Onc Minneapolis USA
| | - J. Chavez
- Moffitt Cancer Center, Hem Onc Tampa USA
| | - B. Shah
- Moffitt Cancer Center, Hem Onc Tampa USA
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