Chemo Led to Worse Survival, Response and Progression in R/R LBCL With CAR-T

Patients with relapsed/refractory large B-cell lymphoma (R/R LBCL) who received treatment with both CAR-T cell therapy and bendamustine chemotherapy prior to apheresis, or blood collection, experienced lower rates of survival and response as well as shorter times until progression than patients who were not treated with bendamustine, according to recent study findings.

Among 439 patients with R/R LBCL, a group of 80 patients who were treated with bendamustine experienced an objective response rate (ORR; the portion of patients whose disease responded partially or completely to treatment) of 53%, compared with 72% for the cohort of bendamustine-naïve patients.

Progression-free survival (PFS; the time a patient lives without their disease spreading or worsening) was 3.1 months versus 6.2 months, respectively, for the patients treated with and without bendamustine, and overall survival (the time a patient lives, regardless of disease status) was 10.3 months versus 23.5 months, respectively, according to study findings published in the Journal of Clinical Oncology.

The respective study was led by a team of Barcelona-based researchers from the Vall d’Hebron Institute of Oncology’s experimental hematology group and the advanced therapies program of the Vall d’Hebron University Hospital’s hematology service.

The study’s researchers drew on the information of patients who had received CAR-T cell therapy in the third or later line of their treatment, 80 (18%) of whom were exposed to bendamustine at a median of six months before T cell collection, with a median of four cycles of treatment, according to a news release issued by Vall d’Hebron Institute of Oncology.

Researchers reported that the differences were mitigated after adjusting for baseline variables and found that the 42 patients treated with bendamustine less than nine months prior to apheresis had lower ORR, shorter PFS and shorter OS than patients not treated with bendamustine.

The ORR was 40% versus 72%, 1.3 months versus 6.2 months for PFS and 4.6 months versus 23.5 months for OS among the bendamustine and bendamustine-naïve groups of patients, respectively. However, researchers also determined that the cumulative dose of bendamustine prior to apheresis did not have an impact on the effectiveness of CAR-T treatment.

“On the basis of our results, the use of bendamustine should be avoided when possible in patients with refractory large B-cell lymphoma who are potential candidates for CAR T-cell therapy,” stated corresponding author Pere Barba, director of the advanced therapies program of Vall d’Hebron University Hospital’s Hematology Service and clinical Investigator of Vall d’Hebron Institute of Oncology’s experimental hematology group in the news release.

LEARN MORE: Stem Cell Transplants Improves Survival Without Progression in Relapsed LBCL Subset

Bendamustine is used to treat chronic lymphocytic leukemia (CLL), non-Hodgkin lymphoma (NHL) and myeloma, and the recent multicenter study was the first to examine and report on the impact of recent exposure to bendamustine on outcomes of CAR-T cell therapy among patients with LBCL, according to the news release.

“Our findings should be considered in future clinical guidelines; not only for these lymphomas but also for other types of lymphoma that may eventually progress and require CAR-T therapies, as we collectively seek to anticipate all treatment scenarios and improve patient outcomes,” Barba stated in the news release.

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