Uttam Rao, MD, MBA, on Comparing Conditioning Regimens for CAR-T
The transplant physician at St. David's South Austin Medical Center of the Sarah Cannon Transplant and Cell Therapy Network discussed a real-world study comparing bendamustine against fludarabine and cyclophosphamide.
“I think the main takeaways is that Bendamustine is effective. It offers safe, effective lymphodepletion prior to CAR-T.”
Currently FDA-approved chimeric antigen receptor T-cell (CAR-T) therapies require patients to undergo a lymphodepleting condition regimen prior to the administration of the CAR-T product itself. Traditionally, fludarabine and cyclophosphamide (flu/cy) regimens have been used for this purpose, including in all registry trial for FDA-approved CAR-T products. Although, over the past few years, an international shortage of flu, which remains ongoing, has spurred some institutions to seek an alternative agent for CAR-T conditioning therapy. In 2022, the Sarah Cannon Transplant and Cell Therapy Network made the switch from flu/cy to bendamustine for CAR-T conditioning. Along with the change, the network chose to continuously collect real-world data from patients who received bendamustine for their conditioning regiment for CAR-T in order to determine whether it is equivalent to flu/cy in terms of safety and efficacy. Uttam Rao, MD, MBA, a transplant physician at St. David's South Austin Medical Center of Sarah Cannon, gave a talk on the findings from this real-world study at the 2024 Tandem Meetings |Transplantation & Cellular Therapy Meetings of ASTCT and CIBMTR, held in San Antonio, Texas, February 21-24, 2024.
After his presentation, CGTLive® spoke with Rao to learn more about the networks findings. Rao emphasized that the data showed that outcomes for patients receiving bendamustine and flu/cy were largely equivalent, with similar results between these patient groups for overall survival and progression-free survival at 1 year posttreatment. Furthermore, Rao noted that the severity of neutropenia was actually greater in patients receiving flu/cy, indicating that bendamustine may actually be safer in this regard. Rao concluded by discussing some of the limitations of the findings, pointing out that longer follow-up and a randomized control clinical trial could provide a greater understanding of the comparison.
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