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.

Click here for more coverage of Tandem 2024.

1. Rao U, Blunk B, Bachier CR, et al. Bendamustine versus fludarabine and cyclophosphamide for lymphodepletion prior to CAR-T therapy. Presented at: 2024 Tandem Meetings, February 21-24, San Antonio, Texas. Abstract #70
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