Multinational retrospective study of impact of recent bendamustine treatment on outcomes with CAR T-cell therapy for large B-cell lymphoma

Approximately 30%-40% of patients with relapsed/refractory large B-cell lymphoma (R/R LBCL) infused with CD19-targeted CAR T cells achieve durable responses. Consensus guidelines suggest avoiding bendamustine before apheresis, but specific data in this setting are lacking. A retrospective study at seven European centers included 439 R/R LBCL patients infused with CD19-targeted CAR T cells, of whom 80 had received bendamustine before apheresis. These patients had lower overall response rate (53% versus 72%; p<0.01), shorter progression-free survival (3.1 versus 6.2 months; p=0.04), and shorter overall survival (10.3 versus 23.5 months; p=0.01). Those with recent (<9 months) bendamustine exposure (n=42) had lower ORR (40% versus 72%; p<0.01), shorter PFS (1.3 versus 6.2 months; p<0.01), and shorter OS (4.6 months versus 23.5 months) in comparison with bendamustine-naïve patients. The authors conclude that recent bendmustine exposure before apheresis was associated with negative treatment outcomes after CD19-targeted CAR T-cell therapy.