Dr. Abid on Adaptive Lymphodepletion in CAR T-Cell Recipients in R/R B-Cell NHL

Muhammad Bilal Abid, MD, MRCP, assistant professor of medicine, Divisions of Hematology/Oncology and Infectious Diseases, Medical College of Wisconsin, discusses the impact of adaptive lymphodepletion in patients with relapsed/refractory B-cell non-Hodgkin’s lymphoma (NHL) who received CAR T-cell therapy.

This evaluation compared toxicity outcomes in adult patients with relapsed/refractory B-cell NHL between June 2018 and August 2020 who received 2 intensities of lymphodepletion chemotherapy. Patients either received the standard dose of lymphodepletion at 30 mg/m2 of fludarabine and 500 mg/m2 of cytarabine per day for each for 3 days prior to receiving axicabtagene ciloleucel (axi-cel; Yescarta), or a lower-dose of 30 mg/m2 of fludarabine for 3 days and 500 mg/m2 of cytarabine for 1 day.

Patients in the low-dose lymphodepletion cohort had a median duration of lymphopenia of 5 days, compared with a median duration of lymphopenia of 11 days in patients who received standard-dose lymphodepletion, Abid says. Moreover, 50% of patients in the low-dose cohort experienced episodes of neutropenic fever in the first 28 days, vs 85% in the standard-dose cohort, Abid explains.

Risk of neurotoxicity, such as cytokine release syndrome or immune effector cell-associated neurotoxicity syndrome, were significantly less in the low-dose cohort, Abid adds. As a result, the use of corticosteroids and tocilizumab (Actemra) was less in the low-dose cohort, Abid concludes.