Bridging therapy for CAR-T
Chimeric antigen receptor (CAR) T-cell therapy has been approved for use in several relapsed/refractory hematologic malignancies and has significantly improved outcomes for these diseases. As a result, bridging therapy has become a widely used tool to stabilize or debulk disease between leukapheresis and CAR T cell administration.
A recent reviewed discussed the criteria for choosing bridging therapy: ” The choice of bridging therapy should be carefully considered (Table 2). Prior regimens and side effects from prior treatment should be evaluated, and therapies should be chosen that avoid worsening any short- or long-term side effects. Consideration should be given to avoiding regimens that may cause significant myelosuppression. Avoidance of regimens that may lead to significant lymphopenia is critical, and nucleoside analogs should be avoided if possible given their importance as lymphodepleting therapy prior to CAR T infusion and risk of prolonged immunosuppression and infectious complications. Intensive chemotherapy is not necessarily superior when used as bridging therapy, and targeted agents can be safely used in selected cases. Additionally, in patients who are candidates, radiation therapy should be considered as it has been used safely and avoids many of the side effects of systemic bridging therapy.”
Shakthi T. Bhaskar,Bhagirathbhai R. Dholaria,Salyka M. Sengsayadeth,Bipin N. Savani,Olalekan O. Oluwole, Role of bridging therapy during chimeric antigen receptor T cell therapy. eJHaem Volume3, Issue S1 Supplement: CHIMERIC ANTIGEN RECEPTOR (CAR) TCELL THERAPY January 2022
Pinnix CC, Gunther JR, Dabaja BS, et al. Bridging therapy prior to axicabtagene ciloleucel for relapsed/refractory large B-cell lymphoma. Blood Adv. 2020;4(13):2871-2883. doi:10.1182/bloodadvances.2020001837