# Lymphodepletion before CAR-T

Source: https://onco.cc/terms/lymphodepletion/  
OnCo record `lymphodepletion` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A short course of chemotherapy (usually fludarabine and cyclophosphamide) given in the days before a CAR-T infusion to clear out the patient's own lymphocytes, making room and growth signals for the engineered cells to expand.

## Summary

Lymphodepletion removes regulatory T cells and cytokine sinks, raising IL-7 and IL-15 levels so infused CAR-T cells proliferate; its intensity correlates with expansion, response and also toxicity. Fludarabine shortages led to bendamustine substitution with similar outcomes. It causes a week or two of cytopenias and infection risk and contributes to prolonged cytopenias after CAR-T. In vivo CAR-T approaches and some allogeneic products aim to work without lymphodepletion, which would remove a major barrier to outpatient and community delivery. Vein-to-vein time includes the wait for manufacturing before lymphodepletion can begin.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: lymphodepleting; lymphodepleting chemotherapy; lymphodepletion chemotherapy; LD chemo; Flu/Cy; fludarabine/cyclophosphamide; fludarabine-cyclophosphamide; bendamustine lymphodepletion; making room; homeostatic expansion

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Chimeric_antigen_receptor_T_cell
- Wikipedia: https://en.wikipedia.org/wiki/Chimeric_antigen_receptor_T_cell

## Connected records

- terms: [Alkylating agents and antimetabolites](https://onco.cc/terms/alkylating-agent/), [Apheresis (leukapheresis)](https://onco.cc/terms/apheresis/), [Bridging therapy](https://onco.cc/terms/bridging-therapy/), [Conditioning regimen (myeloablative, reduced-intensity)](https://onco.cc/terms/conditioning-regimen/), [Cytokine release syndrome and ICANS: grading and management](https://onco.cc/terms/lymphoma-tx-crs-icans/), [Cytopenias and myelosuppression](https://onco.cc/terms/cytopenias/), [The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting](https://onco.cc/terms/lymphoma-tx-car-t-pathway/), [Vein-to-vein time and manufacturing slots](https://onco.cc/terms/vein-to-vein-time/)
- fronts: [Cell Therapy](https://onco.cc/fronts/cell-therapy/)
- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/), [In vivo CAR-T](https://onco.cc/technologies/in-vivo-car-t/)
- drugs: [Bendamustine](https://onco.cc/drugs/bendamustine/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/)
- trials: [JULIET](https://onco.cc/trials/juliet/)
- key papers: [Axicabtagene ciloleucel in relapsed or refractory indolent non-Hodgkin lymphoma (ZUMA-5): a single-arm, multicentre, phase 2 trial](https://onco.cc/key-papers/paper-zuma-5-axi-cel-indolent-lymphoma-lancet-oncol-2022/)
- ideas: [Report the time from apheresis to infusion as a trial endpoint, not a logistics footnote](https://onco.cc/ideas/lymphoma-ev-manufacturing-time-as-a-trial-endpoint/)

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JSON: https://onco.cc/api/v1/entities/lymphodepletion.json