{"entity":{"id":"lymphodepletion","kind":"term","name":"Lymphodepletion before CAR-T","aka":["lymphodepleting","lymphodepleting chemotherapy","lymphodepletion chemotherapy","LD chemo","Flu/Cy","fludarabine/cyclophosphamide","fludarabine-cyclophosphamide","bendamustine lymphodepletion","making room","homeostatic expansion"],"tldr":"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.","asOf":"2026-09-09","wikipedia":"https://en.wikipedia.org/wiki/Chimeric_antigen_receptor_T_cell","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Chimeric_antigen_receptor_T_cell"}],"tags":[],"related":["conditioning-regimen","vein-to-vein-time","cytopenias","apheresis"],"cancers":[],"sections":["cell-therapy"],"technologies":["car-t","in-vivo-car-t"],"targets":[],"drugs":["cyclophosphamide","bendamustine"],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"category":"Treatment jargon"},"route":"/terms/lymphodepletion/","neighbours":{"term":[{"id":"alkylating-agent","kind":"term","name":"Alkylating agents and antimetabolites","route":"/terms/alkylating-agent/"},{"id":"apheresis","kind":"term","name":"Apheresis (leukapheresis)","route":"/terms/apheresis/"},{"id":"bridging-therapy","kind":"term","name":"Bridging therapy","route":"/terms/bridging-therapy/"},{"id":"conditioning-regimen","kind":"term","name":"Conditioning regimen (myeloablative, reduced-intensity)","route":"/terms/conditioning-regimen/"},{"id":"lymphoma-tx-crs-icans","kind":"term","name":"Cytokine release syndrome and ICANS: grading and management","route":"/terms/lymphoma-tx-crs-icans/"},{"id":"cytopenias","kind":"term","name":"Cytopenias and myelosuppression","route":"/terms/cytopenias/"},{"id":"lymphoma-tx-car-t-pathway","kind":"term","name":"The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting","route":"/terms/lymphoma-tx-car-t-pathway/"},{"id":"vein-to-vein-time","kind":"term","name":"Vein-to-vein time and manufacturing slots","route":"/terms/vein-to-vein-time/"}],"section":[{"id":"cell-therapy","kind":"section","name":"Cell Therapy","route":"/fronts/cell-therapy/"}],"technology":[{"id":"car-t","kind":"technology","name":"CAR-T cell therapy","route":"/technologies/car-t/"},{"id":"in-vivo-car-t","kind":"technology","name":"In vivo CAR-T","route":"/technologies/in-vivo-car-t/"}],"drug":[{"id":"bendamustine","kind":"drug","name":"Bendamustine","route":"/drugs/bendamustine/"},{"id":"cyclophosphamide","kind":"drug","name":"Cyclophosphamide","route":"/drugs/cyclophosphamide/"}],"trial":[{"id":"juliet","kind":"trial","name":"JULIET","route":"/trials/juliet/"}],"paper":[{"id":"paper-zuma-5-axi-cel-indolent-lymphoma-lancet-oncol-2022","kind":"paper","name":"Axicabtagene ciloleucel in relapsed or refractory indolent non-Hodgkin lymphoma (ZUMA-5): a single-arm, multicentre, phase 2 trial","route":"/key-papers/paper-zuma-5-axi-cel-indolent-lymphoma-lancet-oncol-2022/"}],"idea":[{"id":"lymphoma-ev-manufacturing-time-as-a-trial-endpoint","kind":"idea","name":"Report the time from apheresis to infusion as a trial endpoint, not a logistics footnote","route":"/ideas/lymphoma-ev-manufacturing-time-as-a-trial-endpoint/"}]}}