Bispecific Antibodies—A New Hope for Patients with Diffuse Large B-Cell Lymphoma

TL;DR

Bispecific antibodies offer a new treatment option for patients with difficult-to-treat diffuse large B-cell lymphoma, showing promise as an alternative to CAR T-cell therapy.

Contribution

This paper highlights the clinical potential and practical advantages of bispecific antibodies in treating R/R diffuse large B-cell lymphoma.

Findings

Bispecific antibodies rapidly become available and avoid autologous CAR T-cell therapy challenges.

BsAbs are effective in patients ineligible for or previously treated with CAR T-cell therapy.

Combining BsAbs with chemotherapy or using them as frontline therapy is being explored to improve outcomes.

Abstract

T-cell-engaging antibodies are a promising new type of treatment for patients with refractory or relapsed (R/R) diffuse large B-cell lymphoma, which has changed the prognosis and evolution of these patients in clinical trials. Bispecific antibodies (BsAbs) bind to two different targets (B and T lymphocytes) at the same time and in this way mimic the action of CAR (chimeric antigen receptor) T-cells. They are the T-cell-engaging antibodies most used in practice and are a solution for patients who do not respond to second- or later-line therapies, including chemoimmunotherapy, followed by salvage chemotherapy and hematopoietic stem cell transplantation. They are a therapeutic option for patients who are ineligible for CAR T-cell therapy and are also active in those with prior exposure to CAR T-cell treatment. A remarkable advantage of BsAbs is their rapid availability, even if the disease progresses rapidly, unlike CAR T-cell treatment, and they avoid the practical and financial challenges raised by autologous CAR T-cell therapies. CAR-T has been proven to have better efficacy compared to BsAbs, but cytokine release syndrome and neurotoxicity have appeared significantly more frequently in patients treated with CAR T-cells. The possibility of combining BsAbs with chemotherapy and their administration for relapses or as a frontline therapy is being studied to increase their efficacy. BsAbs are a life-saving therapy for many patients with diffuse large B-cell malignant non-Hodgkin’s lymphoma (NHL) who have a poor prognosis with classical therapies, but are not without adverse effects and require careful monitoring.

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