Bispecific Antibodies Versus Chimeric Antigen Receptor T‐Cell Therapy in Relapsed/Refractory Diffuse Large B‐Cell Lymphoma: A Comparative Narrative Review of Efficacy, Safety, and Accessibility

TL;DR

This paper compares two immunotherapies for treating relapsed/refractory diffuse large B-cell lymphoma: CAR T-cell therapy and bispecific antibodies, focusing on their effectiveness, safety, and practical use.

Contribution

The paper provides a comparative analysis of CAR T-cell therapy and bispecific antibodies in treating relapsed/refractory DLBCL, highlighting their clinical outcomes, safety, and accessibility.

Findings

CAR T-cell therapy achieves durable complete response rates of 40%–60% but faces challenges with manufacturing, cost, and toxicity.

Bispecific antibodies offer immediate availability and outpatient administration with a favorable safety profile, though long-term durability is still being studied.

Abstract

Diffuse large B‐cell lymphoma (DLBCL) is the most common subtype of non‐Hodgkin lymphoma, and despite advances in frontline therapies such as rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone, approximately 30%–40% of patients develop relapsed or refractory (rel/ref) disease. This subgroup has historically faced poor prognoses with limited treatment options, prompting the development of novel immunotherapeutic strategies. Chimeric antigen receptor T‐cell (CAR T) therapy and bispecific antibodies (BsAbs) have emerged as transformative approaches in this setting.

This narrative review compares these therapies across multiple domains, including mechanisms of action, clinical efficacy, safety profiles, logistics, cost, and accessibility.

CAR T therapies have demonstrated durable complete response rates (40%–60%) and extended progression‐free survival (median 11–12.5 months), but they are limited by complex manufacturing, high cost, and potentially severe toxicities. In contrast, BsAbs offer immediate, off‐the‐shelf availability, with promising efficacy and a more favorable safety profile that enables outpatient administration, although long‐term durability remains under investigation.

This review provides clinicians with a comprehensive comparison to support evidence‐based treatment selection in rel/ref DLBCL.

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