Systematic review and meta-analysis of CAR T-cell therapy and bispecific antibody sequence for large B-cell lymphoma
The optimal treatment sequence for large B-cell lymphoma (LBCL) is unknown. Systematic review and meta-analysis of studies published between January 2010 and September 2025 compared effectiveness of bispecific antibodies (BsAb) after CAR T-cell therapy (CAR-T) versus CAR-T after BsAb. The analysis included patients across 15 clinical trials and 15 retrospective studies. Five studies represented 113 patients for CAR-T after BsAb, 20 studies represented 737 patients for BsAb after CAR-T, and five studies included BsAb combination treatments after CAR-T with 125 patients. The pooled complete response rate for CAR-T after BsAb was 53.7% (95% CI 39.8-67.0; I2= 38.0%), compared with 29.4% (25.1-34.0; 34.8%) for BsAb after CAR-T, and 46.4% (37-9-55.2; 0%) for BsAb combination treatments after CAR-T. The objective response rate in patients treated with CAR-T after BsAb was improved compared with patients treated with CAR-T without previous BsAb exposure (pooled risk ratio 1.62; 95% CI 1.24-2.11). The authors conclude that these results suggest that BsAb therapy before CAR-T could improve future CAR-T effectiveness for LBCL.