Bridging to CAR T-cell therapy in LBCL with CD20 × CD3 BsAbs vs conventional treatment

Results from a multicenter, retrospective analysis evaluating the use of CD20 × CD3 bispecific antibodies (BsAbs) vs conventional treatment as bridging to chimeric antigen receptor (CAR) T-cell therapy in patients with large B-cell lymphoma (LBCL) were presented by Ruth Fluemann at the European Hematology Association (EHA) 2026 Congress, June 11–14, 2026, Stockholm, SE. Patients received either conventional bridging or no bridging (ConCAR; n = 45) or glofitamab, epcoritamab, or glofitamab + gemcitabine + oxaliplatin (Glo-GemOx) bridging (BisCAR; n = 67). Endpoints included safety, responses, progression-free survival (PFS), overall survival (OS), and immune profiling before and after CAR T-cell therapy. 

Key data: During bridging, cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) were generally low grade in the BisCAR group (CRS, Grade 1–2, 48%; Grade 3–4, 4%; ICANS, Grade 1–2, 4%; Grade 3–4, 0%), while no CRS or ICANS occurred in the ConCAR group. Rates of Grade 3–4 cytopenia were lower in the BisCAR group vs the ConCAR group (3% vs 22%). Rates of CRS following CAR T-cell therapy were not increased in the BisCAR (Grade 1–2, 70%; Grade 3–4, 2%) vs ConCAR (Grade 1–2, 67%; Grade 3–4, 7%) group. Rates of ICANS were also not increased in the BisCAR (Grade 1–2, 22%; Grade 3–4, 4%) vs ConCAR (Grade 1–2, 16%; Grade 3–4, 13%) group. The overall response rates (ORRs) after bridging and at Months 1 and 3 post CAR T-cell therapy were numerically higher in the BisCAR (69%, 85%, and 80%, respectively) vs ConCAR (61%, 72%, and 66%, respectively) group. Bridging strategy did not significantly impact PFS or OS. Glofitamab-based bridging was associated with transient immune-cell activation without evidence of negative or detrimental effects on CAR T-cell function and expansion.

Key learning: Bridging to CAR T-cell therapy with BisCAR did not impair CAR T-cell efficacy and resulted in high response rates before and after CAR T-cell therapy, as well as lower hematologic toxicity compared with ConCAR, supporting BsAb-based bridging as an alternative to chemotherapy-based approaches and warranting further evaluation in prospective trials.