Real-World Bispecific Antibody Use Post-CAR T in DLBCL

Geoffrey Shouse, DO, PhD, an assistant professor at City of Hope Comprehensive Cancer Center in Duarte, California, and a member of the lymphoma division, discusses what motivated this retrospective review of bispecific antibodies in diffuse large B-cell lymphoma (DLBCL) at City of Hope and evaluates the patient population utilized in this trial.

The treatment paradigm for DLBCL has been significantly altered by the emergence of cellular therapies like chimeric antigen receptor (CAR) T-cell therapy. However, effective options remain limited for patients who relapse after CAR T. Bispecific antibodies, such as epcoritamab-bysp (Epkinly) and glofitamab-gxbm (Columvi), have emerged as promising subsequent therapies.

“The treatment landscape for diffuse large B-cell lymphoma has really seen a revolution over the last 5 years…with the advent of cellular therapies, including CAR T. Now, CAR T has moved up to the second-line, and in patients where there's relapse after CAR T therapy, we do not have a lot of very good options for treatment that are effective, but bispecific antibodies have become kind of the next hope in that setting,” explains Shouse.

Shouse notes that while these bispecific antibodies are now standard of care for such patients, their use in clinical practice might differ from the strict inclusion criteria of pivotal trials. A City of Hope review presented on at the 2025 Transplant and Cellular Therapy Meetings sought to understand how patients treated in a real-world setting, including those who might have been excluded from trials due to factors like shorter time since CAR T or significant comorbidities, fared with bispecific antibody therapy.

“Compared to the clinical trials, we had about half of the patients that met the inclusion criteria and probably would have been included, and then about half that did not. The main reasons for them not meeting the inclusion criteria were either how close it was after CAR T-cell therapy that they ended up getting the bispecific antibody or their comorbidities. They tended to be basically sicker or more refractory patients than would have been on the trial,” explains Shouse.

REFERENCE:

Shouse G, Thiruvengadam S, Chen L, et al. Bispecific antibody treatment for diffuse large B cell lymphoma, a real-world evidence (RWE) study. Presented at: 2025 Transplant and Cellular Therapy Meetings; February 12-15, 2025; Honolulu, HI. Abstract 889.