SynthesisFrontiers in immunology2026
Efficacy-safety trade-off and patient selection: a meta-analysis informing clinical choice between CAR-T and bispecific antibodies for R/R B-NHL.
Synthesis in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
This meta-analysis compared chimeric antigen receptor T-cell (CAR-T) therapy and bispecific antibodies (BsAbs) for relapsed/refractory B-cell non-Hodgkin lymphoma (R/R B-NHL), focusing on efficacy and safety. We analyzed 59 phase I/II trials involving 2,914 patients. CAR-T achieved higher ORR (72% [95% CI 67-77%] vs. 50% [38-62%]) and CR (54% [49-59%] vs. 33% [23-46%]) than BsAbs. However, it was associated with higher rates of grade ≥3 CRS (8% [6-11%] vs. 4% [3-7%]), ICANS (12% [9-16%] vs. 6% [2-18%]), and neurotoxicity (8% [6-10%] vs. 6% [2-13%]). Among CAR-T constructs, dual-targeting products (CD19/20 and CD19/22) showed higher efficacy with more varied toxicity profiles; among BsAbs, CD3×CD20 had a more favorable safety profile relative to CD3×CD19. These results suggest CAR-T may be preferable when deep remission is the priority, whereas BsAbs could be a better fit for frail patients or those seeking outpatient care with lower toxicity risks. Treatment selection should be tailored to patient characteristics, including age, tumor burden, and comorbidities. Together, these results provide a comprehensive, evidence-based framework to guide individualized treatment and sequencing in clinical practice.
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