CAR T-cell vs bispecific antibodies in relapsed/refractory mantle cell lymphoma: a systematic review and meta-analysis.

Background: Mantle cell lymphoma (MCL) is an aggressive B-cell lymphoma with limited treatment options for relapsed/refractory (R/R) cases. CAR T-cell therapy and CD20×CD3 bispecific antibodies are promising immunotherapies, but no study has systematically compared their efficacy and safety in R/R MCL. Methods: This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD42024622564). A comprehensive search of PubMed, Embase, and the Cochrane Library (from inception to October 27, 2024) was performed to identify studies evaluating CAR T-cell therapy and bispecific antibodies in R/R MCL (third-line or later). Random-effects and fixed-effects models were used to calculate pooled complete response (CR) rates, overall response (OR) rates, and Grade ≥3 adverse events. Sensitivity analyses were conducted to assess the robustness of the results. Results: Five studies (237 patients) were included. Pooled CR rates were 0.63(95% CI, 0.51-0.74)for bispecific antibodies and 0.70(95%CI, 0.63-0.77) for CAR T-cell therapy (P <0.05). OR rates were similar (0.75 vs. 0.88). Grade ≥3 cytokine release syndrome rates were comparable (0.06 vs. 0.06), but neurotoxicity cannot be compared. Conclusion: CAR T-cell therapy demonstrated higher CR rates versus bispecific antibodies, supporting their role as effective third-line treatments for R/R MCL. Randomized trials are needed to confirm these findings. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024622564.