Sequencing of Bispecific Antibodies May Influence Outcomes in R/R Follicular Lymphoma
Key Takeaways
- Prior exposure led to similar overall response rates (ORR) but lower complete response (CR): Patients who had previously been treated with chimeric antigen receptor (CAR) T, bendamustine, and prior lines of therapy (LOT) saw no apparent change in ORR but experienced lower rates of CR.
- Timing of bispecific antibodies affects progression-free survival (PFS): The patients who received CAR T after being treated with bispecific antibodies experienced lower PFS than patients who received CAR T before the bispecific antibodies.
- Low rates of infection: Infection occurred in 27.4% of patients. Cytokine release syndrome (CRS) occurred in 34.9% of patients. Immune effector cell-associated neurotoxicity syndrome (ICANS) occurred in 2.4% of patients.
A multicenter observational study assessed the sequencing of bispecific antibodies in patients with relapsed or refractory follicular lymphoma (R/R FL) to monitor how different orders of treatment affect their efficacy and toxicity. The study observed 86 patients across 11 US medical centers who received bispecific antibodies between 2023 and 2025.
The Effects of Prior Exposure
Out of the 86 patients, 81 were evaluated for responses to treatment. The ORR for this group was 86.4%, and CR was achieved in 57 (70.4%) patients. The ORR was similar for patients who had previously received CAR T, bendamustine, and prior LOT, indicating that ORR is not affected by prior treatment. The CR, however, was found to be higher in patients without this prior exposure.
Fourteen patients received CAR T prior to being treated with bispecific antibodies, and 8 patients received CAR T after. The study found that PFS was lower in the 8 patients who received CAR T after being treated with bispecific antibodies. The timing and order of CAR T and bispecific antibodies had no apparent effect on overall survival (OS).
Rate of Infection
CRS occurred in 29 (34.9%) patients, with all cases being grade 2 or lower. ICANS occurred in 2 (2.4%) patients, both cases being grade 1 events. After being treated with bispecific antibodies, 23 (27.4%) patients experienced an infection.
Clinical Implications
The results indicate some connection between prior treatment exposure with patient outcomes. The sequencing of bispecific antibodies appears to have an effect on PFS as well.
Due to the study’s small sample size, more research is required. The authors noted, “Our findings warrant further investigation in a larger cohort with longer follow-up.”
Reference
Nze C, Bock A, Xu Y, et al. Real world outcomes of sequencing bispecific antibodies (BsAb) in patients with relapsed/refractory follicular lymphoma (R/R FL): a multi-center cohort study from cubic consortium. Blood. 2025;146(1):1837. doi:10.1182/blood-2025-1837
