Comparison of Bispecific T-cell Engager Antibodies and CAR-T Therapies for Patients With Relapsed/Refractory Diffuse Large B-cell Lymphoma: A Systematic Review and Meta-Analysis
Author(s)
Chun-Hsuan Chang, Master1, Ping-Hsuan Hsieh, PhD1, Yu-Guang Chen, PhD2.
1National Defense Medical Center, Taipei City, Taiwan, 2Tri-Service General Hospital, Taipei City, Taiwan.
1National Defense Medical Center, Taipei City, Taiwan, 2Tri-Service General Hospital, Taipei City, Taiwan.
OBJECTIVES: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. Recent advances have led to the approval of chimeric antigen receptor T-cell (CAR-T) therapies, including axicabtagene ciloleucel (axi-cel), lisocabtagene maraleucel (liso-cel), and tisagenlecleucel (tisa-cel), as well as bispecific T-cell engager antibodies (TCEAbs) such as glofitamab, epcoritamab, and odronextamab for relapsed or refractory (r/r) DLBCL. While CAR-T therapies offer potential for durable remission, their use is limited by high cost, toxicity, and time needed for individualized cell manufacturing. In contrast, TCEAbs have a favorable safety profile and are available off the shelf, enabling earlier treatment. Although both strategies show promise, real-world comparative data remains limited.
METHODS: This study assessed the efficacy of TCEAbs and CAR-T therapies in patients with r/r DLBCL. Studies published through May 29, 2025, were identified in PubMed and Embase. Eligible studies enrolled patients who had received at least two prior lines of systemic therapy. Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) were digitized and reconstructed as individual patient data for pooled survival analyses and indirect comparisons.
RESULTS: Nine studies including 1,445 patients met the inclusion criteria. Complete remission rates were 58.4% for axi-cel, 56.7% for liso-cel, 41.4% for tisa-cel, 40.0% for epcoritamab, 39.0% for glofitamab, and 31.5% for odronextamab. Axi-cel and liso-cel had the most favorable two-year OS and PFS. Epcoritamab demonstrated comparable OS (hazard ratio [HR] = 1.29, 95% confidence interval [CI]: 0.96-1.74). Glofitamab (HR = 1.54, 95% CI: 1.15 to 2.07), tisa-cel (HR = 1.58, 95% CI: 1.22 to 2.04), and odronextamab (HR = 1.87, 95% CI: 1.39 to 2.51) showed significantly higher mortality risk versus axi-cel.
CONCLUSIONS: Axi-cel, liso-cel, and epcoritamab provided the best survival outcomes. Inferior results for some TCEAbs may reflect inclusion of patients with prior CAR-T exposure, which is linked to poor prognosis.
METHODS: This study assessed the efficacy of TCEAbs and CAR-T therapies in patients with r/r DLBCL. Studies published through May 29, 2025, were identified in PubMed and Embase. Eligible studies enrolled patients who had received at least two prior lines of systemic therapy. Kaplan-Meier curves for overall survival (OS) and progression-free survival (PFS) were digitized and reconstructed as individual patient data for pooled survival analyses and indirect comparisons.
RESULTS: Nine studies including 1,445 patients met the inclusion criteria. Complete remission rates were 58.4% for axi-cel, 56.7% for liso-cel, 41.4% for tisa-cel, 40.0% for epcoritamab, 39.0% for glofitamab, and 31.5% for odronextamab. Axi-cel and liso-cel had the most favorable two-year OS and PFS. Epcoritamab demonstrated comparable OS (hazard ratio [HR] = 1.29, 95% confidence interval [CI]: 0.96-1.74). Glofitamab (HR = 1.54, 95% CI: 1.15 to 2.07), tisa-cel (HR = 1.58, 95% CI: 1.22 to 2.04), and odronextamab (HR = 1.87, 95% CI: 1.39 to 2.51) showed significantly higher mortality risk versus axi-cel.
CONCLUSIONS: Axi-cel, liso-cel, and epcoritamab provided the best survival outcomes. Inferior results for some TCEAbs may reflect inclusion of patients with prior CAR-T exposure, which is linked to poor prognosis.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
CO61
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Oncology