Bispecific antibodies in relapsed/refractory diffuse large B-cell lymphoma.

Modern immunochemotherapy protocols allow 60–70% of diffuse large B-cell lymphoma (DLBCL) patients to be cured by first-line therapy. Those with primary resistance or early relapse have a poor prognosis, and classical salvage regimens are effective in less than 20% of these patients. Targeted chemotherapy and immunotherapy protocols are considered the current standard of care. Chimeric antigen receptor T cell (CAR-T cell) therapy and bispecific antibodies (BsAbs) are regarded as the two most effective methods. Epcoritamab and glofitamab are novel BsAbs approved for the treatment of DLBCL after two lines of systemic therapy. Their high efficacy and safety have been confirmed in phase II multicenter studies. BsAbs are an alternative to CAR-T cell therapy in patients who do not qualify for it or who cannot wait for CAR-T cell preparation due to rapidly progressing disease. Although BsAbs are approved as monotherapy, combinations with chemotherapy and immunomodulatory agents are being explored in ongoing clinical studies. The high efficacy of BsAbs has prompted further research into their potential role in earlier lines of treatment, including first line and debulking before CAR-T cell therapies.