P041 | BISPECIFIC ANTIBODIES IN OLDER PATIENTS WITH NON-HODGKIN LYMPHOMA: A SINGLE-CENTER EXPERIENCE

Background. Older patients with non-Hodgkin lymphoma (NHL) often face worse outcomes due to disease biology, comorbidities, and limited chemotherapy tolerance. Bispecific antibodies (BSAs) may offer an effective and better-tolerated alternative for this population. Methods. We conducted a retrospective analysis of 32 patients aged ≥65 years treated with BSAs in a single center between November 2018 and February 2025. Inclusion criteria encompassed patients with histologically confirmed B-cell NHL who received at least one dose of a bispecific antibody. Data collected included demographics, disease characteristics (histology, stage, IPI), prior therapies, baseline labs, ECOG performance status, and comorbidities. Outcomes assessed were overall response rate (ORR), complete response (CR), progression-free survival (PFS), overall survival (OS), and adverse events. Univariate analyses were performed to identify prognostic factors for OS and PFS. Results. Most patients were treated within clinical trials, while 5 patients received therapy outside of this setting. Median age was 73.5 years (range 65–85); 84.4% had aggressive B-cell NHL (DLBCL n=27). Five patients had indolent histology (3 follicular, 2 marginal zone). Patients received a median of two prior lines of therapy; most presented with stage IV disease (78.1%) and high IPI (55.6%). ORR was 65.6%, with CR in 53.1%. Of the 32 patients, 28 received Glofitamab, 3 Epcoritamab, and 1 Mosunetuzumab. Among Glofitamab-treated patients, 19 received combination therapy with an additional agent including targeted immunoconjugates and costimulatory molecules . 17 (53.1%) patients achieved CR, 4 (12.5%) PR and 11 (34.4 %) (NR or PD) . With a median follow-up of 12.3 months, 19 patients are alive and 15 still in CR. Overall, 13 patients died in 70% of cases, death was lymphoma-related, while in 2 patients it was secondary to infections and in 1 to a secondary malignancy. CRS occurred in 3 patients, with only one experiencing grade ≥2. Univariate analyses identified ECOG >1 and hemoglobin < 12 g/dL as significant prognostic factors associated with worse OS and PFS (p<0.05). Conclusions. BSAs show promising efficacy and manageable toxicity in older NHL patients although clinical trials and AIFA based selection criteria likely favored fitter individuals. Larger, real-world studies are needed to validate these results and optimize patient selection.