Comparative survival and time toxicity outcomes of CAR-T versus bispecific antibody therapies in relapsed/refractory FL
Chimeric antigen receptor T-cell (CAR-T) and CD20xCD3 bispecific antibody (BsAb) therapies are both effective for relapsed/refractory (R/R) follicular lymphoma (FL), but comparative real-world survival outcomes and time toxicity have not been characterized. We performed a multicenter retrospective study of 228 patients with R/R FL treated with standard-of-care CAR-T (n = 141) or BsAb (n = 87) across 17 U.S. academic centers in the third-line or later setting. Progression-free survival (PFS) and overall survival (OS) were stratified by 2 or ≥3 prior lines of therapy (LOT2 or LOT3+), including propensity matching. Time toxicity was measured by physical health care contact days. Median PFS was not reached (NR) with CAR-T and 581 days with BsAb in the LOT2 cohort (p < .0001), and was NR with CAR-T and 584 days with BsAb in the LOT3+ cohort (p = .0064). CAR-T recipients were younger (p < .0001) and had better performance status (p = .007) but were more refractory to prior LOT (p = .017). PFS advantages of CAR-T were independent of these differences. OS did not differ between treatment groups. CAR-T had significantly greater time toxicity over the first year, with higher mean contact days than BsAb in both the LOT2 (58 vs 44) and LOT3+ (69 vs 49) cohorts. In this large multicenter cohort of patients with R/R FL, CAR-T was associated with superior PFS but greater time toxicity compared with BsAb therapy. These findings provide real-world outcomes data and time toxicity benchmarks to support treatment sequencing decision-making in R/R FL.
Authors
- Reem Karmali (ORCID: https://orcid.org/0000-0003-0984-4376)
- Hua-Jay Jeffery Cherng (ORCID: https://orcid.org/0000-0002-8266-8447)
- Nicole Altomare (ORCID: https://orcid.org/0000-0002-7085-4031)
- Danielle S. Wallace (ORCID: https://orcid.org/0000-0001-9371-6777)
- Brian Thomas Hill (ORCID: https://orcid.org/0000-0001-8781-3327)
- Arjab Adhikari
- Mazie Tsang (ORCID: https://orcid.org/0000-0003-1215-4210)
- Danny Trotier (ORCID: https://orcid.org/0009-0003-3997-5286)
- Edd Ricker (ORCID: https://orcid.org/0000-0001-8779-1105)
- Arjun Gupta (ORCID: https://orcid.org/0000-0003-0875-4731)
- Jose Caetano Villasboas (ORCID: https://orcid.org/0000-0002-2907-0809)
- Dilan Anil Patel (ORCID: https://orcid.org/0000-0003-0765-4990)
- Allison Marie Bock (ORCID: https://orcid.org/0000-0002-3174-8877)
- Taylor Brooks (ORCID: https://orcid.org/0009-0007-4352-9296)
- Pallawi Torka (ORCID: https://orcid.org/0000-0002-1681-5883)
- Christopher Mwaniki Wanjiku
- Madiha Iqbal (ORCID: https://orcid.org/0000-0001-6752-5440)
- Jennifer C. Keenan (ORCID: https://orcid.org/0000-0001-8276-5733)
- Jonathan Harry Schatz (ORCID: https://orcid.org/0000-0003-1842-228X)
- Asaad Trabolsi (ORCID: https://orcid.org/0000-0002-2479-1797)
- Jordan Andrew Snyder (ORCID: https://orcid.org/0000-0002-1001-134X)
- Ajay Major (ORCID: https://orcid.org/0000-0001-7261-1335)
- Samin Houshyar (ORCID: https://orcid.org/0009-0000-8727-436X)
- Charlotte Burton Wagner (ORCID: https://orcid.org/0000-0003-0568-0781)
- Priyanka Avinash Pophali (ORCID: https://orcid.org/0000-0002-2410-9540)
- Timothy J. Voorhees (ORCID: https://orcid.org/0000-0001-7603-6454)
- Nausheen Ahmed (ORCID: https://orcid.org/0000-0003-4336-4982)
- Supriya Gupta (ORCID: https://orcid.org/0000-0001-5144-3467)
- Nidhi Desai (ORCID: https://orcid.org/0000-0001-6630-278X)
- Diana Abbott (ORCID: https://orcid.org/0009-0005-7769-9678)
- John Sharp (ORCID: https://orcid.org/0000-0001-5765-8549)
- Jessica A. Chicola
- Haya Al Any
- Mohamed Rajab
- Alline Nogueira Serodio (ORCID: https://orcid.org/0009-0001-3192-7568)
Institutions
- Northwestern University (US)
- City Of Hope National Medical Center (US)
- University of Minnesota (US)
- Cleveland Clinic (US)
- Mayo Clinic (US)
- Memorial Sloan Kettering Cancer Center (US)
- University of Wisconsin–Madison (US)
- University of Miami (US)
- University of Kansas (US)
- Colorado School of Public Health (US)
- Oregon Health & Science University (US)
- Washington University in St. Louis (US)
- Columbia University Irving Medical Center (US)
- Ochsner Medical Center (US)
- Huntsman Cancer Institute (US)
- University of Rochester Medical Center (US)
- The University of Kansas Cancer Center (US)
- University of Wisconsin Carbone Cancer Center (US)
- City of Hope (US)
- Mayo Clinic Hospital (US)
- Mayo Clinic in Florida (US)
- UNC Lineberger Comprehensive Cancer Center (US)
- Masonic Cancer Center (US)
- Cleveland Clinic Abu Dhabi (AE)
- University of Colorado Anschutz Medical Campus (US)
- The Ohio State University (US)
- University of Colorado Denver (US)
Publication Details
- Journal
- Blood Advances
- Published
- 2026-10-30
- DOI
- https://doi.org/10.1182/bloodadvances.2026020899
- Primary Topic
- CAR-T cell therapy research
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Incyte
- Genentech