Bispecific Antibodies Versus Chimeric Antigen Receptor T-Cell Therapy in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Comparative Narrative Review of Efficacy, Safety, and Accessibility.

INTRODUCTION: Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma, and despite advances in frontline therapies such as rituximab, cyclophosphamide, doxorubicin hydrochloride (hydroxydaunorubicin), vincristine sulfate (Oncovin), and prednisone, approximately 30%-40% of patients develop relapsed or refractory (rel/ref) disease. This subgroup has historically faced poor prognoses with limited treatment options, prompting the development of novel immunotherapeutic strategies. Chimeric antigen receptor T-cell (CAR T) therapy and bispecific antibodies (BsAbs) have emerged as transformative approaches in this setting.

METHODS: This narrative review compares these therapies across multiple domains, including mechanisms of action, clinical efficacy, safety profiles, logistics, cost, and accessibility.

RESULTS: CAR T therapies have demonstrated durable complete response rates (40%-60%) and extended progression-free survival (median 11-12.5 months), but they are limited by complex manufacturing, high cost, and potentially severe toxicities. In contrast, BsAbs offer immediate, off-the-shelf availability, with promising efficacy and a more favorable safety profile that enables outpatient administration, although long-term durability remains under investigation.

CONCLUSION: This review provides clinicians with a comprehensive comparison to support evidence-based treatment selection in rel/ref DLBCL.