The approval of autologous chimeric antigen receptor (CAR)-T cell therapy dramatically improved outcomes for patients with multiple myeloma and aggressive lymphoma; however, the treatment comes with major logistical challenges, safety concerns and high cost
More recently, bispecific T-cell engagers have emerged, offering an off-the-shelf alternative with potentially better safety but lower efficacy
For now, autologous CAR-T is prioritized for those who are candidates for both, due to longer term data, especially as it relates to durability of response
But, both approaches are seeking to push into earlier lines as part of combination regimens, and allogeneic CAR-Ts are aiming to provide the efficacy of CAR-T with an off-the-shelf product
There are two distinct T-cell therapy based approaches available to treat multiple myeloma (MM) and aggressive lymphomas
Approved T-Cell Therapies in Multiple Myeloma and Non Hodgkins Lymphoma
In MM, bispecifics may lag in ORR compared to auto CAR-T
but offer significantly better safety
Auto CAR-T vs. Bispecific (Multiple Myeloma)
Similar observations for auto-CART vs. bispecifics
hold true for LBCL/DLBCL
Auto CAR-T vs. Bispecific (LBCL/DLBCL)
Long-term follow up and one time treatment favor auto CAR-T over bispecifics; allogeneic CAR-T is aiming to offer the best of both
Comparison of T-cell Based Therapies
2024 could see the first allo CAR-T pivotal read out; other trials could move auto CAR-T and bispecifics into earlier lines, raising questions about optimal candidates for each and sequencing
Pivotal Trials to Watch in Multiple Myeloma and LBCL/DLBCL
We are looking forward to new data at ASH 2023 exploring use in earlier lines of therapy and in novel combinations
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