Comparative infection risk in CAR T vs bispecific antibodies in B-cell lymphoma: a systematic review and meta-analysis.

CD3xCD20 bispecific antibody (BsAb) therapy and CD19-directed chimeric antigen receptor T-cell therapy (CAR T) are novel immunotherapies that have shown impressive efficacy in B-cell lymphomas, but also come with significant morbidity and mortality, including infections. This meta-analysis compares rates of infections between commercially approved CAR T and BsAb therapy in patients with B-cell non-Hodgkin lymphoma (B-NHL). We conducted a systematic review for prospective trials assessing commercially approved CAR T and BsAbs in patients with B-NHL. Twenty-five studies comprising 3202 patients were included in the analysis. We used random effects models to evaluate all-grade infections, grade 3+ infections, and infection-related mortality, calculating both pooled rates per patient and per patient-month. While CAR T and BsAbs had similar rates of all-grade infections per patient (0.44 vs 0.54; P = .18), BsAbs had a higher rate of infection per patient-month (0.0397 vs 0.0167; P = .0012). Similarly, CAR T and BsAbs had similar rates of grade 3+ infections per patient (0.16 vs 0.22; P = .08), while BsAbs had a higher rate of grade 3+ infections per patient-month (0.0165 vs 0.0069; P = .0003). CAR T and BsAb products had similar rates of infection-related mortality per patient (0.04 vs 0.03; P = .26) and per patient-month (0.0023 vs 0.0022; P = .96). Our findings point to the potential increased burden of infections over time in patients receiving BsAb therapy, particularly for patients on indefinite therapy.