NHL: Are Bispecific Antibodies a Safe Treatment?

TOPLINE:

Bispecific antibodies (BsAbs) demonstrated a manageable safety profile in patients with non-Hodgkin lymphoma (NHL), with the prevalence of all-grade cytokine release syndrome (CRS) being 48% but that of grade ≥ 3 CRS being only 2%. The analysis of 2192 patients revealed a 38% and 26% prevalence of all-grade and grades ≥ 3 neutropenia, respectively, with 38% and 12% occurrence rates of all-grade and grade ≥ 3 infections, respectively.

METHODOLOGY:

• A systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines examined 32 trials involving 2192 patients with NHL.
• Participants had a median age of 66 (range, 55-84) years, with a median of two prior lines of therapy (range, 0-5), followed-up for a median of 9.4 months (range, 2.8-32.0).
• Analysis focused on the prevalence and rates of infection, neutropenia, CRS, and immune effector cell–associated neurotoxicity syndrome across multiple studies.
• Researchers utilized generalized linear mixed modeling meta-analysis to estimate adverse events prevalence, with heterogeneity assessed using I² and T² statistics.

TAKEAWAY:

• Combination therapy showed significantly higher rates of all-grade infections (46%; 95% CI, 40-52; I², 56%) than BsAbs monotherapy (30%; 95% CI, 22-40; I², 87%; χ², 7.72; P = .05).
• All-grade CRS occurred in 48% of patients (95% CI, 42-54; I², 83%), with only 2% experiencing grades ≥ 3 severity (95% CI, 2-3; I², 0%).
• Mosunetuzumab demonstrated lower rates of all-grade infections (29%; 95% CI, 20-39) than epcoritamab (43%; 95% CI, 38-48) and glofitamab (48%; 95% CI, 35-61).
• Immune effector cell–associated neurotoxicity syndrome showed low prevalence, ie, 5% for all-grade (95% CI, 3-8; I², 70%) and 1% for grades ≥ 3 (95% CI, 1-2; I², 0%).

IN PRACTICE:

“Despite these variations, BsAbs demonstrated an overall manageable safety profile, suggesting their viability as a treatment option in the relapsed/refractory setting. Standardized safety reporting and vigilant monitoring are essential to optimize their clinical use and improve patient outcomes,” wrote the authors of the study.

SOURCE:

The study was led by Rodrigo Fonseca, Mayo Clinic, Phoenix, Arizona. It was published online in Blood Neoplasia.

LIMITATIONS:

According to the authors, heterogeneity observed across studies affected the generalizability of findings, stemming from differences in study design, treatment regimens, and varying adverse event reporting standards. Limited patient demographic information and inconsistent reporting of treatment discontinuation data restricted comprehensive analysis. Most included trials were in early phases and required additional follow-up to better assess the range of associated adverse events, particularly for patients achieving durable responses.

DISCLOSURES:

Talal Hilal reported consulting for BeiGene. The remaining authors disclosed no competing financial interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.