B 细胞淋巴瘤中 CAR-T 与双特异性抗体感染风险的比较：系统综述与荟萃分析

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.