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EHA 2026 | Sequencing CAR T-cell therapy and bispecific antibodies in relapsed follicular lymphoma
Marco Ladetto, MD, Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy, discusses treatment sequencing for patients with high-risk or relapsed follicular lymphoma. He reviews the roles of CAR T-cell therapy and bispecific antibodies, emphasizing the importance of individualized decision-making and highlighting the growing range of therapeutic options available for patients who experience multiple relapses. This interview took place at the 31st Congress of the European Hematology Association (EHA) in Stockholm, Sweden.
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Transcript
Well, that is a point, the difficult point, because we don’t know very much. I really discussed the opportunity and the possibility of giving CAR-T before and by specific later on or vice versa. Basically, all these issues should be clearly put into perspective. Also, we have a careful discussion with the patient because some patients may accept undergoing a treatment maybe in a CAR-T center which is not close to their place, so basically the decision should be very strategic...
Well, that is a point, the difficult point, because we don’t know very much. I really discussed the opportunity and the possibility of giving CAR-T before and by specific later on or vice versa. Basically, all these issues should be clearly put into perspective. Also, we have a careful discussion with the patient because some patients may accept undergoing a treatment maybe in a CAR-T center which is not close to their place, so basically the decision should be very strategic. What we know is that in third line we now, after multiple, even after multiple or very rapid relapses, we can obtain very good results with both these immunotherapeutic treatments. There are criteria that suggest using CAR-T first, and these, especially for the patients with very high-risk features, that could be the strategy, especially if they are younger, while by specific, also provide an excellent approach. Basically, the sequence is not fixed, basically, what we do not have clear evidence that says use one before and the other later, but we can basically evaluate case by case. The main point is that if the patient fails one of the two, then you can use the other one. Also, consider that there are also alternative approaches that are under development. I just remember the zanubrutinib and ibrutinib combination and the use of Obinutuzumab plus rituximab and also lenalidomide. So we have several studies, but of course, the potential use of one immunotherapeutic approach and then the other is clearly feasible. And there are at least indications, mostly rising from other lymphomas, that this can be used sequentially. And therefore, I would stress the point that the patient’s choice, either CAR-T or by specific, still has the opportunities for additional treatment later on.
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