EHA 2026 | Approaching bridging therapy decisions in patients with lymphoma undergoing CAR T-cell therapy

I think that bridging therapy is essential in the CAR T-cell process. As I mentioned earlier, patients with decreased metabolic tumor volume do better at the time of cell infusion than those patients with high metabolic tumor volume. And this has been shown over numerous studies. There’s also been studies that have shown that patients who receive bridging therapy are more likely to receive a complete response or partial response over patients who don’t receive bridging therapy. But it’s also important to note that the number of cycles of bridging therapy actually seems to negatively impact CAR-T outcomes. So whereas physicians or clinicians have been used to providing as much therapy as possible to try and get the best response before patients proceed with a consolidated cellular therapy treatment, for CAR-T cell therapy, that paradigm has shifted. So it’s important to give a cycle of bridging therapy in an attempt to reduce metabolic tumor volume, but it’s also important to make sure that patients are proceeding with CAR T-cell therapy as early as possible. So how I approach this strategy is really looking at what patients received in the frontline therapy. As more clinicians adopt the POLARIX clinical trial and more patients are seeing Pola upfront, that kind of limits it as a bridging option. But if patients have received R-CHOP chemotherapy and have not received Polarix or Pola-R-CHP, for those unfamiliar with the study, then I really do favor a Pola-R bridging regimen. It doesn’t target any of the same targets as CAR T-cell therapy. It doesn’t really utilize T-cell engaging mechanisms. And so really, I’m not worried about it impacting efficacy of CAR T-cell therapy. I’m really interested right now in seeing some of our CD19 targeting agents in the bridging therapy space, because I think there’s a lot of data that is actually contradicting what we were feeling quite nervous about in the early days, that treating with tafasitamab or loncastuximab maybe would impact efficacy of CAR. And it seems to be that that maybe is a fallacy. But I would be interested to see that data before I’m proceeding with these CD19 engaging therapies, pre-CAR T-cell therapy. And then I think the big elephant in the room is really how we sequence bispecific antibodies. So those T-cell engaging therapies, peri-CAR T-cell therapy. There was some data out of ASH earlier this year that demonstrated that patients who proceed with CAR T-cell therapy prior to bispecific antibodies have improved outcomes compared to those patients who proceed with bispecific antibodies prior to CAR T-cell therapy. But it’s important to note that this data was quite limited in number and didn’t really address whether that bispecific antibody was given as a true prior line of therapy or as a bridging therapy. And so I think it’s important that we continue to follow this data as it evolves because bispecific antibodies may offer a really effective bridging therapy, especially if we can figure out how to rapidly ramp up these patients in a safe manner without hindering CAR-T efficacy. And so I think overall time will tell and data will tell, but these are some places we should really keep an eye on, particularly as more patients do receive Pola-R-CHP in the frontline setting and kind of eliminate Pola-R as a bridging therapy for us moving forward.