EBMT 2025 | Optimizing bridging therapy strategies before CAR T-cell therapy

So, bridging therapy before CAR-T is one of the big question marks in this specific setting. So we know that patients do better after CAR-T if they go into the CAR T-cell procedure with less tumor burden. So ideally, it would be nice to have really effective and low toxicity bridging strategies to optimize the long-term outcome of patients being treated with CAR-T. 

After having said that, we don’t have prospective clinical trials that demonstrate the benefit of one bridging strategy over another one and probably we will never have them. So here we need first of all to individualize each patient and take into consideration first of all how much disease on board the patient has, also the treatments that the patient has received before and also the toxicity profile of the treatment that we want to give as a bridging treatment strategy. 

For those patients with localized disease, radiotherapy can be a perfect option because it’s very effective, it’s not very toxic. For those patients with non-localized disease, that by the way represent the vast majority of them, it depends a little bit on what we have available. Sometimes only polychemotherapy is available and we have to go for that. Sometimes we have the possibility to use targeted strategies, for instance, polatuzumab vedotin that has demonstrated to be an interesting bridging approach for patients that go into CAR T-cells. 

And if I have to make a kind of a guess for the future, I think that the use of bispecific monoclonal antibodies that are targeting CD20 and CD3. They are very effective. They usually have not been seen by the patient, at least in the way that we are using CAR-T, and I think that there are some data that indicate that could be a very good bridging strategy.

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