ASH 2025 | Outcomes after epcoritamab or glofitamab in R/R LBCL: insights from the REALBiTE retrospective study

The REALBiTE cohort is the largest collection of individuals with relapsed or refractory large B-cell lymphoma that have been treated in the United States with the bispecific antibodies epcoritamab or glofitamab. We set out in 2023 to try to document and describe the outcomes of these medicines in patients who have these conditions. We had a total of 331 patients that we described at this year’s annual meeting, and the overall response rate was 55% with a 33% complete response rate to the two medicines overall. The other main point of our presentation this year was survival outcomes. So we had 14 months of follow-up and the median progression-free and overall survival were 2.5 and 7.7 months respectively. 

One of the other major points that we went over at this year’s annual meeting was what happens to patients who have progressive disease or relapse while receiving these medicines or after the treatment with these medicines are complete. So we had 189 individuals who had progressive disease or relapse after treatment with epcoritamab or glofitamab, and we described the 108 of them who had any subsequent treatments. So that means that almost 70 or 80 patients received no treatment after bispecific therapy. So among those who did, the most common way that they were treated after bispecifics was with a combination of chemotherapy and immunotherapy and the second most common regimen that was used was actually local therapy like radiation. After relapse with bispecifics, it’s challenging to treat these patients, as may be no surprise to practitioners. The best overall response to chemotherapy was 35%, and that was actually some of the highest of any of the modalities that were used. 

A couple of small groups of interest in the people who we described were 12 patients who actually went on to receive allogeneic hematopoietic progenitor cell transplantation after bispecific use, six of whom did so to consolidate a complete response to bispecifics, five patients consolidated partial response and one had allotransplant as a salvage maneuver. Of those 12 individuals, there were 275 days of median follow-up, and eight of them remained alive and disease-free after transplant. So it’s a procedure and a maneuver that is feasible and could potentially provide a durable disease control for a fraction of healthy and well-selected patients. 

Last, there was 23 patients who received CAR T-cell therapy after bispecifics. And the overall response rate was about 50% in those patients. But interestingly, almost all who responded had complete response to CAR T-cell therapy. So these results really stimulate future research in trying to develop the best sequence of therapies, including approved medicines like CAR T-cells, but also developing and advancing existing therapies, for example, in combination to try to treat an otherwise very challenging group of patients who need better advancements in their care.

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