Comparative Infection Risk in CAR T vs Bispecific Antibodies in B cell Lymphoma: A Systematic Review and Meta-Analysis.

CD3xCD20 bispecific antibody (BsAb) therapy and CD19 directed chimeric antigen receptor (CAR) T cell therapy 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 bispecific antibody therapy in patients with B cell lymphomas (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 = 0.18), BsAbs had a higher rate of infection per patient-month (0.0397 vs 0.0167; p = 0.0012). Similarly, CAR T and BsAbs had similar rates of grade 3+ infections per patient (0.16 vs 0.22; p = 0.08) while BsAbs had a higher rate of grade 3+ infections per patient-month (0.0165 vs 0.0069; p = 0.0003). CAR T and BsAbs products had similar rates of infection-related mortality per patient (0.04 vs 0.03; p = 0.26) and per patient-month (0.0023 vs 0.0022, p = 0.96). Our findings point to the potential increased burden of infections over time in patients receiving BsAb therapy, particularly for patients on indefinite therapy.