Diffuse large B-cell lymphoma (DLBCL) and mantle cell lymphoma (MCL), as aggressive B-cell lymphomas, can evade T-cell immune surveillance by altering the tumor immune microenvironment, promoting disease development and progression. This understanding has led to the emergence of T-cell-based immunotherapies, including bispecific antibodies and chimeric antigen receptor (CAR) T-cell therapy, as important therapeutic options.
To standardize and guide the rational use of T-cell immunotherapies, the 2025 Chinese Expert Consensus on T-Cell Immunotherapy for Aggressive B-Cell Lymphoma was officially released. Experts, including Prof. Ma Jun, Prof. Wu Depei, Prof. Mei Heng, and Prof. Zhao Donglu, have provided in-depth interpretations of this consensus, covering its significance, the efficacy and safety of bispecific antibodies, and clinical recommendations.
The consensus highlights T-cell immunotherapy’s mechanisms, efficacy data for relapsed/refractory (R/R) LBCL and R/R MCL, treatment sequencing of bispecific antibodies versus CAR-T therapies, and management of adverse events. It also offers recommendations for special patient populations with liver or kidney dysfunction.
For Large B-cell Lymphoma (LBCL)
- CAR-T therapy is recommended for adults with R/R LBCL after failure of first-line immunochemotherapy within 12 months.
- Bispecific antibodies or CAR-T may be used as third-line or later options depending on patient conditions.
- GemOx or polatuzumab vedotin plus bispecific antibodies, or CAR-T cell therapy, are options for patients ineligible for autologous stem cell transplant (ASCT).
- Bispecific antibodies may be preferred in high-risk patients for infections, CRS, or neurotoxicity.
- CNS-involved R/R LBCL patients should be evaluated comprehensively for appropriate therapy.
For Mantle Cell Lymphoma (MCL)
- For R/R MCL patients who have received ≥2 prior systemic therapies including BTK inhibitors, zilovertamab vedotin is recommended.
- Bispecific antibodies, such as glofitamab, can be considered given their promising efficacy.
Data from global phase III trials (e.g., STARGLO) support glofitamab combined with GemOx as a beneficial second-line regimen for transplant-ineligible patients, doubling median OS compared to rituximab-GemOx. Other studies showed durable remissions and improved quality of life with bispecific antibodies in difficult-to-treat cases.
Experts highlighted that bispecific antibodies have advantages as off-the-shelf agents with rapid availability, in contrast to CAR-T therapy’s longer preparation. They may also result in fewer grade ≥3 CRS or neurotoxic events, supporting their role in high-risk populations or patients who cannot wait for CAR-T therapy.
Finally, the consensus helps clinicians standardize T-cell immunotherapy in China, improve treatment accessibility, and optimize long-term outcomes for aggressive B-cell lymphoma patients.
