CAR T, Bispecifics Reshape Relapsed Lymphoma Care: Madhav Seshadri, MD

Bispecific antibodies have rapidly matured into a standard-of-care option for patients with relapsed or refractory follicular lymphoma and diffuse large B-cell lymphoma (DLBCL), according to Madhav Seshadri, MD, an assistant professor in the malignant hematology group at UCSF who specializes in lymphoma and chronic lymphocytic leukemia (CLL).

Phase 3 Data Drive Adoption, Sequencing Questions Persist

During an interview at an Institute for Value-Based Medicine® event in San Francisco on August 11, 2026, hosted by The American Journal of Managed Care^®, Seshadri pointed to recent phase 3 trials comparing bispecific antibody combinations with chemotherapy against prior standards of care. He noted that response rates and long-term outcomes were significantly superior with the newer regimens. That evidence has helped establish bispecific antibodies as an effective option for patients who are ineligible for transplant or CAR T-cell therapy.

Despite this progress, Seshadri said the optimal sequencing of CAR T-cell therapy and bispecific antibodies remains unsettled. The choice often hinges on convenience, patient preference, eligibility, and comorbidities rather than a clear evidence-based algorithm. He mentioned early data presented at the American Society of Hematology annual meeting suggest that concerns about diminished T-cell fitness following bispecific antibody exposure may not meaningfully compromise subsequent CAR T-cell outcomes, though longer follow-up is still needed.

CAR T Remains First Choice for Curative Intent

For eligible patients with relapsed or refractory DLBCL, Seshadri said he continues to recommend CAR T-cell therapy first, citing its longer track record of durable remissions and curative potential compared with bispecific antibody combinations.

"For eligible patients with relapsed/refractory DLBCL, I still offer CAR T as their best chance of a long-term remission or cure, although these bispecific antibody combinations certainly are very reasonable alternatives," he explained.

Seshadri characterized bispecific regimens as reasonable alternatives rather than replacements for CAR T in this setting, particularly for patients who cannot tolerate or access cellular therapy. He also addressed access barriers to CAR T-cell therapy, sequencing questions in CLL, and the role of artificial intelligence in clinical decision-making.