Bispecific Antibodies in the CAR T-Cell Era: Bridging Therapy, Sequencing, and Emerging Paradigms

Abstract

Delays in accessing CAR T-cell therapy remain a significant barrier for patients with aggressive hematologic malignancies, with many failing to reach infusion due to manufacturing delays, waitlist mortality, comorbidities, and disease progression. Bispecific antibodies, with their off-the-shelf availability, rapid cytoreductive potential, and manageable toxicity, have emerged not only as a promising bridging modality to preserve eligibility and optimize patients before CAR T-cell therapy but also as standalone therapies. This review synthesizes current evidence on bispecific antibodies, including comparative safety/efficacy with CAR T-cell, their toxicity profile, emerging resistance patterns, and, most importantly, their role as a bridging therapy before CAR T-cell treatment.