Review
Syed Abbas Ali, MBBS, outlines practical criteria for choosing between CAR-T and bispecifics in relapsed/refractory myeloma. Patient fitness, logistics, antigen expression, and prior lines all factor in. The convergence of efficacy has shifted the debate from "which works better" to "which fits this patient's life."
Analysis
Though both harness T-cell cytotoxicity, BCMA bispecifics engage endogenous T cells continuously, while CAR-T creates a durable, engineered effector population. The logistics diverge radically: bispecifics are off-the-shelf infusions with manageable CRS, while CAR-T requires leukapheresis, manufacturing wait times, and intensive toxicity monitoring. Understanding these distinctions guides sequencing strategy.
Review
Bone Marrow Transplantation
As CAR-T expands into autoimmune disease, this review in Bone Marrow Transplantation synthesizes learnings from hematologic malignancies. Next-generation approaches — allogeneic "off-the-shelf" CARs, regulatory CAR-T for immune tolerance, RNA CARs, and bispecific T-cell engagers — are poised to complement or compete with autologous platforms. The field is moving fast.
Study
In a first-in-human phase 1 trial, RB-1355 — an intratumoral therapy of autologous, repolarized M1 macrophages — demonstrated systemic responses in heavily pretreated B-cell and T-cell lymphomas, including post-CAR-T and post-bispecific patients. This macrophage-based approach represents a third pillar of cellular therapy, complementing T-cell platforms with innate immune effectors.