448 | BISPECIFIC ANTIBODIES AS HOLDING OR BRIDGING THERAPY BEFORE CAR‐T IN LARGE B‐CELL LYMPHOMA

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promising for candidates for CART.Here, we analyzed the two PV-containing regimens as BT to CART, evaluating the effects of adding bendamustine on subsequent CART infusion and outcomes.Methods: This multicenter, observational, retrospective study was conducted on the Italian CART-SIE study, including patients diagnosed with refractory or relapsed LBCL and treated with commercial anti-CD19 CART (axi-cel, tisa-cel, liso-cel).Patients were infused between July 2020 and January 2025 and stratified by BT.The primary endpoints were overall response rate (ORR) to BT and incidence of adverse events after BT; the secondary endpoints were ORR, overall survival (OS) and progression-free survival (PFS) after CART, and immune cellassociated adverse events within 30 days after CART infusion.Results: A cohort of 200 LBCL patients received PV as a bridge to CART, including 122 patients in combination with BR and 78 with R. Median age at CART was 61 years.Most patients were diagnosed with diffuse LBCL (53.5%), with stage III/IV disease in 84% of cases (Table 1).Among all, 75% received axi-cel, 23% tisa-cel and 1% liso-cel, mainly as third-line therapy (81.5%).With a median follow-up of 11.9 months, median OS and PFS were 35.1 and 10.1 months after infusion, respectively.Based on BT, patients' characteristics were similar between the two groups, notably disease burden (LDH) and performance status (ECOG) before CART.Of the 197 evaluable responses to BT, no statistically significant differences were observed in ORR after BT between PV-BR and PV-R groups (51.7% vs. 48.7%,p = 0.666).However, a significantly higher incidence of hematological toxicities was observed in the bendamustine-treated patients than the PV-R (41.0% vs. 16.0%,p = 0.001), with no differences in infections after BT.The ORR after CART was similar between PV-BR and PV-R groups (73.7% vs. 80.8%, p = 0.804), as the occurrence of severe CRS and ICANS (5.3% vs. 2.8%, p = 0.409 and 4.1% vs. 0.0%, p = 0.159, respectively).Conclusions: In this multicenter, retrospective study PV-R and PV-BR were efficacious in controlling the tumor prior to CART, with similar responses and immune cell-associated toxicities after infusion.The higher incidence of hematological toxicities in the PV-BR group, combined with the resulting potential delay in CART infusion highlights the PV-R regimen as the treatment of choice, paving the way for a chemo-sparing regimen as a bridge to CART.

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