Comparative Efficacy and Safety of Bispecific T-Cell Engagers (BiTEs) Versus Immune Checkpoint Inhibitors (ICIs) in...

Targeted immunotherapies have significantly revolutionized the treatment of hematologic malignancies. Among the most promising immunotherapies are bispecific T-cell engagers (BiTEs) and immune checkpoint inhibitors (ICIs). We aim to comprehensively evaluate the efficacy and safety of BiTEs and ICIs in the treatment of various hematologic malignancies.

An extensive literature search from inception until January 2025 was conducted in PubMed, Web of Science, Cochrane Library, and Google Scholar. The primary outcomes of our study were objective response rate (ORR) and treatment-related adverse events (AEs) of grade 3 or above.

Thirty-one clinical trials involving 2507 patients with hematologic malignancies were included in our analysis. For patients with non-Hodgkin lymphoma (NHL), multiple myeloma, and myeloid malignancies, the pooled data showed that BiTEs resulted in ORRs of 34.1%, 60%, and 18.5%, whereas ICIs resulted in ORRs of 21.9%, 4.2%, and 13.8%, respectively. Furthermore, our statistical analysis demonstrated a pooled ORR of 47.1% for acute lymphoblastic leukemia (ALL) patients treated with BiTEs. The most common treatment-related AEs of grade 3 or greater in NHL patients treated with BiTEs and ICIs were neutropenia (17.1% and 7.2%, respectively). Similarly, the most common AEs of grade 3 or above in multiple myeloma, myeloid malignancy, and ALL patients treated with BiTEs were neutropenia (45.2%), CRS (12.9%), and anemia (21.4%).

BiTEs and ICIs are promising therapeutic strategies for patients with hematologic malignancies. However, BiTEs seem more effective than ICIs, especially in the treatment of NHL and multiple myeloma.