Bispecific Antibodies vs. CAR-T: How Do These Cancer Immunotherapies Compare?

Bispecific antibodies and CAR-T cell therapy are the two leading forms of T-cell-redirecting immunotherapy for blood cancers, and both now have multiple FDA-approved products for multiple myeloma and B-cell lymphomas. They share a core idea — physically link a patient's own T cells to a cancer cell so the T cell can kill it — but they differ enormously in how the drug is made, how it's given, how effective it is, and what it costs. This article compares the two approaches mechanistically, walks through head-to-head efficacy and safety data in myeloma and lymphoma, and lays out where each treatment currently stands with the FDA.

How Each Therapy Works

CAR-T cell therapy is a custom-manufactured “living drug.” A patient's own T cells are collected by apheresis, shipped to a manufacturing facility, genetically engineered to express a chimeric antigen receptor (CAR) that recognizes a tumor marker (such as CD19 on lymphoma cells or BCMA on myeloma cells), expanded into millions of copies, and infused back into the same patient — a process that typically takes several weeks.

Bispecific antibodies work differently: they are off-the-shelf proteins, not cells. Each bispecific antibody has two binding arms — one that grabs a marker on the tumor cell (such as CD19, CD20, BCMA, or GPRC5D) and one that grabs CD3 on a nearby T cell — physically bridging the two and triggering the T cell to kill the cancer cell on the spot, without any genetic engineering or lab-grown cell product. Because they're manufactured in bulk like any other biologic drug, they can be given by injection in a clinic on a recurring schedule (often weekly, tapering over time), rather than as a single infusion.

Blinatumomab, a CD19xCD3 bispecific for acute lymphoblastic leukemia, was the first of this class approved by the FDA, back in December 2014 — years before the newer generation of bispecifics for myeloma and lymphoma arrived.

Efficacy: Multiple Myeloma

Several BCMA- and GPRC5D-targeting bispecifics are now FDA-approved for relapsed/refractory multiple myeloma:

• Teclistamab (Tecvayli), approved October 28, 2022, produced a 61.8% overall response rate in the MajesTEC-1 trial among heavily pretreated patients (median 5 prior lines of therapy).
• Elranatamab (Elrexfio), approved August 14, 2023, showed a 61% overall response rate in BCMA-naive patients in the MagnetisMM-3 trial.
• Talquetamab (Talvey), approved August 9, 2023 as the first GPRC5D-directed bispecific, showed response rates of roughly 73% across its two dosing schedules.

By comparison, ciltacabtagene autoleucel (Carvykti), a BCMA-directed CAR-T, produced a 97.9% overall response rate in the CARTITUDE-1 trial, with 80.4% of patients reaching stringent complete response at 18-month follow-up — notably higher and deeper than any single bispecific in myeloma to date. This is a real and consistent pattern in the data: CAR-T tends to produce higher response rates and deeper remissions in myeloma, while bispecifics offer meaningfully strong (though somewhat lower) response rates with far less logistical burden.

Efficacy: Large B-Cell Lymphoma

In relapsed/refractory large B-cell lymphoma, two CD20xCD3 bispecifics are approved:

• Epcoritamab (Epkinly) produced a 63% overall response rate and 39% complete response rate in the EPCORE NHL-1 trial, with somewhat higher responses (69% ORR) in patients who had never received CAR-T.
• Glofitamab (Columvi), approved June 15, 2023, showed a 56% overall response rate and 43% complete response rate, with a median duration of response of 18.4 months.

CAR-T therapies for large B-cell lymphoma, such as axicabtagene ciloleucel (Yescarta), showed higher initial response rates in the pivotal ZUMA-1 trial — an 83% objective response rate with 58% complete responses. As in myeloma, CAR-T tends to edge out bispecifics on raw response depth in lymphoma, though cross-trial comparisons should be read cautiously since patient populations and prior treatment histories differ between studies.

Side Effect Profiles: CRS and Neurotoxicity

Both drug classes carry FDA boxed warnings for cytokine release syndrome (CRS) and neurotoxicity (ICANS), because both work by activating T cells throughout the body — but the pattern differs. CAR-T's CRS tends to occur more often and more severely: in CARTITUDE-1, CRS occurred in 94.8% of cilta-cel patients, though the large majority were grade 1–2 and resolved within about two weeks. Bispecifics generally show lower rates of severe CRS: teclistamab's CRS rate was 72.1% overall but only 0.6% grade 3, epcoritamab's was 49.6% overall with 2.5% grade 3+, and elranatamab's was 57.7% overall with 0% grade 3–4 reported. Glofitamab's CRS rate was 70% overall with 4.1% grade 3 or higher. Because of this risk, most bispecifics require a “step-up” dosing regimen and initial hospitalization or close monitoring during the first doses, and talquetamab is available only through a restricted REMS program due to its CRS and ICANS risk.

Manufacturing, Logistics, and Cost

This is where the two approaches diverge most sharply for patients and health systems. CAR-T requires individualized manufacturing — cells are collected, sent to a lab, engineered, and shipped back, a process that can take three to six weeks or longer, during which some patients need “bridging therapy” to control their disease. Bispecific antibodies are off-the-shelf and can be started essentially immediately in an outpatient or infusion-clinic setting.

Cost reflects this difference. A real-world claims analysis presented at AMCP Nexus 2025 found the total 12-month cost of care was roughly $702,000 for CAR-T versus $372,000 for bispecific antibody therapy — a difference of about $330,000, driven mainly by CAR-T's higher drug acquisition cost ($521,000 vs. $183,000). Bispecifics also had far lower adverse-event-related costs (under $500 vs. $9,000 for CAR-T) in that analysis, consistent with their milder CRS profile.

Current FDA Approval Status

As of 2026, approved bispecific T-cell engagers include blinatumomab (ALL, 2014), teclistamab (myeloma, 2022), talquetamab and elranatamab (myeloma, 2023), and epcoritamab and glofitamab (large B-cell lymphoma, accelerated approval 2023, with epcoritamab also approved in follicular lymphoma). Approved CAR-T products for these same diseases include axicabtagene ciloleucel and other CD19 CAR-Ts for lymphoma, and ciltacabtagene autoleucel and idecabtagene vicleucel for myeloma. Several products carry accelerated approvals pending confirmation of clinical benefit in ongoing trials, and label updates continue as longer-term safety and efficacy data mature.

Bottom Line

Bispecific antibodies and CAR-T cell therapy are both real, FDA-approved advances for patients with relapsed or refractory multiple myeloma and B-cell lymphomas, and neither should be thought of as simply a “lesser” version of the other. CAR-T currently tends to deliver deeper, more durable single-treatment responses, while bispecifics offer an off-the-shelf option that can start faster, requires no cell collection or engineering wait, and — in the data so far — comes with a somewhat gentler severe-CRS profile and substantially lower cost. The right choice for an individual patient depends on disease biology, prior treatments, how quickly they need therapy to start, and access to a specialized CAR-T center — decisions best made with a hematology-oncology team who can weigh the specific trial data against that patient's situation.