Toxicidad de las células CAR-T en comparación con los anticuerpos biespecíficos en el tratamiento de mieloma múltiple: revisión sistemática

Abstract

Title: Toxicity of CAR-T Cells Compared to Bispecific Antibodies in the Treatment of Multiple Myeloma: A Systematic Review Objectives: To determine the toxicity of CAR-T cell therapies and bispecific antibodies in the treatment of multiple myeloma. Methodology: Clinical trials in adults reporting toxicity associated with CAR-T or bispecific antibodies, published in the last 5 years, in English or Spanish, with access to full text were included. Systematic reviews, meta-analyses, pediatric studies, and studies lacking toxicity data were excluded. The sources used were PubMed and Cochrane Library. The last search was on April 4, 2025. The risk of bias was assessed using the ROBINS-I tool. A narrative synthesis was performed, grouping adverse effects by type of immunotherapy. Results: Six clinical trials were included. CAR-T therapies showed a high incidence of cytokine release syndrome and neurotoxicity. Bispecific antibodies presented frequent hematological and infectious toxicities, with lower neurotoxicity and milder cytokine release syndrome. Discussion: Limitations include moderate risk of bias, inaccuracy in reporting, and lack of direct comparative studies. The evidence suggests that bispecific antibodies present a more manageable toxicity profile, although they require monitoring. Conclusions: CAR-T cells are associated with a higher frequency of severe events such as cytokine release syndrome and neurotoxicity, while bispecific antibodies show more moderate but prolonged toxicities.