Bridging Strategies to CAR-T Therapy: Perspectives on Incorporating BTKi’s

CAR-T Bridging Strategies and Optimization

Bridging therapy with BTK inhibitors is recommended for CLL patients proceeding to CAR-T cell therapy, particularly those with bulky lymphadenopathy or rapidly progressive disease. The 3-4 week vein-to-vein manufacturing time necessitates disease control strategies to optimize patients for CAR-T infusion. Clinical data supporting ibrutinib bridging includes evidence of improved T-cell function and enhanced CAR-T cell efficacy, with benefits observed even in patients previously refractory to BTK inhibitors. While ibrutinib-specific data exists, theoretical and preclinical evidence suggests that newer selective BTK inhibitors may provide similar T-cell enhancing effects with potentially lower toxicity. Practical considerations for CAR-T bridging include cardiac monitoring recommendations due to rare but serious cardiac events, patient monitoring during the bridging period, and coordination with cellular therapy teams. The approach is particularly important for high-risk patients who are typical CAR-T candidates and have often exhausted multiple targeted therapy options.