Columvi vs. CAR-T Therapy: Which Option Is More Accessible for Lymphoma Patients?

 Introduction

Choosing a treatment for lymphoma is not just about medical outcomes. It is also about time, access, readiness, and what is realistically possible for a patient and their family. With newer therapies entering the picture, patients are often faced with options that sound promising but feel difficult to compare.

This piece looks at two such treatments and explores how they differ when it comes to access and availability, helping patients and caregivers think through what each option may mean in real life.

Overview of Columvi and How It Works

Columvi (glofitamab gxbm) is a prescription medication used to treat adults with certain types of large B cell lymphoma, including diffuse large B cell lymphoma, whose disease has returned or did not respond to earlier treatments, after they have already received two or more prior cancer therapies.1

Columvi is a bispecific monoclonal antibody, which means it is designed to attach to two different cells at the same time. One part of the drug binds to CD20, a protein found on B cells, including lymphoma cells. The other part binds to CD3, a protein found on T cells, which are key immune cells involved in killing abnormal cells. 2

By connecting a T cell directly to a cancerous B cell, Columvi helps the immune system do its job more effectively. This close contact activates the T cell, causing it to multiply and release substances that break down and destroy the lymphoma cell. In simple terms, Columvi works by bringing the body’s immune fighters face to face with cancer cells and helping them eliminate them. 2

CAR-T Therapy: Promise and Challenges

CAR T cell therapy is a form of immunotherapy that uses a patient’s own immune cells to fight cancer. Doctors take T cells, genetically reprogram them so they can recognise cancer cells more precisely, and then return them to the body. These engineered cells are designed to latch onto cancer cells and destroy them directly, without needing the usual immune system signals.

This approach has been especially successful in blood cancers. CAR T therapies targeting a protein called CD19 have transformed treatment for many B cell cancers and now make up a large share of approved and experimental cell therapies. Because of this success, researchers are also exploring CAR T therapy for solid tumors, autoimmune diseases, and infections.3

However, CAR T therapy comes with major challenges. In many patients, the effect does not last long term because the modified cells do not survive or multiply enough. Relapse is common, with 30 to 50 percent of patients experiencing cancer return within a year when cancer cells lose or reduce the target that CAR T cells recognise. Solid tumors add another layer of difficulty, as they create environments that block immune cells and exhaust them over time. 3

Safety is another concern. CAR T therapy can cause severe immune reactions such as cytokine release syndrome and neurological side effects known as ICANS. While these can be managed with medications, their causes are still not fully understood, and long term safety data is limited.

Finally, access remains a huge barrier. CAR T therapy is complex, highly personalised, and extremely expensive, often costing over half a million dollars per treatment. 3

Comparing Efficacy Between Columvi and CAR-T

Columvi is intended for patients who are not able to receive CAR T cell therapy, cannot access it, or have already been treated with CAR T cell therapy. Before starting Columvi, patients receive a pretreatment medicine called obinutuzumab.2

When comparing Columvi vs CAR-T therapy in real-world use, differences in efficacy become clearer when prior treatment exposure and disease burden are taken into account. Among patients treated with Columvi, the overall response rate was 47%, including 27% complete responses and 20% partial responses, despite a heavily pretreated population in which 71% had previously received CAR-T therapy. Responses were numerically higher in patients treated with Columvi after CAR-T (52% overall response rate) compared with those who were CAR-T–naive (30%). Survival outcomes followed a similar pattern: median progression-free survival was 4.5 months in CAR-T–exposed patients versus 1.15 months in CAR-T–naive patients, while median overall survival was 8.2 months compared with 3.4 months, respectively. Columvi also showed a rapid median time to best response of 54 days. Together, these findings suggest that while CAR-T therapy represents a major treatment milestone, Columvi demonstrates meaningful efficacy both after CAR-T and in patients who have not yet received CAR-T, with outcomes strongly influenced by underlying disease aggressiveness.4

Safety Profiles: Differences and Overlaps

After glofitamab infusion, cytokine release syndrome (CRS) was reported in 60% of patients, with all cases limited to grade 1, infections occurred in 30%, and no immune effector cell–associated neurotoxicity syndrome (ICANS) was observed. Following CAR T-cell infusion in the same patients, CRS was more frequent, occurring in 90% of patients, including grade 1 events and grade 2 events. Infections were also slightly higher after CAR T-cell therapy at 40%, and ICANS was reported in 20% of patients. Overall, while both treatments were associated with immune-related adverse events such as CRS and infections, glofitamab bridging therapy was characterized by lower CRS frequency, milder severity, and absence of neurotoxicity compared with subsequent CAR T-cell therapy.5

Accessibility: Cost, Infrastructure, and Availability

CAR-T therapy has shown strong potential in treating relapsed or refractory diffuse large B-cell lymphoma, but access remains a major hurdle. Key challenges include high costs, limited availability, complex logistics, and differences in physician experience or preference, all of which can restrict patient access, especially in Asia. Current clinical data suggest CAR-T could be curative when patient-specific factors and prior treatments are carefully considered, but long-term follow-up from larger studies is still needed to confirm its full potential.6

Glofitamab offers advantages such as shorter turnaround times and the potential to be administered outside large academic centres, as well as serving as a bridge to CAR-T therapy. However, accessibility remains limited, available only through compassionate use programs and is awaiting formal approval, while in South Korea it is approved but not reimbursed.

Compared with CAR-T, bispecific antibodies generally have lower rates of complete response and progression-free survival but they also tend to have fewer severe adverse events and can be delivered more flexibly. Cost, infrastructure, and long-term safety data continue to be key factors shaping patient access and broader adoption of these therapies.6

Patient Suitability: Who Benefits From Each Approach

CAR-T therapy has improved survival when used as part of advanced treatment strategies, but options become limited once relapse occurs post–CAR-T. In such cases, bispecific antibodies like glofitamab may offer a promising alternative. Evidence from reported cases shows that glofitamab can trigger proliferation of residual CAR-T cells and achieve objective responses, with therapy generally well tolerated. One patient completed all 12 planned cycles and remained progression-free at the last follow-up, highlighting that glofitamab may benefit patients who relapse after CAR-T.7

Role of Named Patient Program in Accessing Columvi

For patients in countries where Columvi (glofitamab) isn’t yet approved or commercially available, a Named Patient Program (NPP) can be a vital access route. Under such programs, healthcare providers or treating physicians submit individual requests to pharmaceutical manufacturers to obtain Columvi on behalf of specific patients when there are no suitable local treatment alternatives and clinical trial enrollment isn’t possible.

Named Patient Programs help bridge regulatory gaps by allowing access to medicines that are approved in other jurisdictions but not yet registered locally, providing a pathway for patients with serious conditions to receive potentially beneficial therapies outside standard market availability. These programs require compliance with regulatory processes and documentation but offer an alternative option for patients who otherwise would lack access to innovative cancer treatments.

Expert Opinions on Sequencing These Therapies

In relapsed or refractory follicular lymphoma, both CAR-T therapy and bispecific antibodies like glofitamab offer powerful immunotherapy options, but their sequencing remains a nuanced decision. CAR-T therapy can deliver high complete response rates and potential long-term remission, yet it is associated with complex adverse events and requires specialized monitoring.

Bispecific antibodies, on the other hand, offer off-the-shelf availability and generally more manageable safety profiles, though they may involve more frequent dosing and slightly lower response rates. Because no direct head-to-head trials exist, expert consensus emphasizes tailoring treatment sequencing based on patient-specific factors, prior therapies, and logistical considerations, balancing efficacy, safety, and accessibility to achieve the best outcomes.8

Future Trends in Lymphoma Treatment Access

As lymphoma care evolves, access to newer therapies like glofitamab is expected to broaden beyond traditional clinical trial and major‑center settings.

In areas where formal approval and reimbursement are still pending, compassionate access and early access schemes are already enabling some patients to receive bispecific antibodies while regulatory pathways progress.

Looking ahead, continued approvals, expanded compassionate use programs, and integration of bispecifics into community and outpatient settings could help reduce barriers related to cost, infrastructure, and geographic access, bringing cutting‑edge lymphoma treatments to a broader patient population

Conclusion

Choosing between Columvi and CAR-T therapy often comes down to more than clinical outcomes alone. While CAR-T offers the possibility of deep and durable responses, its high cost, complex infrastructure needs, and limited availability can delay or restrict access for many patients. Columvi, as an off-the-shelf bispecific antibody, provides a more readily accessible option with meaningful efficacy, particularly for patients who are not eligible for CAR-T, have relapsed after CAR-T, or need treatment without long manufacturing timelines. As access pathways such as compassionate use and Named Patient Programs expand, therapies like Columvi may play an increasingly important role in bridging treatment gaps and supporting timely care for patients with relapsed or refractory lymphoma.4,6,8

FAQs

Is Columvi easier to access than CAR-T therapy? 
Yes, Columvi is an off-the-shelf treatment and can be accessed more quickly than CAR-T, which requires individualized cell manufacturing and specialized centers.⁶

Can Columvi be used after CAR-T therapy? 
Real-world data show that Columvi can produce meaningful responses in patients who have previously received CAR-T therapy.⁴

References

1. Roche. Columvi (glofitamab) prescribing information. Columvi website. Accessed December 15, 2025. https://www.columvi.com/

2. Glofitamab (Columvi): CADTH Reimbursement Review: Therapeutic area: Relapsed or refractory diffuse large B-cell lymphoma [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2024 Apr. Clinical Review. Available from: https://www.ncbi.nlm.nih.gov/books/NBK604438/

3. Cao LY, Zhao Y, Chen Y, et al. CAR-T cell therapy clinical trials: global progress, challenges, and future directions from ClinicalTrials.gov insights. Front Immunol. 2025;16:1583116. Published 2025 May 20. doi:10.3389/fimmu.2025.1583116 

4. Evgenii Shumilov, et al. Safety and efficacy of glofitamab for relapsed/refractory large B-cell lymphoma in a multinational real-world study. Blood Adv 2025; 9 (15): 3865–3877. doi: https://doi.org/10.1182/bloodadvances.2024014903 

5. Lili Zhou, Botao Wang, Ping Li, Yan Lu, Shiguang Ye, Shaoguang Li, Aibin Liang; Glofitamab effectively bridging CD19-specific CAR T- cell therapy while maintaining safety in patients with refractory DLBCL. Blood 2025; 146 (Supplement 1): 7265. doi: https://doi.org/10.1182/blood-2025-7265 

6. Tan, Y.H., Yoon, D.H., Davies, A.J. et al. Improving access to chimeric antigen receptor T-cells for refractory or relapsing diffuse large B cell lymphoma therapy in Asia. Discov Onc 16, 181 (2025). https://doi.org/10.1007/s12672-025-01860-5 

7. Heini AD, Bacher U, Porret N, et al. Experiences with Glofitamab Administration following CAR T Therapy in Patients with Relapsed Mantle Cell Lymphoma. Cells. 2022;11(17):2747. Published 2022 Sep 2. doi:10.3390/cells11172747