Bridging Therapy As A Springboard for CAR T-Cell Therapy
- Bridging therapy is a critical short-term strategy used after relapse to keep fast-moving lymphoma under control while patients wait for their personalized CAR T-Cells to be manufactured.
- Its goal is not just to “hold the disease at bay,” but to reduce tumor burden, prevent symptoms from escalating, and ensure patients are strong enough to safely receive and benefit from CAR T-Cell Therapy.
- Because CAR T-Cell Therapy preparation can take several weeks, bridging helps protect patients during this vulnerable gap — lowering complications and improving the chances of a successful infusion.
- Working with a specialized lymphoma team ensures that bridging therapy supports T-Cell collection, minimizes side effects, and aligns perfectly with the timing of CAR T-Cell manufacturing.
“If somebody’s relapsed, to me it’s a no-brainer to talk about something that could cure you. Of course, most people want to be cured,” – Dr. Lauren C. Pinter-Brown, hematologist-oncologist specialized in the diagnosis and treatment of patients with lymphomas at UC Irvine Comprehensive Cancer Center, told SurvivorNet. “Not everybody is fit enough for CAR T-Cell Therapy, but for those who are, that’s our goal.”
Read More
How Bridging Fits Into the Car T-Cell Therapy Timeline?
CAR T-Cell Therapy (chimeric antigen receptor T-cell therapy) is a type of immunotherapy that uses a patient’s own immune cells to find and destroy cancer.“The current marketed CARs are ones that have to be manufactured from the person. So that means the person undergoes a leukapheresis, a procedure where their T cells are removed from them, sent to a company so that they can be re-engineered to go after their lymphoma.” Here’s how it works, step by step:
- Collection (Leukapheresis)
- The patient undergoes a procedure called pheresis, where white blood cells (specifically T cells) are removed from the bloodstream.
- Engineering
- In a specialized laboratory, these T cells are genetically modified to produce a receptor (the CAR) that recognizes a specific protein on the surface of lymphoma cells.
- Manufacturing
- Once engineered, the CAR T-Cells are multiplied in large numbers. This process can take three to six weeks.
- Infusion
- In a one time procedure, the cells are then infused back into the patient, where they seek out and kill lymphoma cells.
“And that may take several weeks. If the person is considering using a marketed CAR, then the next conversation is, do we need to do something to get their lymphoma under better control during that time period that they’re waiting for the CAR?” adds Dr Pinter-Brown.
Bridging Therapy
“A bridging therapy is used as a bridge from where you are now to getting your CAR,” says Dr Pinter-Brown.
The goal is to control or reduce the amount of cancer (what doctors call “disease burden”) so that the patient remains stable and ideally stay strong by the time CAR T-Cells are ready. Doctors use “Bridging Therapy” to keep the lymphoma under control without weakening the immune system too much, because doing so could reduce how well the CAR T-Cells work later.
Dr Pinter-Brown explained to SurvivorNet that some people don’t need bridging because they have very little lymphoma left.
“But many people have a lot of lymphoma around. It means that they’ll have more side effects when they get their CAR. It means that they’ll be more debilitated when they get to their CAR. And so we use what’s called bridging therapy. It’s some kind of therapy that enables a bridged from now until the CAR T. And probably the best bridging therapy, if it’s possible, would be something that would debulk or get rid of most of the lymphoma before the CAR T.”
“There’s usually some chemotherapy that’s administered before the CAR to enable the body to accept it and not destroy it right away”
What Treatments Are Used as Bridging Therapy?
The exact choice varies widely and depends on prior treatments, lymphoma type, and how aggressive the relapse is.
Common bridging strategies include:
- Targeted therapies and such as polatuzumab vedotin (brand name Polivy) or loncastuximab tesirine (brand name Zynlonta)
- Monoclonal antibodies like tafasitamab with rituximab (or its newer combinations) as well as brentuximab vedotin with loncastuximab and polatuzumab
- Steroids to temporarily control symptoms
- Radiation therapy, especially for localized bulky disease causing pain or compression.
- A 2025 study published in Frontiers in Oncology evaluated 51 patients with aggressive B-cell lymphoma who received bridging radiation before CAR T-Cell Therapy. Researchers found that patients who underwent radiation had significantly better progression-free and overall survival — with a median overall survival of 22 months and 82% responding at 30 days post-CAR T-Cell infusion. These results suggest that, for select patients, targeted radiation can be an effective bridge to CAR T-Cell Therapy, especially when all visible disease is treated.
- Chemotherapy regimens with reduced intensity
- If the disease is too widespread for focused radiation, or there’s no single “problem area,” the bridging therapy still can be offered, often using low-intensity chemotherapy.
Questions to Ask Your Doctor
Here are some practical questions you might bring to your next visit:
- Do I need bridging therapy before CAR T-Cell Therapy, or can we proceed directly?
- What are the main side effects or risks I should be aware of with bridging therapy?
- What type of treatment will you use for my bridge, and how will it affect my T-cell collection?
- How long will it take to manufacture my CAR T-Cells, and what happens if my disease progresses during that time?
In some cases, especially in Orange County, targeted radiation at centers like UC Irvine has been shown to significantly improve early response rates and survival after CAR T-Cell Therapy, making the choice of treatment center especially important.
Learn more about SurvivorNet's rigorous medical review process.
