Comparative Effectiveness of CAR T-Cell Therapy versus Blinatumomab in Relapsed or Refractory Diffuse Large B-Cell Lymphoma: A prospective cohort study

Background Relapsed or refractory Diffuse Large B-Cell Lymphoma (DLBCL) presents major therapeutic difficulties that need for creative solutions. Although their respective processes are different, CAR T-cell therapy and Blinatumomab have yet unknown relative efficacy. Objectives Guiding optimum treatment choice in high-risk DLBCL patients, this research intends to evaluate effectiveness, safety, progression-free survival (PFS), and complete remission rates (CRR) comparing CAR T-cell therapy and Blinatumomab. Methods This prospective cohort research compares, in 400 patients with relapsed/refractory Diffuse Large B-Cell Lymphoma (DLBCL) across five high-volume cancer centres in Saudi Arabia, the relative effectiveness and safety of CAR T-cell treatment with Blinatumomab. Stratified by illness severity and age, patients—n = 200 per group—have randomised therapy allocation. While Blinatumomab entails continuous intravenous infusion in six-week cycles, CAR T-cell treatment consists in lymphodepleting chemotherapy, T-cell collecting, genetic alteration, and reinfusion. Among the main results are remission rates, general survival, and progression-free survival. Strong statistical analysis, careful data collecting from electronic health records, and blinded outcome evaluations guarantee validity and repeatability of findings. Results Examining 400 patients with relapsed/refractory DLBCL (200 CAR T-cell, 200 Blinatumomab) matched for age (mean: 61.4 years, SD ± 8.9), gender (57% vs. 55% male), BMI (27.6 vs. 27.9 kg/m²), and comorbidities, this study found With a greater complete remission rate (58% vs. 34%) and longer median progression-free survival (16.8 vs. 9.4 months, CAR T-cell treatment produced better results. But it caused severe CRS (78% vs. 48%), neurotoxicity (52% vs. 38%), and extended cytopenias (neutropenia: 62% vs. 44%). Though less hazardous, blinatumomab needed several cycles to be continuously effective. With sustained remissions (42% PFS at 24 months vs 18%), CAR T-cell treatment clearly has long-term benefits. Balancing effectiveness, toxicity, and patient-specific dangers, personalised therapy selection is crucial. Conclusion Higher complete remission rates and longer PFS than Blinatumomab allow CAR T-cell treatment to offer better long-term disease management in relapsed/refractory DLBCL. Its increased toxicity load, however, calls for extensive care; Blinatumomab provides a less toxic, temporary substitute needing several cycles for long-term effectiveness.