Efficacy and Safety of Mosunetuzumab in Relapsed/Refractory Non-Hodgkin Lymphoma: A Systematic Review

Background:

Bispecific antibodies (BsAbs) represent a promising new class of immunotherapy for lymphoma treatment. mosunetuzumab, a CD20xCD3 T-cell engaging bispecific monoclonal antibody, directs T cells to eliminate malignant B cells. It was the first to receive approval for relapsed or refractory follicular lymphoma. This study evaluates the safety and efficacy of intravenous mosunetuzumab in various treatment regimens for relapsed/refractory non-Hodgkin lymphoma.

Methods:

A systematic literature search was conducted on PubMed using keywords “Mosunetuzumab” AND “lymphoma” from inception to January 1, 2024. Four non-randomized clinical trials (nRCTs, N=303) were identified and included in accordance with PRISMA guidelines.

Results:

In 4 clinical trials 303 patients were concluded, of which 186 patients were diagnosed with diffuse large B-cell lymphoma (DLBCL), and 117 patients were diagnosed with follicular lymphoma (FL), 98 patients with DLBL received mosunetuzumab plus polatuzumab vedotin, 80 patients with DLBCL received mosunetuzumab monotherapy, 90 patients with FL were treated with mosunetuzumab monotherapy, and 27 patients with FL received mosunetuzumab in combination with lenalidomide. 186 patients had diffuse large B-cell lymphoma (DLBCL), and 117 patients had follicular lymphoma. overall response rate (ORR), complete response (CR), and partial response (PR) were reported in 42%, 24%, 18% patients with DLBCL who received intravenous mosunetuzumab monotherapy respectively. ORR, CR, and PR were reported in 59%, 46% and 13% patients with DLCBL receiving mosunetuzumab plus polatuzumab vedotin. ORR, CR, and PR were reported in 72% 54% and 18% patients, respectively, treated with intravenous mosunetuzumab monotherapy in follicular lymphoma. ORR, CR, and PR were reported in 92%, 77% and 15% patients, respectively, treated with combination with lenalidomide in follicular lymphoma. Cytokine release syndrome (CRS) was the most common side effect occurred at any grade, neutropenia was the most common reported grade ≥3 followed by CRS, grade 3 or more of immune cell-associated neurotoxicity syndrome was limited.

Conclusions:

Mosunetuzumab in combination with lenalidomide demonstrated higher efficacy and good tolerability in patients with relapsed/refractory non-Hodgkin lymphoma, especially in achieving high response rates inFL. Intravenous mosunetuzumab monotherapy was active in both DLBCL and FL with low rates of toxicity and favorable safety profile. Long-term follow-up is necessary to assess durability of responses and overall safety and survival outcomes with these different treatment approaches.

No relevant conflicts of interest to declare.