# Bridging therapy while CAR T cells are manufactured

Source: https://onco.cc/protocols/car-t-bridging/  
OnCo record `car-t-bridging` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Making CAR T cells from your own blood takes several weeks. During that wait many people have a short course of treatment, called bridging, to keep the cancer under control so they are well enough for the CAR T cells. It is given only after the blood cells have been collected, and is chosen so it will not cause infections or organ problems that could delay the infusion.

## Summary

EBMT/JACIE 2019: bridging maintains disease control between collection and infusion; the aim is control rather than remission. Give it only after leukapheresis; avoid regimens that cause infection, bleeding or organ dysfunction; omit it for stable, low-burden disease when turnaround is short; avoid long half-life immunotherapies that may impair CAR T-cell expansion (alemtuzumab, daratumumab, checkpoint inhibitors, brentuximab vedotin). Lymphoma options include rituximab, gemcitabine, oxaliplatin, bendamustine, pixantrone, oral regimens such as PEP-C or cyclophosphamide 100 mg daily, lenalidomide or ibrutinib, high-dose steroids, or radiotherapy to bulky or symptomatic masses. In ALL, CRS risk tracks blast burden, so bridging matters more, usually with reduced-dose B-ALL agents. Frequent monitoring is mandatory, at the treating or referring centre.

Myeloma (Rasche 2026, industry-funded expert consensus, anti-BCMA CAR T): bridging for the large majority; target at least partial response; switch regimen if not reached; usually 6 to 8 weeks; about 2 weeks' washout before lymphodepletion; avoid agents the patient was refractory to and anti-BCMA agents before anti-BCMA CAR T; consider radiotherapy for extramedullary disease; talquetamab for heavily pretreated patients. SITC 2020: assess disease burden by imaging, marrow or lumbar puncture before starting CAR T-cell therapy. The adult B-ALL Delphi consensus (Blood 2026) covers bridging and pre-CAR T leukaemia staging, but only its abstract was read.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: bridging therapy; CAR-T bridging; bridging chemotherapy; holding therapy before CAR T; bridging radiotherapy
- Tags: protocol; cell-therapy; car-t

## Connected records

- protocols: [Leukapheresis to collect T cells for CAR T-cell manufacture](https://onco.cc/protocols/car-t-apheresis/), [Lymphodepleting chemotherapy before CAR T-cell infusion](https://onco.cc/protocols/car-t-lymphodepletion/), [Referral and eligibility assessment for CAR T-cell therapy](https://onco.cc/protocols/car-t-referral-and-eligibility/)
- cancers: [Acute lymphoblastic leukaemia](https://onco.cc/cancers/all-leukemia/), [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Follicular lymphoma](https://onco.cc/cancers/follicular-lymphoma/), [Mantle cell lymphoma](https://onco.cc/cancers/mantle-cell-lymphoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Primary mediastinal (thymic) large B-cell lymphoma](https://onco.cc/cancers/primary-mediastinal-b-cell-lymphoma/)
- technologies: [CAR-T cell therapy](https://onco.cc/technologies/car-t/)
- drugs: [Bendamustine](https://onco.cc/drugs/bendamustine/), [Carfilzomib](https://onco.cc/drugs/carfilzomib/), [Cyclophosphamide](https://onco.cc/drugs/cyclophosphamide/), [Dexamethasone](https://onco.cc/drugs/dexamethasone/), [Etoposide](https://onco.cc/drugs/etoposide/), [Gemcitabine](https://onco.cc/drugs/gemcitabine/), [Ibrutinib](https://onco.cc/drugs/ibrutinib/), [Lenalidomide](https://onco.cc/drugs/lenalidomide/), [Methylprednisolone](https://onco.cc/drugs/methylprednisolone/), [Oxaliplatin](https://onco.cc/drugs/oxaliplatin/), [Pixantrone](https://onco.cc/drugs/pixantrone/), [Pomalidomide](https://onco.cc/drugs/pomalidomide/), [Procarbazine](https://onco.cc/drugs/procarbazine/), [Rituximab](https://onco.cc/drugs/rituximab/), [Talquetamab](https://onco.cc/drugs/talquetamab/), [Venetoclax](https://onco.cc/drugs/venetoclax/)
- terms: [Bridging therapy](https://onco.cc/terms/bridging-therapy/), [The CAR-T pathway in lymphoma: referral, apheresis, bridging and the waiting](https://onco.cc/terms/lymphoma-tx-car-t-pathway/)

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