{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:48:08Z","timestamp":1788536888317,"version":"build-2803163510"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:00:00Z","timestamp":1772841600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European J of Haematology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Primary refractory Diffuse Large B\u2010Cell Lymphoma is associated with poor outcomes and limited responsiveness to conventional salvage therapies. Although CAR T\u2010cell therapy represents the standard of care in this setting, a substantial proportion of patients cannot receive it despite meeting disease\u2010related criteria. In this review, \u201cunsuitable\u201d refers to patients who are temporarily or functionally unable to undergo CAR T\u2010cell therapy because of reversible clinical conditions, rapidly progressive disease requiring immediate cytoreduction, or logistical and social barriers, rather than permanent contraindications. For these patients, prompt alternative strategies are required. Conventional platinum\u2010based or gemcitabine\u2010 and bendamustine\u2010containing regimens retain a role for short\u2010term disease control but offer limited durability. In contrast, novel antibody\u2010based therapies, including polatuzumab\u2010containing combinations, loncastuximab tesirine, and tafasitamab plus lenalidomide, have expanded treatment options with improved tolerability. Most notably, CD20\u2009\u00d7\u2009CD3 bispecific antibodies represent a major therapeutic advance, providing off\u2010the\u2010shelf immune engagement with predominantly outpatient administration. From a practical perspective, early identification of reversible barriers to CAR T\u2010cell therapy and timely use of bispecific antibodies or other antibody\u2010based regimens are critical to achieve rapid disease control, preserve organ function, and, when feasible, restore eligibility for cellular therapy.<\/jats:p>","DOI":"10.1111\/ejh.70153","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T21:23:32Z","timestamp":1773005012000},"page":"771-784","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Management of Primary Refractory Diffuse Large B\u2010Cell Lymphoma in Patients Unsuitable for\n                    <scp>CAR<\/scp>\n                    T\u2010Cell Therapy"],"prefix":"10.1111","volume":"116","author":[{"given":"Santino","family":"Caserta","sequence":"first","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica Antonia","family":"Martino","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamdouh","family":"Skafi","sequence":"additional","affiliation":[{"name":"Emergency and Internal Medicine Department Saint Joseph Hospital  East Jerusalem Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Eugenia","family":"Alvaro","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Bruzzese","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Amodio","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine University of Catanzaro  Catanzaro Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenio","family":"Lucia","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Olivito","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Labanca","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6339-632X","authenticated-orcid":false,"given":"Francesco","family":"Mendicino","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Vigna","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fortunato","family":"Morabito","sequence":"additional","affiliation":[{"name":"AIL Sezione di Cosenza  Cosenza Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5256-0726","authenticated-orcid":false,"given":"Massimo","family":"Gentile","sequence":"additional","affiliation":[{"name":"Department of Onco\u2010Hematology Hematology Unit, AO of Cosenza  Cosenza Italy"},{"name":"Department of Pharmacy, Health and Nutritional Science University of Calabria  Rende Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024012760"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_390802"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/cells12192392"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hem3.70119"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022018730"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.19860"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13045\u2010025\u201001702\u20105"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.4103\/jmau.jmau_66_22"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/20406207211072839"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S269624"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers18030469"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.20314"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/antiox12061255"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2020003848"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol32030142"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.xkme.2025.101141"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.21147\/j.issn.1000\u20109604.2025.05.04"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2024015599"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/14796694.2024.2393566"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17904"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcyt.2025.07.007"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41571\u2010022\u201000607\u20103"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.903562"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408\u2010021\u201000459\u20107"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines12092106"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms25126447"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO\u201024\u201002242"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO\u201025\u201001957"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2021013289"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14453"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.seminhematol.2023.12.001"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1159\/000489717"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdj996"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1039\/c8dt90088d"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.27630"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078\u20100432.CCR\u201025\u20102392"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1159\/000549477"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.32592\/ARI.2025.80.2.301"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1200\/CCI\u201025\u201000051"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2023021274"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.283480"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1515\/biol\u20102025\u20101129"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12288\u2010023\u201001667\u2010w"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102017\u201008\u2010802561"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17152479"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(24)01774\u20104"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.4274\/tjh.galenos.2025.2025.0352"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1910607"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2025.1585556"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41420\u2010024\u201002077\u20101"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41408\u2010024\u201000997\u2010w"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers16122243"},{"key":"e_1_2_12_54_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1432799"}],"container-title":["European Journal of Haematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.70153","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ejh.70153","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ejh.70153","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:05:03Z","timestamp":1777982703000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ejh.70153"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,7]]},"references-count":53,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/ejh.70153"],"URL":"https:\/\/doi.org\/10.1111\/ejh.70153","archive":["Portico"],"relation":{},"ISSN":["0902-4441","1600-0609"],"issn-type":[{"value":"0902-4441","type":"print"},{"value":"1600-0609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,7]]},"assertion":[{"value":"2026-01-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-02-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-07","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}