Patient-derived lymphoma spheroids reveal predictive markers of glofitamab resistance in relapsed/refractory B-NHL

ABSTRACT: Bispecific antibodies (bsAbs) such as glofitamab represent a promising therapeutic approach for relapsed/refractory B-cell non-Hodgkin lymphoma (R/R B-NHL), but resistance mechanisms remain poorly understood. This study aimed to identify predictive markers of bsAb resistance based on the response of 3-dimensional patient-derived lymphoma spheroids (PDLS) established from 39 R/R B-NHL samples. PDLS were treated with glofitamab for 3 days, and B-cell depletion was quantified to assess the ex vivo treatment response. Comprehensive immune profiling was performed on patient samples using multiparametric flow cytometry, single-cell RNA sequencing, codetection by indexing spatial proteomics, and functional assays. High responders to glofitamab possessed CD8+ T cells with consistently higher cytotoxic and activation signatures across effector differentiation states, whereas low responders showed enrichment of exhausted CD8+ T cells with enhanced expression of exhaustion markers (T-cell immunoglobulin and ITIM domain [TIGIT], LAG3, and PD1). Furthermore, low responders exhibited elevated functional CD4+ T follicular helper (Tfh) cells in close proximity to malignant B cells, thus promoting their survival through interleukin-21 and C-X-C motif chemokine ligand 13 signaling pathways. Analysis of pretreatment RNA-sequencing data from 48 patients with R/R B-NHL confirmed that high Tfh cell abundance is associated with poor glofitamab response. In PDLS, anti-TIGIT cotreatment enhanced glofitamab efficacy in low responders, and Tfh cell depletion experiments confirmed that reducing Tfh cell activity increased B-cell depletion. Together, these findings identify CD8+ T-cell exhaustion and functionally activated Tfh cells as key factors associated with glofitamab resistance in R/R B-NHL. This work supports their potential use as predictive biomarkers for selecting patients with higher probability of response and provides a foundation for future combination therapeutic strategies.