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Jeremy S. Abramson, MD, MMSc
Jeremy S. Abramson, MD, MMSc
Posted: Monday, April 7, 2025
Brexucabtagene autoleucel, a chimeric antigen receptor (CAR) T-cell therapy, demonstrated significantly higher 1-year overall survival and lower nonrelapse mortality compared to allogeneic hematopoietic cell transplantation (alloHCT) in patients aged 50 and older with relapsed or refractory mantle cell lymphoma (MCL).
Despite these advantages, long-term progression-free and overall survival were comparable between the two therapies, underscoring the need for individualized treatment decisions, noted senior author Sascha Dietrich, MD, of the Department of Hematology, Oncology and Clinical Immunology at University Hospital Düsseldorf, Germany, and colleagues.
A retrospective propensity score–matched analysis compared 64 patients treated with brexucabtagene autoleucel in the ZUMA-2 trial with 64 matched patients from the European Society for Blood and Marrow Transplantation registry who underwent alloHCT. The median follow-up was 36.5 months for the brexucabtagene autoleucel group and 34.1 months for the alloHCT group.
One-year overall survival was significantly higher for patients who received brexucabtagene autoleucel vs those who underwent alloHCT (81.3% vs 59.2%). One-year nonrelapse mortality was significantly lower with brexucabtagene autoleucel vs alloHCT (3.6% vs 21.2%). Long-term overall and progression-free survival curves converged, likely due to higher relapse rates in the brexucabtagene autoleucel cohort and increased nonrelapse mortality in the alloHCT group, noted the investigators. Acute graft-vs-host disease occurred in 42.9% of the patients who underwent alloHCT.
These findings reinforce current expert recommendations favoring CAR T-cell therapy over alloHCT for patients with MCL who experience relapse after receipt of Bruton’s tyrosine kinase inhibitors, wrote the researchers. The reduced toxicity and broader eligibility criteria associated with brexucabtagene autoleucel suggest it may be the preferred option, particularly for older patients or those with comorbidities. However, alloHCT remains a viable treatment option for MCL, especially for younger patients with high-risk disease features.
The study’s retrospective nature and reliance on registry data may have introduced potential biases, noted the authors. Future prospective studies, ideally with a randomized design, are needed to further clarify optimal treatment sequencing and assess the long-term safety and efficacy of brexucabtagene autoleucel vs alloHCT in relapsed or refractory MCL.
The study authors concluded, “Patients aged ≥ 50 years with relapsed or refractory MCL had superior overall survival and lower nonrelapse mortality 1 year after receiving brexucabtagene autoleucel compared with alloHCT. However, the long-term progression-free survival and overall survival are similar for both treatments. Individual risk–benefit evaluation is essential to guide optimal treatment decisions.”
Disclosures: The study authors reported no conflicts of interest.
