OUTCOMES OF PATIENTS OVER 70 YEARS TREATED WITH BREXU-CEL FOR R/R MANTLE CELL LYMPHOMA: A STUDY FROM THE CTIWP OF EBMT

Mantle cell lymphoma (MCL) predominantly affects older adults, and treatment options for relapsed/refractory (R/R) disease remain limited. Brexucabtagene autoleucel (brexu-cel) has demonstrated high efficacy in R/R MCL, but data in elderly populations are scarce. This retrospective, real‑world analysis evaluated patients aged ≥70 years with R/R MCL treated with brexu‑cel and reported to the EBMT registry between 2020 and 2024. A total of 233 patients from 96 centers across 13 countries were included (median age at infusion, 74.6 years; 44% >75 years). Most had ECOG 0-1 (89%) and were heavily pretreated; 62% had prior BTK inhibitor exposure. At day +100, the best overall response was complete remission in 78% and partial remission in 13%. At 30 days, the cumulative incidence of any-grade cytokine release syndrome (CRS) was 80% (grade ≥3, 9%) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) was 57% (grade ≥3, 22%). At 1 year, overall survival (OS) was 74%, progression-free survival (PFS) 62%, relapse/progression incidence (R-PI) 25%, and non-relapse mortality (NRM) 13%. Patients aged >75 years had outcomes comparable to those aged 70-75 years. In multivariable analysis, ECOG ≥2 remained the strongest predictor of inferior OS (HR 4.50; p<0.001) and PFS (HR 3.10; p<0.001), while age was not independently associated with outcomes. Brexu-cel is effective in patients aged ≥70 years with R/R MCL, achieving high remission rates and meaningful survival, despite relative high incidence of NRM. Functional status, rather than age, should guide eligibility.

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Journal
Blood Advances
Published
2026-03-04
DOI
https://doi.org/10.1182/bloodadvances.2025019367
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

OUTCOMES OF PATIENTS OVER 70 YEARS TREATED WITH BREXU-CEL FOR R/R MANTLE CELL LYMPHOMA: A STUDY FROM THE CTIWP OF EBMT

A. Huynh, P. Dreger, A. Sureda, Nicole Santoro et al.
Blood Advances
Lymphoma Diagnosis and Treatment
article

OUTCOMES OF PATIENTS OVER 70 YEARS TREATED WITH BREXU-CEL FOR R/R MANTLE CELL LYMPHOMA: A STUDY FROM THE CTIWP OF EBMT

A. Huynh, P. Dreger, A. Sureda, Nicole Santoro, Rachel Protheroe, Simona Pagliuca, Urban Novak, Jarl Mooyaart, Maiana Hamdan Melo Coelho, Tom van Meerten, VG Rocha, Michael Northend, Ron Ram, Ali Bazarbachi, Francis Ayuketang Ayuk, Jorinde Desiree Hoogenboom, Jürgen Kuball, Ibrahim Yakoub-Agha, Shankara Paneesha, Florent Malard, Robin Sanderson
article en

Abstract

Mantle cell lymphoma (MCL) predominantly affects older adults, and treatment options for relapsed/refractory (R/R) disease remain limited. Brexucabtagene autoleucel (brexu-cel) has demonstrated high efficacy in R/R MCL, but data in elderly populations are scarce. This retrospective, real‑world analysis evaluated patients aged ≥70 years with R/R MCL treated with brexu‑cel and reported to the EBMT registry between 2020 and 2024. A total of 233 patients from 96 centers across 13 countries were included (median age at infusion, 74.6 years; 44% >75 years). Most had ECOG 0-1 (89%) and were heavily pretreated; 62% had prior BTK inhibitor exposure. At day +100, the best overall response was complete remission in 78% and partial remission in 13%. At 30 days, the cumulative incidence of any-grade cytokine release syndrome (CRS) was 80% (grade ≥3, 9%) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) was 57% (grade ≥3, 22%). At 1 year, overall survival (OS) was 74%, progression-free survival (PFS) 62%, relapse/progression incidence (R-PI) 25%, and non-relapse mortality (NRM) 13%. Patients aged >75 years had outcomes comparable to those aged 70-75 years. In multivariable analysis, ECOG ≥2 remained the strongest predictor of inferior OS (HR 4.50; p<0.001) and PFS (HR 3.10; p<0.001), while age was not independently associated with outcomes. Brexu-cel is effective in patients aged ≥70 years with R/R MCL, achieving high remission rates and meaningful survival, despite relative high incidence of NRM. Functional status, rather than age, should guide eligibility.

Blood Advances
University of Bern (CH), University Hospitals Birmingham NHS Foundation Trust (GB), University Medical Center Groningen (NL), University College London Hospitals NHS Foundation Trust (GB), Universität Hamburg (DE), Universidade de São Paulo (BR), Heidelberg University (DE), Tel Aviv Sourasky Medical Center (IL), University Hospitals Bristol NHS Foundation Trust (GB), University Hospital of Bern (CH), University Hospital Heidelberg (DE), San Raffaele University of Rome (IT), Centre Hospitalier Universitaire de Bordeaux (FR), University Medical Center Utrecht (NL), Sorbonne Université (FR), Assistance Publique – Hôpitaux de Paris (FR), Institut universitaire du cancer de Toulouse Oncopole (FR), European Society for Blood and Marrow Transplantation (NL), Centre Hospitalier Régional et Universitaire de Nancy (FR), Hôpital Saint-Antoine (FR), Institut Català d'Oncologia (ES), University Medical Center Hamburg-Eppendorf (DE), Azienda USL di Pescara (IT), King's College Hospital (GB), University College London (GB), American University of Beirut (LB)
Amgen, Sanofi, Gilead Sciences, Alexion Pharmaceuticals, Swedish Orphan Biovitrum
Openalex Percentile: Top 35%
Lymphoma Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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