Bridging practices prior to brexucabtagene autoleucel for mantle cell lymphoma in the United Kingdom: An analysis of modality, response, toxicity and survival

Bridging therapy (BT) prior to brexucabtagene autoleucel (brexu-cel) in mantle cell lymphoma (MCL) is supported by limited evidence. Here, we report BT modality and outcome in 176 patients at 15 centres in the United Kingdom. BT was delivered to 90% (158/176), the majority receiving standard chemotherapy +/- radiotherapy (53%) (SD chemo +/- RT) or targeted therapy (TT) alone (23%). Clinicians favoured SD chemo +/- RT in those with Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 1, blastoid disease, bulk >5 cm and elevated lactate dehydrogenase. Overall response rate (ORR) was 46%. Higher ORR was observed with SD chemo +/- RT (58%), particularly R-BAC (64%). Progressive disease despite BT was associated with a lower ORR to brexu-cel (77% vs. 91%, p = 0.03) and a higher risk of ≥grade 3 ICANS (OR 3.43, 95% CI 1.44-8.10, p = 0.01). SD chemo +/- RT was associated with a higher incidence of ≥grade 3 neutropenia (Month 1), ≥grade 3 thrombocytopenia (Month 1, Month 3) and early non-relapse mortality (<90 days, 13% vs. 0%) compared to TT alone. Neither BT modality nor response impacted progression-free or overall survival post-infusion. Review of haematopoietic reserve prior to the selection of BT regimen, rigorous management of delayed cytopenia post-infusion and more effective and tolerable BT should be prioritised.

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Publication Details

Journal
British Journal of Haematology
Published
2026-03-08
DOI
https://doi.org/10.1111/bjh.70357
Primary Topic
Lymphoma Diagnosis and Treatment
Type
article
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article

Bridging practices prior to brexucabtagene autoleucel for mantle cell lymphoma in the United Kingdom: An analysis of modality, response, toxicity and survival

Caroline Besley, Rajesh Alajangi, Shweta Gupta, Shreyas Hanmantgad et al.
British Journal of Haematology
Lymphoma Diagnosis and Treatment
article

Bridging practices prior to brexucabtagene autoleucel for mantle cell lymphoma in the United Kingdom: An analysis of modality, response, toxicity and survival

Caroline Besley, Rajesh Alajangi, Shweta Gupta, Shreyas Hanmantgad, Rod Johnson, Thomas Creasey, Carlos González Arias, Ceri Jones, Alison Delaney, Graeme Ferguson, Ben Uttenthal, Angharad Pryce, S. Iyengar, Olateni Awofisayo, Lourdes Calvente Rubio, K. Panopoulou, Shenbagaram Kasivisvanathan, Sridhar Chaganti, Amrith Mathew, Maeve O'Reilly, Andrea Kuhnl, William Wilson, Claire Roddie, Bernard Maybury, Graham P. Collins, Ahmed Abdulgawad, Frances Seymour, Robin Sanderson, Jonathan Lambert
article en

Abstract

Bridging therapy (BT) prior to brexucabtagene autoleucel (brexu-cel) in mantle cell lymphoma (MCL) is supported by limited evidence. Here, we report BT modality and outcome in 176 patients at 15 centres in the United Kingdom. BT was delivered to 90% (158/176), the majority receiving standard chemotherapy +/- radiotherapy (53%) (SD chemo +/- RT) or targeted therapy (TT) alone (23%). Clinicians favoured SD chemo +/- RT in those with Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 1, blastoid disease, bulk >5 cm and elevated lactate dehydrogenase. Overall response rate (ORR) was 46%. Higher ORR was observed with SD chemo +/- RT (58%), particularly R-BAC (64%). Progressive disease despite BT was associated with a lower ORR to brexu-cel (77% vs. 91%, p = 0.03) and a higher risk of ≥grade 3 ICANS (OR 3.43, 95% CI 1.44-8.10, p = 0.01). SD chemo +/- RT was associated with a higher incidence of ≥grade 3 neutropenia (Month 1), ≥grade 3 thrombocytopenia (Month 1, Month 3) and early non-relapse mortality (<90 days, 13% vs. 0%) compared to TT alone. Neither BT modality nor response impacted progression-free or overall survival post-infusion. Review of haematopoietic reserve prior to the selection of BT regimen, rigorous management of delayed cytopenia post-infusion and more effective and tolerable BT should be prioritised.

British Journal of Haematology
University College Hospital (GB), Cardiff and Vale University Health Board (GB), University of Cambridge (GB), Leeds Teaching Hospitals NHS Trust (GB), Birmingham City Hospital (GB), Cancer Research UK (GB), Cambridge Hospital (US), Manchester Royal Infirmary (GB), University Hospital Southampton NHS Foundation Trust (GB), University of Bristol (GB), University of Oxford (GB), London Cancer (GB), Bridge University (SS), Sheffield Teaching Hospitals NHS Foundation Trust (GB), Bristol Hospital (US), Royal Marsden Hospital (GB), Newcastle upon Tyne Hospital (GB), The Christie NHS Foundation Trust (GB), NIHR Surgical Reconstruction and Microbiology Research Centre (GB), CRUK Lung Cancer Centre of Excellence (GB), King's College Hospital (GB), Queen Elizabeth University Hospital (GB), University College London (GB)
Good health and well-being
Openalex Percentile: Top 31%
Lymphoma Diagnosis and Treatment
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