Improved Outcomes with TKI Maintenance Following Brexucabtagene Autoleucel in Philadelphia-chromosome ALL
Brexucabtagene-autoleucel (brexu-cel) produces high rates of measurable residual disease-negative (MRD-) complete response (CR) in adults with Philadelphia-chromosome positive (Ph+) acute lymphoblastic leukemia (ALL); however, subsequent relapses remain frequent. It is unclear whether maintenance with tyrosine kinase inhibitors (TKIs) can enhance remission durability. We evaluated outcomes among adults with relapsed/refractory Ph+ ALL who received commercial brexu-cel and achieved MRD- CR across 19 U.S. institutions. Considering TKI maintenance as a time-varying covariate, we analyzed outcomes based on receipt of subsequent TKI maintenance versus no maintenance. Patients receiving consolidative transplantation or non-TKI maintenance were excluded. Fifty-one patients were included: 20 received TKI maintenance and 31 received no maintenance. The use of TKI maintenance was associated with a significantly lower 1-year cumulative incidence of relapse (HR 0.12; 95% CI, 0.02-0.88; p=0.037) which translated into improved progression-free survival (PFS, HR 0.19; 95% CI, 0.04-0.85; p=0.029) and a trend towards improved overall survival (OS, HR 0.34; 95% CI, 0.07-1.62; p=0.18). There was no difference in non-relapse mortality (NRM, HR 0.83; 95% CI, 0.12-5.87; p=0.85). This real-world analysis supports the administration of TKI maintenance in Ph+ ALL following achievement of MRD- CR with brexu-cel as a strategy to improve PFS following chimeric antigen receptor T cell therapy.
Authors
- Lori S. Muffly (ORCID: https://orcid.org/0000-0002-9887-6136)
- Melhem Solh (ORCID: https://orcid.org/0000-0003-3766-5623)
- Rawan Faramand (ORCID: https://orcid.org/0000-0001-7750-781X)
- Joshua Sasine (ORCID: https://orcid.org/0000-0001-9866-462X)
- Fevzi Yalniz (ORCID: https://orcid.org/0000-0003-3569-8632)
- George Yaghmour (ORCID: https://orcid.org/0000-0002-6988-3556)
- Paul Shaughnessy (ORCID: https://orcid.org/0000-0003-4023-3864)
- Navneet S. Majhail (ORCID: https://orcid.org/0000-0001-7082-891X)
- Matthew P. Connor (ORCID: https://orcid.org/0000-0003-1186-0623)
- TIMOTHY E. O'CONNOR
- Vinod A. Pullarkat (ORCID: https://orcid.org/0000-0001-9129-3424)
- Bijal Shah (ORCID: https://orcid.org/0000-0003-4328-6021)
- Jessica Leonard (ORCID: https://orcid.org/0000-0001-5576-0048)
- Tamer Adel Othman (ORCID: https://orcid.org/0000-0001-6376-4495)
- Gregory W. Roloff (ORCID: https://orcid.org/0000-0003-2109-5152)
- LaQuisa C. Hill (ORCID: https://orcid.org/0000-0003-4304-935X)
- Ibrahim N. Muhsen (ORCID: https://orcid.org/0000-0002-7156-2532)
- Caitlin Guzowski
- Talal Hilal (ORCID: https://orcid.org/0000-0001-8249-4128)
- Chenyu Lin (ORCID: https://orcid.org/0000-0002-4542-4232)
- Aaron C. Logan (ORCID: https://orcid.org/0000-0002-1179-5879)
- Ryan D. Cassaday (ORCID: https://orcid.org/0000-0002-3424-2425)
- Minoo Battiwalla (ORCID: https://orcid.org/0000-0001-6440-1899)
- Sean Tracy (ORCID: https://orcid.org/0000-0001-7047-2589)
- Kaitlyn C. Dykes (ORCID: https://orcid.org/0000-0002-1638-1755)
- Abdullah Ladha (ORCID: https://orcid.org/0009-0006-9598-6467)
- Noelle V. Frey (ORCID: https://orcid.org/0000-0003-3688-9836)
- Virginia Tan
- Nikeshan Jeyakumar (ORCID: https://orcid.org/0000-0001-9979-4434)
- Jiasheng Wang (ORCID: https://orcid.org/0000-0003-3053-5439)
- Amy Zhang (ORCID: https://orcid.org/0000-0002-9130-0660)
- Katherine C. Sutherland (ORCID: https://orcid.org/0009-0006-5935-8279)
- Katharine Miller
- Rasmus T. Hoeg
- Marc S. Schwartz
- John Mathews
- Ibrahim Aldoss
- Muthu Kumaran
- Stephanie B. Tsai
- Noam E. Kopmar
- Shahbaz A. Malik
- Sumithira Vasu
- Luke Mountjoy
Institutions
- Northside Hospital (US)
- University of Southern California (US)
- Cedars-Sinai Medical Center (US)
- Houston Methodist (US)
- City Of Hope National Medical Center (US)
- Loyola University Medical Center (US)
- University of Kentucky (US)
- University of California, Los Angeles (US)
- Oregon Health & Science University (US)
- Duke University (US)
- Palo Alto University (US)
- University of California, San Francisco (US)
- Baylor College of Medicine (US)
- University of Washington (US)
- University of Arkansas Medical Center (US)
- Hospital of the University of Pennsylvania (US)
- University of Minnesota System (US)
- Moffitt Cancer Center (US)
- University of Alabama at Birmingham (US)
- University of California San Diego (US)
- University of Chicago (US)
- Sarah Cannon (US)
- Methodist Hospital (US)
- City of Hope (US)
- HOPE Clinic (US)
- Mayo Clinic Hospital (US)
- HonorHealth (US)
- CHRISTUS Transplant Institute (US)
- Colorado Blood Cancer Institute (US)
- University of Colorado Anschutz Medical Campus (US)
- The Ohio State University (US)
- University of Pennsylvania (US)
- University of California, Davis (US)
- Stanford University (US)
Publication Details
- Journal
- Blood Advances
- Published
- 2026-06-25
- DOI
- https://doi.org/10.1182/bloodadvances.2026020707
- Primary Topic
- Acute Lymphoblastic Leukemia research
- Type
- article
- Field-Weighted Citation Impact
- 0.00